Osteoporosis: how do I treat it?

Published in Medicinewise Living

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You can help to prevent osteoporosis by taking action early and building healthy bones throughout your life.
Image: Andrew Bassett / shutterstock.com

Osteoporosis is a bone-weakening condition that affects over 1 million Australian men and women. Often described as being 'silent' in nature, many people don’t know they have osteoporosis until they experience a broken bone (fracture).  

What is osteoporosis?

If you have osteoporosis, your bones become fragile and brittle, and can be damaged more easily. This means even a slight bump, strain or minor fall might result in fracture.There are several ways to treat osteoporosis and help avoid fractures, such as:

What are the complications of osteoporosis?

The most common osteoporotic fractures happen in the hips, spine and wrists. These types of fractures can cause long-term pain, disability and loss of independence.

Osteoporotic fractures can also lead to postural changes (e.g. stooped back), height loss and muscle weakness.

Am I at risk of osteoporosis?

Older people are at a greater risk of osteoporosis. In Australia, it is estimated that one in two women and one in three men aged over 60 will experience a fracture because of osteoporosis.

Postmenopausal women are at particular risk because production of the female sex hormone oestrogen — which plays an important role in maintaining bone strength — declines after menopause.

Many other factors, including your lifestyle, diet, family history and having certain medical conditions can affect your bones and increase osteoporosis risk, as can the long-term use of some medicines (e.g. corticosteroids).

Speak with your doctor about your risk of osteoporosis and fractures and what you can do to reduce that risk.

How is osteoporosis diagnosed?

A diagnosis of osteoporosis needs to be confirmed by a doctor. If you are at high risk of osteoporosis, or your doctor thinks you already have it, they may suggest having a specific test called a DEXA scan to measure your bone mineral density (BMD). This test is quick and painless, like an X-ray.

The scan compares your BMD to the bone density of an average young adult, and produces a result called a T-score. If you have osteoporosis, your T-score will be minus 2.5 (-2.5) or lower.

The lower your T-score, the more brittle your bones are, and the greater your risk of fracture. For example, a score of minus 3 (-3) is worse than a score of minus 2.5 (-2.5).

How is osteoporosis treated?

There are a number of ways to help manage your osteoporosis and prevent fractures.

You should speak with your doctor about the treatment options most suitable for your situation.

Lifestyle

Establishing a healthy lifestyle is important.

Weight-bearing and resistance forms of exercise, adequate calcium and vitamin D intake, limited alcohol consumption and no smoking all contribute to good bone health.

If you have osteoporosis you may need to avoid exercises that involve twisting, sudden movements or bending forward from the spine.

Talk to your doctor or physiotherapist about suitable exercises for you.

Medicines

There are several kinds of prescription medicines for osteoporosis. Many of the medicines available act by slowing down bone loss. They are called antiresorptives and are the most commonly prescribed medicines for the treatment of osteoporosis. Antiresorptives include the group known as bisphosphonates (with active ingredients such as alendronate, etidronate, risedronate, zoledronic acid), as well as denosumab, raloxifene and strontium ranelate.

One medicine (teriparatide), for people with severe osteoporosis, works by increasing bone formation.

In certain instances hormone replacement therapy is also an option for some postmenopausal women.

Calcium and/or vitamin D supplements can also be a useful option for some people with osteoporosis. Be aware that some prescription medicines for osteoporosis are co-packaged with calcium and/or vitamin D.  

If you are prescribed any medicine for osteoporosis, it's important to take it exactly as directed, for as long as your doctor or pharmacist advise, and to understand that the benefits may only occur after taking your medicine for many months. Your doctor may also need to monitor the effect of your treatment through the use of specific tests.

Other treatments

Besides improving bone health, your doctor, physiotherapist or occupational therapist can advise on ways to reduce your risk of falls that could cause fractures.

These can range from exercises to improve muscle strength and 'fall-proofing' your house (e.g. securing loose floor rugs, and electrical or phone cords, or using a non-slip mat for the bath or shower), to checking your vision and ensuring the medicines you take are not affecting your balance.

When should I see a health professional?

Speak with a doctor about your risk of osteoporosis if you:

  • are going through menopause or are postmenopausal
  • have a family history of osteoporosis or fractures
  • are aged 65 or over and have experienced a fracture after a fall or a slight injury.

Healthy bones need…

Calcium — try dairy, canned fish, tofu, soy beans, other beans and green leafy vegetables.

Vitamin D — helps the body absorb calcium. Sensible sun exposure is the best natural source.

Exercise — can include brisk walking, tai chi, dancing, aqua aerobics and gentle weight exercises. Recommendations may differ from person to person.

You can help to prevent osteoporosis by taking action early and building healthy bones throughout your life.

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