Building better bones

Written by Pip Harry for Australian Seniors.

Do you know your bones? Research by the not-for-profit organisation Healthy Bones Australia (formerly Osteoporosis Australia) shows that one in two Australian adults suffering a fracture fail to follow up with a bone mineral density test to investigate whether they have osteoporosis. The majority also aren’t on any preventative medication for osteoporosis, even though they tick the boxes for clinical or lifestyle risks.

The experts say osteoporosis is more common than we might think. “In those aged 50 years and over, 66% have osteoporosis or osteopenia,” says Dr Sandra Iuliano, senior research fellow at the University of Melbourne’s Department of Endocrinology. “And fractures are more common in women than men.”

Poor bone health can lead to fractures

It’s estimated there will be over 183,000 fractures due to poor bone health in 2022, says Associate Professor Peter Wong, medical director at Healthy Bones Australia. “The most serious fractures are in the hip and spine,” he says. “However, fractures at other sites are more common, such as the wrist, leg and arm fractures.”

The most common bone health issue is osteoporosis, a disease that reduces the density and quality of bones, making them thinner and more brittle. A less severe form is osteopenia – low bone density where it’s not quite thin enough to be called osteoporosis.

“These are commonly related to certain medical conditions, such as rheumatoid arthritis, coeliac disease, thyroid conditions, early menopause/low testosterone, chronic liver or kidney disease and certain medications, especially corticosteroids and some prostate or breast cancer treatments which block hormones,” says Professor Wong. “Of course, a family history is important – but sadly, you can’t choose your family!”

Lifestyle can also be a factor, with risk factors including insufficient calcium intake and vitamin D, lack of exercise, smoking and alcohol consumption.

Early intervention

Don’t expect obvious red flags to signal a problem with your bone health. “Osteoporosis and osteopenia usually cause no symptoms until the person falls and breaks the bone,” warns Professor Wong. “So, we need to see people with risk factors investigated and diagnosed early so we can protect their bone health and prevent fractures.”

If you’re aged over 50 and have any osteoporosis risk factors (or even if you don’t), speak to your GP about your bone health and request a bone density scan. “This is a simple painless test to check bone thickness,” explains Professor Wong. “It’s also very important that anyone who has a fracture from a fall from a standing height (also known as a minimal or low trauma fracture or a fragility fracture), be investigated for poor bone health. Too often, we see people dismiss a fracture from a fall as ‘bad luck’ when in fact they may have osteoporosis.”

The importance of diagnosis and treatment of bone health

Poor bone health can significantly impact your quality of life, so it’s important to get in front of the disease. “Depending on the severity and site of the fracture, you may require admission to hospital for surgery, hospital stay, rehabilitation and home care. Fractures disrupt daily life and have a big impact on individuals and their family and can take a long time to recover.”

Early diagnosis and treatment will improve bone health to protect against further fractures. “We are fortunate in Australia to have a range of treatment options which are effective in reducing risk of fracture and helping protect your bone health,” he says.

To turn the tables on osteoporosis, experts say it’s important to maintain adequate calcium intake, recommended blood vitamin D levels and do regular weight-bearing exercise to improve and maintain bone health. Equally, it’s important not to drink alcohol to excess or smoke. Here are some treatment options.

Diet and nutrition for healthy bones

Milk and other dairy foods are high in bone-strengthening calcium and other nutrients that are essential for good bone health, like protein, magnesium, zinc, potassium and phosphorus. Include milk, cheese or yoghurt in your diet on a daily basis. “I would advise four servings of dairy a day for women and 3.5 servings for men,” says Dr Iuliano.

Can’t eat dairy? Lots of other foods are rich in calcium, including fruits, vegetables and certain nuts. Add leafy greens bok choy, broccoli or kale to your salads or sides, top your toast with canned fish such as sardines or tuna, crunch on almonds, hazelnuts or walnuts, and buy calcium-enriched soy products.

Don’t forget vitamin D – found in fresh salmon and other oily fish, mushrooms, egg yolks and fortified breakfast cereals. “Vitamin D is also important because it helps us absorb the calcium we eat,” says Professor Wong.

Supplements and medication to improve bones

Vitamin D works in a few ways to support bone health. It helps with calcium absorption from food in the intestine, ensures renewal and mineralisation of bone and also helps keep muscles strong, reducing the risk of falls.

We get 70-80% of our vitamin D needs from exposure to the sun, but sunlight isn’t always a reliable source. A blood test will determine if you’re low on D and need supplements for a top-up. “Vitamin D supplements, prescribed by a doctor or pharmacist, may be needed if people are unable to get enough sunlight exposure to make their own vitamin D and are deficient,” says Dr Iuliano.

Other medications work to lower your risk of breaking a bone. “Anti-osteoporotic medications, prescribed by a doctor, reduce the risk of fractures,” says Dr Iuliano. This medication is taken as tablets or via injection. “They are usually very well-tolerated and have been shown to significantly lower the risk of breaking a bone,” adds Professor Wong. Better yet, they’re usually available on the government-subsidised Pharmaceutical Benefits Scheme.

How does strength training improve bone density?

A mix of weight-bearing, resistance training and balance exercises promotes good bone health. “Exercise should be regular, at least three times per week, for at least 30 minutes each time,” says Professor Wong. “Make sure you increase intensity as our bones like some stress placed on them.”

Weight-bearing exercise is when your bones and muscles have to work against gravity to keep you upright, making them stronger. Head out for a hike, take an aerobics class, play tennis or netball, or try skipping, step-ups or star jumps.

Resistance training uses weights to enhance bone strength and stability. Try resistance band workouts, free weights or machine weights, or using your own body weight with dips, push ups and sit ups. Balance exercise challenges our body to stay stable and prevent falls. Try tai chi, walking on a beam or uneven surface, or balance poses like standing on one foot.

Exercise to avoid: people with diagnosed osteoporosis should always consult their doctor before embarking on a fitness program. You might be advised to avoid very high-impact activities, or exercises with twisting of the spine and hip. Discover the best strengthening exercises for seniors.

“I want others to avoid the pain I’ve gone through”

Elaine Cotter, 57, healthcare manager, mother and grandmother, living with osteoporosis.

After making a slight twisting movement while cooking, Melbourne-based GP practice manager Elaine Cotter was overwhelmed by sudden, severe lower back pain. Aged 52, she lived a healthy, active lifestyle. “I exercised, ate well and had boundless energy. I’ve never smoked, I don’t drink,” says Elaine.

Seeking various medical specialists, including a rheumatologist, a neurosurgeon and four pain physicians, Elaine was misdiagnosed with osteoarthritis and prescribed antidepressants, corticosteroid injections and even sleeping pills. She also embarked on a weekly physiotherapy regime, but found she pulled up sore and stiff after her treatments.

What will happen if osteoporosis is left untreated?

After three years, Elaine was still in excruciating pain and confused at her arthritis diagnosis. Noticing a small curve in her upper spine in 2019, she requested a bone mineral density scan from her GP. The scan showed she was living with severe osteoporosis. Further tests also revealed vertebral fractures and hyperparathyroidism (overactive parathyroid glands in the neck), which can be a risk factor for osteoporosis, along with vitamin D deficiency.

Elaine’s mother was diagnosed with osteoporosis at 70, and her sister had a fall at 52, fracturing both arms. “Despite my family history of bone disease, it never crossed my mind, nor was it even suggested to me, that I may be at risk for developing osteoporosis, even after going through menopause,” says Elaine. “Because I had never experienced any falls, no-one suspected I was living with bone fractures. So, I’m not actually sure how long I had been living with osteoporosis.”

Today, Elaine receives ongoing osteoporosis treatment and takes daily supplements, including vitamin D and calcium. She also wears a supportive back brace. “My late diagnosis has resulted in years of ongoing pain and many fractures,” says Elaine. “I encourage everyone to talk to your doctor about your bone health to prevent osteoporosis. The disease has substantially impacted my life, and I want others to avoid the pain I have gone through.”

For further osteoporosis help, go to healthybonesaustralia.org.au or call 1800 242 141. To check your risk factors, go to knowyourbones.org.au

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