What is Osteoporosis / Osteopenia?
Osteoporosis (meaning 'porous bones') is a condition that causes bones to become thin, weak and fragile. Osteoporosis is a systemic skeletal disease characterized by low mineral bone mass and microarchitectural deterioration of bone tissue.
The inside of a healthy bone has small spaces, like a honeycomb. Osteoporosis increases the size of these spaces, causing the bone to lose strength and density. In addition, the outside of the bone grows weaker and thinner.
Osteopenia is another term used to describe bone thinning. Osteopenia specifically describes a condition of low bone density, and is the range of bone density between normal bones and Osteoporosis.
Image: The effect of Osteoporosis on Bones
The problem with thin bones
Without corrective treatment Osteoporosis will worsen. As bones get thinner and weaker, the risk of fracture increases. As a result, even a minor bump or accident can cause a fracture (broken bone).
Severe osteoporosis can result in a fracture from a fall or even from a strong sneeze or cough. They can also include back or neck pain, or loss of height.
Back or neck pain or loss of height can be caused by a compression fracture. This is a break in one of the vertebrae in your neck or back, which is so weak that it breaks under the normal pressure in your spine.
More commonly Osteoporotic fractures occur in the hip, spine or wrist from falls. All fractures are very traumatic, however hip fractures are the most serious type of osteoporosis-related fractures, because they can be life-altering, debilitating injuries.
Poor Health: People with osteoporosis were 2.7 times as likely to describe their health as poor (15%) compared with those without the condition (5.4%)
Increased Pain: People with osteoporosis were 2.3 times as likely to experience severe or very severe bodily pain in the last 4 weeks (23%) compared with those without the condition (10%).
Fractures: In Australia there is a fracture every 3.4 minutes (395 per day or 2,765 per week) related to Osteoporosis. By 2022 this is projected to increase to 1 fracture every 2.9 minutes. Of all osteoporotic fractures in Australia, 46% are vertebral, 16% are hip and 16% are wrist.
Increased Fracture Risk: After an initial fracture the risk for subsequent fracture more than doubles in the next 6 to12 months, and persists for up to 10 years.
Fractures due to osteoporosis can result in chronic pain, disability, loss of independence and premature death
Increased Psychological Distress: People aged 45 and over with osteoporosis were 2.9 times as likely to experience very high levels of psychological distress (12%) compared with those without the condition (4%).
Image: hip fracture
Osteoporosis, the undiagnosed epidemic
Osteoporosis is often under-diagnosed. Osteoporosis has no overt symptoms, as a result it is often not diagnosed until a fracture occurs.
Approximately 22% of adults over 5o years of age will have Osteoporosis, and 87% will have Osteopenia. These statistics are worsening in western countries
Osteoporosis is more common in women than men. In 2017–18, 29% of women aged 75 and over had osteoporosis compared with 10% of men
In caucasian populations, about 50% of women and 20% of men older than 50 years will have a fragility fracture in their remaining lifetime. In addition for caucasian women there is a one in six lifetime risk of hip fracture.
Older age groups also tend to be affected. The proportion of women with Osteoporosis increases with age, with those 75 and over being most affected. Over 1 in 4 women aged 75 years and older have Osteoporosis.
Image: prevalence of Osteoporosis
Osteoporosis the risk factors
Risk factors associated with the development of Osteoporosis include the following modifiable and non-modifiable factors:
white / asian race
low peak bone mass
family history of Osteoporosis
personal medical history -
personal history of fracture
low intake of calcium,
low vitamin D levels,
low body weight (BMI < 21 kg/m),
Estrogen deficiency (ie: post-menopausal)
excess alcohol consumption,
low physical inactivity, and
long-term corticosteroid use.
Other medications or chemicals that have been shown to have adverse effects include thyroid hormone treatment (L-Thyroxine), anxiolytics, sedatives, antidepressants and neuroleptics, as well as certain antipsychotics (lithium), antacids containing aluminium and barbiturates.
Osteoporosis is also common in people with malabsorption disorders such as coeliac disease and with certain hormonal disorders such as thyroxine excess.
How is Osteoporosis Diagnosed?
If you have risk factors for Osteoporosis your doctor should refer you for a bone density test – a simple scan that indicates if bones are in the range of normal, low bone density (osteopenia) or osteoporosis.
Diagnosis of Osteoporosis requires a specialised X-ray known as a 'Dual energy X-ray Absorptiometry (DXA) scan' to determine the Bone Mineral Density (BMD).
DXA is a fast, quantitative technique that is capable of detecting quite small percentages of bone loss by measuring the attenuation through the body of low radiation X-ray beams with two different photon energies, using hydroxyapatite (bone mineral) and soft tissue as reference materials. To identify the bone outline at particular sites, edge detection software is employed. The bone density of the whole skeleton can be evaluated, but the most commonly measured sites to assess the risk of osteoporosis using DXA are the proximal femur (and femoral neck) and lumbar spine (L1-L4).
For DXA scans, the World Health Organization has defined a number of threshold values for Osteoporosis. These values are based on units of standard deviation (SD) and are described as T- or Z-scores. To calculate the T-score, the recommended reference range uses femoral neck measurements in Caucasian women aged 20 to 29 years from the National Health and Nutrition Examination Survey (NHANES) III reference database. For both men and women, the same female reference range is used for the diagnostic criteria.
Status - Femoral neck BMD T-score (SD)
Normal, -1 and above
Osteopenia, Between -1 and -2.5
Osteoporosis, -2.5 or lower
Severe Osteoporosis, -2.5 or lower and presence of at least one fragility fracture
The T-score is a reference value derived from bone density measurements in a population of young healthy females. The diagnosis of Osteoporosis is when an individuals’ T-score for BMD at the femoral neck is equal to or more than 2.5 SDs below the reference value. In practice, Osteoporosis is often defined using a T-score measured at other sites, for example at the lumbar spine.
The Z-score reference value is derived from bone density measurements adjusted for age and sex. It therefore expresses the number of SDs that an individuals’ BMD needs to differ from the expected mean in his/her age and sex group. As such, it is mainly used to assess children and adolescents.
Image: Bone Density T Score
Preventing and Managing Osteoporosis
The development of Osteoporosis can be slowed down, stopped or even reversed by:
Consuming optimal amounts of calcium and other nutrients required for bone development. Calcium is an essential nutrient that plays a key role in stimulating bone growth and maintaining bone density.
Taking in adequate amounts of vitamin D. The body uses vitamin D to help with calcium absorption. It is found in milk, green leafy vegetables, and sunlight. Like calcium, it should be taken to levels recommended by a physician.
Exercising strengthens the bones and promotes new bone growth. It also increases overall health and improves quality of life, may reduce risk of falls which can decrease the chances of a fracture causing accident. Exercise training is the only strategy that can improve all modifiable fracture risk factors (bone strength, fall risk, fall impact), but it must be appropriately prescribed and adherence needs to be maintained.
Falls prevention, when osteoporosis is present, even minor trauma such as coughing, minor knocks or falls can lead to fractures. Older people have slower response times and more often fall to the side, suffering direct impacts to the hip. Their falls are often "intrinsic", or unrelated to external obstacles. They may be the result of postural instability, decreased muscular performance, malnutrition, comorbidity (e.g. poor vision, cognitive impairment) and medications.
Not all exercise programs are created equal. Most exercise programs do not include the correct amount of weight bearing and resistance to stimulate bone growth. For example walking, cycling, swimming, Yoga and Mat Pilates will not improve bone density. In addition generalised exercise programs that don't adequately take into account an individual's current health / medical status can be dangerous.
That is why we created the Bone Density Booster (BDB) program. It is based on the best available research into exercise for bone density, and optimises for each individual the required level of activity to safely progress and develop bone strength. The Bone Density Booster program is the only program of its kind available online and also in person at our clinic.