Osteoporosis & Osteopenia
What is Osteoporosis & Osteopenia?
Osteoporosis is defined as “a skeletal disorder characterised by a compromised bone strength predisposing a person to an increased risk of fracture”. Osteopenia is the same, however it is to a lesser degree as there is a larger bone mineral density remaining. These are both conditions that affect the integrity of the bone through having a decreased bone mineral density and place the individual at a higher risk of having fractures throughout their life.
It is important to identify that when the word "fracture" is used, this is meaning any type of "break" in the bone. This includes “big breaks” like a compound fracture (where bone breaks the skin), “big breaks” where the bone is in two pieces, or any other form of separation of the bone that people see as being classed as a broken bone. Fractures also include “small breaks” as what is often associated with the term fracture. Essentially, all broken bones are actually called fractures and there are many different subtypes of these fractures.
This is what it looks like when we have Healthy/Normal bone density vs low bone mineral density AKA Osteoporosis;
As you can see, there is more hollow space in the bone, meaning they will be more brittle, thus a higher fracture risk.
Who is most likely to develop it? Why?
1 in 3 women compared to 1 in 5 men aged 75+ are affected by the condition.
Two of the main reasons why women are more likely to develop osteoporosis over men are;
In general women have smaller and thinner bones.
By this age bracket (75+), women have gone through menopause meaning their oestrogen has dropped. Oestrogen plays a role in the building of bone in women, so when it drops, bone building decreases.
There are also some risk factors that predispose individuals to a higher risk of developing osteoporosis (over the age of 50) and these can include;
Family history of osteoporosis
Early menopause
Diabetes
Excessive alcohol use
Low Testosterone
Long term smoking
malabsorption/coeliac
Inflammatory arthritis
Previous fractures
Certain medications
How will I know if I have it?
Often people will not know they have Osteoporosis, as it does not regularly present with pain unless a fracture is present.
This is why it is important to get what is called a DEXA scan if you're a woman aged 65+ or man aged 70+ as per the Healthy Bones Australia recommendations. It is also important to seek this if you have experienced recent fracture that does not make sense (for example bumping into the kitchen bench and fracturing from that), is worse than expected (for example falling down and shattering your hip) or you are having multiple fracture in a short amount of time.
A Dexa scan is the gold standard for identifying bone mineral density, and is able
to provide an accurate snapshot of your body composition including your muscle mass, subcutaneous vs visceral fat mass, fluid retention and bone mineral density among other measures.
For determining if a person has osteopenia or osteoporosis, the bone mineral density is the most important measure. The scan will produce what is known as a T-score which compares the bone mineral density of the subject to that of an average 30 year old. A T-score above -1 is considered normal, between -2.5 and –1 is considered low bone mineral density and is classed as osteopenia, and a score below –2.5 is classed as osteoporosis. The DEXA scan also produces a Z-score which compares your bone mineral density to that of your age group and ethnicity, instead of a 30-year old.
See picture below for clarity.
How and when can I get a DEXA scan?
Fortunately for Australians, our Medicare system can actually cover DEXA scans if you meet a certain criterion.
The most likely criterion for referral is being over the age of 70 to have your initial bone scan completed. If you are assessed as having normal bone mineral density or mild osteopenia, you will then be entitled to one scan every 5 years. If you are assessed as having moderate to marked osteopenia you are then eligible for one scan every two years.
Other criteria to make you eligible to get a DEXA scan through Medicare include but are not limited to having the following concerns;
1 or more factures occurring after minimal trauma
Having had a previous scan indicating low bone mineral density that requires monitoring
Prolonged glucocorticoid therapy
Male or female hypogonadism (females lasting more than 6months before the age of 45)
Proven malabsorptive disorders
I have Osteoporosis/Osteopenia, what does this mean for me?
Having either of these conditions presents a higher risk of fracture in comparison to the average person. This, however, should not be a deterrent to doing the things you enjoy, or even just normal everyday activities. Doing these things will help to keep your bones strong and ensure you maintain your quality of life.
Sadly, as allied health professionals we do often see this diagnosis or resulting fractures as a starting point for what we call the "cycle of falls", shown below.
Luckily for us, there are lots of different health professionals that can help you stop this cycle from perpetuating, and there are lots of things you can do to get out of this cycle.
This looks different for everyone but can be as simple as, still doing the shopping, still climbing the stairs, still doing the thing that caused you to fall in the first place. It can also be more complex such as completing a specific strengthening program or seeking mental health assistance to deal with the fear of falling.
What can I do about it?
Unfortunately, Osteoporosis is not a condition you can cure, but it is one that can be managed and there are different treatments that can help slow the progression down to preserve your bone mineral density.
These include;
Exercise intervention
Dietary intervention
Medication/ Pharmaceutical intervention
A combination of all three interventions is optimal and often will need to be supplemented with Psychological support to assist with managing the fear element in the "cycle of falls".
Stay tuned to find out how Diet and Exercise can assist your management of Osteoporosis and Osteopenia.
Written by Gabby Baker