An estimated 1.2 people in Australia currently have osteoporosis, and many more have low bone density. Because of the bone disease’s link to declining oestrogen, women who have entered menopause are most at risk.
Osteoporosis is characterised by low bone mass that leads to an increased risk of fracture of the hip, wrist, or spine. It’s said to be the most common disease in humans, and it can actually shorten people's lifespan.
Around 6.3 million Australians have low bone density, which also can lead to fractures and ultimately develop into osteoporosis.
We consulted two in-the-know doctors to lay out the myths and realities of these conditions and the drugs used to treat them.
1. You may not know if you have osteopenia or osteoporosis
These conditions are silent. Your first indication of either may be a fracture or the loss of more than two inches in height(!). But there are many known risks, including being on high doses of steroids, having an eating disorder like anorexia, and weighing less than 57kg. A family history of the conditions, fair skin, and poor nutrition, especially a lack of dairy foods high in calcium, are also risk factors, as are cigarette smoking and high alcohol consumption.
2. Drugs can stop or reverse the problem
There’s a class of drugs called bisphosphonates that are prescribed to treat low bone density. They prevent bone loss by inactivating the osteoclast, a type of bone cell that reabsorbs bone tissue, or by preventing its formation. Other medications promote bone growth.
However, these drugs can lead to bone, joint, and/or muscle pain; oesophageal erosions; heartburn; arrhythmias; or rapid heartbeat. “You’re balancing the risks and benefits,” says gynaecologist Dr Mary Jane Minkin. “Oral bisphosphonates also carry a very slight risk of jaw problems, and some fractures. But they’re very rare.”
People on these medications should get regular reviews.
3. If you have osteopenia you probably don't need medication
Patients diagnosed with osteopenia and not osteoporosis are rarely prescribed drugs (with the exception of those with breast cancer who are on aromatase inhibitors for therapy, who are therefore at higher risk for bone loss).
“In general, when I diagnose osteopenia in my patients, we sit down and have a good talk,” says Dr Minkin. “If she’s smoking, can she stop or at least cut down? Is she getting calcium-rich foods? Is she taking her vitamin D? Is she doing weight-bearing exercises regularly? I’m a big nut on strength training; I encourage all my patients to go to the gym and exercise.”
Regular exercise can help you look after your bone health. Weight-bearing exercises in particular (like running, climbing stairs and dancing) can lower your risk of osteoporosis.
4. Think area rugs, thyroid checks, and everything in between
Good diet, exercise, adequate calcium intake, normal vitamin D levels, and taking precautions at home so you don’t fall are all important. “Good habits around the house help,” says Dr Minkin. “Don’t set yourself up for fractures: keep throw rugs out of the way, wear sensible shoes, and so on.”
Parathyroid and thyroid hormone levels can also impact bone health. “Hyperparathyroidism is amazingly common, and the surgery to remove the overactive gland is usually quite successful,” she says. “I recently received a letter from a patient who had her overactive parathyroid removed a few months ago—she hasn’t felt this good in ages, because her calcium had been high, and that can make you feel crummy. There is a lot of management other than medications.”
5. Having low bone density doesn’t mean you’re destined for fractures
While a decrease in bone density does correlate with fracture risk, Lane contends that it only accounts for 20% to 60% of the risk. “There are many factors that contribute, and you don’t have to have osteoporosis to fracture a bone,” adds Dr Minkin.
6. Osteoporosis drugs can actually make bones more brittle and breakable
“Improving bone density lowers risk, but does not totally prevent fractures,” says Lane. “And prolonged use of osteoporosis drugs is associated with loss of bone toughness and brittleness in some people. Still, these drugs help more patients than they hurt.”
A conversation with your doctor can help you identify what is right for you and your bone-health situation.
Worried about your bone health? Check your risk of osteoporosis at Know Your Bones.
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