Osteoporosis | Kōiwi ngoikore

Osteoporosis (kōiwi ngoikore) is a condition that causes your bones to become thinner and weaker than normal. This means that they can break easily, such as after a small bump or fall.

Key points about osteoporosis

  1. Osteoporosis affects more than half of women and about one third of men over 60 years, as well as some younger people.
  2. Some people are more likely to get osteoporosis because they have risk factors, including family history, being very thin and long-term use of certain medicines.
  3. Ask your doctor for an osteoporosis check if you have had a fracture of the wrist, hip or spine for the first time, you are 50 years or older and have had a fracture or you have had a fracture that happened more easily than it should, eg, after a slight bump or a simple fall.
  4. There are treatments that can slow the progression of osteoporosis and to help prevent you getting broken bones.
  5. Osteoporosis can be prevented by strengthening your bones. This can be achieved by keeping physically active, getting enough vitamin D and calcium in your diet and not smoking. 

Image credit: 123rf

What are the symptoms of osteoporosis?

One of the challenges with osteoporosis is that there are no early warning symptoms or signs. You may not know you have osteoporosis until you have one of the following:

  • A fracture of your wrist, hips, spine or other bones that happens more easily than it should, eg, after a slight bump or a simple fall. This type of fracture is also known as fragility fracture.
  • Loss of height – as the vertebrae of your spine weaken they compress and the spine curves.
  • With more severe osteoporosis, fractures that occur doing routine things like bending, lifting or just getting up from a chair. This happens because brittle bones have trouble supporting body weight. 

Ask your doctor for an osteoporosis check if you experience the following: 

  • fracture of the hip, wrist or spine for the first time
  • you are 50 years old or older and you have had a fracture
  • you have had a fracture that happened more easily than it should, eg, after a slight bump or a simple fall.

Who is at risk of osteoporosis?

Both men and women may have certain risk factors that can make them more likely to develop osteoporosis. Some of the risk factors that increase your likelihood of getting osteoporosis can't be changed, such as your gender or age, but many others can. See more at can osteoporosis be prevented?

Risk factors for osteoporosis

  • Being female – women are at a greater risk of developing osteoporosis because of the rapid decline in oestrogen levels during menopause.
  • Increasing age – bones get thinner as you age.
  • A family history of osteoporosis or fractures.
  • Being very thin and unable to put on weight.
  • Smoking.
  • Drinking too much alcohol.
  • doing too little exercise.
  • Having low levels of calcium and vitamin D.
  • Previous falls.
  • Long-term use of some medicines such as steroids, thyroxine, antiepileptic drugs, chemotherapy drugs or methotrexate.
  • In women, irregular periods or early menopause (before 45 years old, often caused by having your ovaries removed) can decrease oestrogen levels. In men, too little testosterone in conditions such as primary or secondary hypogonadism can also increase your risk.
  • Being immobilised in bed for long periods.
  • Some medical conditions such as rheumatoid arthritis, Crohn’s disease, coeliac disease, COPD, anorexia, hyperthyroidism or hyperparathyroidism.

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What are the complications of osteoporosis?

It's important to diagnose osteoporosis as the underlying cause if you get fractures easily, so you can get treated appropriately. If osteoporosis is left undiagnosed and untreated, it can cause complications. These include:

  • suffering from more fractures in the future
  • chronic pain
  • immobility
  • loss of independence
  • reduced quality of life
  • long-term nursing care
  • increased risk of death.

How is osteoporosis diagnosed?

Your doctor can assess your risk for osteoporosis from your medical history and by asking you about your lifestyle. Physical signs that you may have weak bones include:

  • previous fractures (often of your wrist, hip or spine)
  • a loss of height or stooping
  • a curved spine.

Your doctor may suggest you have a bone density scan (also called a DEXA scan) to check for bone weakness. Blood tests may also be done to rule out causes such as any medical conditions that can cause osteoporosis.

How is osteoporosis treated?

Treatment for osteoporosis will depend on the results of bone density scans, age, gender, medical history and severity of the condition. To help decide which treatment is suitable, you and your doctor may use a FRAX score or a Garvan score. These shows your risk of having a fracture due to osteoporosis in the next 10 years. Read more about osteoporosis tools.

Treatment most commonly involves lifestyle changes such as exercise to strengthen your bones and medicines that aim to increase bone density and reduce the risk of bone fracture. If you have a medical condition that causes your bones to be weak, treatment of the underlying medical condition is also be needed.

Exercise

There are 3 types of exercises that are good for people with osteoporosis:

  • weight-bearing aerobic exercise, such as dancing
  • resistance training using free weights, such as elastic band resistance and body-weight resistance
  • exercises to improve posture, balance and body strength, such as tai chi. 

Ideally, you should exercise at least 3–4 times a week and include something from all 3 groups each week.

Read more about other lifestyle changes to prevent osteoporosis and take care of your bones.

Medicines

Bisphosphonates such as alendronaterisedronate and zoledronic acid are the most common medicines for osteoporosis. Other medicine options include hormone replacement therapy (HRT)raloxifeneteriparatide and denosumab. If you can't get enough calcium from a balanced diet, or have vitamin D deficiency, you may be prescribed calcium and vitamin D supplements to support your bone health while you are on osteoporosis treatment. 

Calcium supplements

Research shows that it is best to get your calcium from the food you eat, so calcium tablets are not usually started now when you are diagnosed and are often stopped if you are on them.

Read more about treatments for osteoporosis.

How can I prevent osteoporosis?

Being aware of the risk factors you can change means that you can take steps to keep your bones healthy and strong, which will reduce the chance of osteoporosis developing.

Risk factors you can change

Preventative action

Smoking
Diet low in calcium
  • The best sources of calcium are low-fat milk and milk products, as the calcium in milk is easily absorbed by your body.
  • Aim for 4 servings of low-fat dairy products a day.
  • Read more about calcium.
Low vitamin D levels
  • Vitamin D helps increase the absorption of calcium in food and optimises bone health and muscle function.
  • As little as 15 minutes in the sun (without sunscreen) 3 times a week enables your body to make enough vitamin D.
  • However, be sensible with your sun exposure as it increases your risk of skin cancer. Read more about sensible sun exposure.
Being physically inactive or doing non-weight bearing exercise only
  • Aim to be physically active every day.
  • Include a range of strength-training exercises, weight-bearing aerobic activities and flexibility exercises.
  • Read more about physical activity.
Excessive alcohol
  • If you drink alcohol, aim to keep your drinking within the recommended limits for low-risk drinking.
  • Read more about alcohol.

Read more on how to prevent osteoporosis

Falls prevention

A fall at any age can be dangerous but falls become increasingly common and far more likely to cause injury after the age of 55 years. If you have osteoporosis, you are more likely to break a bone if you fall, and if you do you might need a long time to recover.

Learning how to prevent falls can help you avoid broken bones and the problems they can cause.

Read more about falls and falls prevention

Learn more

Live Stronger NZ 
All about osteoporosis Osteoporosis NZ
Osteoporosis and you Osteoporosis NZ
Preventing osteoporosis booklet
 Ministry of Health, NZ 
Osteoporosis and fractures Osteoporosis NZ
Stop at one International Osteoporosis Foundation

References

  1. Guidance on the diagnosis and management of osteoporosis in New Zealand Osteoporosis NZ
  2. Osteoporosis resources for health professionals Osteoporosis NZ
  3. Osteoporosis Auckland Regional HealthPathways, NZ, 2020
  4. Risedronate now fully subsidised – what is its place in practice? BPAC, NZ, 2013
  5. Bisphosphonates – addressing the duration conundrum BPAC, NZ, 2019

Reviewed by

Dr Helen Kenealy is a geriatrician and general physician working at Counties Manukau DHB. She has a broad range of interests and has worked in a variety of settings including inpatient rehabilitation, orthgeriatrics and community geriatrics.
Credits: Health Navigator Editorial Team . Reviewed By: Dr Helen Kenealy, geriatrician and general physician, CMDHB Last reviewed: 22 Oct 2020