Osteoporosis and osteopenia

Osteoporosis and osteopenia are conditions where the bones lose strength and quality, resulting in bones becoming weaker and more susceptible to fracture. In osteopenia, the bones have lost some strength, but not to the same degree as in osteoporosis.

Approximately two-thirds of Australians aged over 50 have osteoporosis or osteopenia.

Osteoporosis and osteopenia are not an inevitable part of ageing; they can be treated and prevented. In Australia, osteoporosis affects 13% of women aged 50-69 years and 43% of women aged 70 years and older¹. Bone loss may also occur in men and younger people (e.g. female distance athletes and people with chronic medical conditions). The most common outcome of osteoporosis or osteopenia is a bone break or “fracture”. A fracture (broken bone) usually occurs from a fall or low-load impact. Fractures commonly occur at the hip, pelvis, spine, ribs, arm or wrist. Once you have had one fracture, the risk of sustaining more fractures increases, particularly spinal fractures. Many people experience pain and difficulty doing everyday life activities like work and recreation after a fracture. The good news is that you can get help.

Osteoporosis/osteopenia is usually managed with a combination of medication, exercise and lifestyle modifications, including focusing on optimal nutrition.

There is a lot you can do to manage your bone health and reduce the risk of fractures. See the right care for Osteoporosis fact sheet. Right care includes:

• Weight bearing, resistance exercise at least 3 times per week^2-4. This might include a combination of walking, dancing and exercising your body against resistance (eg using weights). It is important to seek guidance from a health professional before commencing high resistance exercise, particularly if you are uncertain how to start and if your bone loss is advanced.
• Adopt a well-balanced diet rich in calcium and protein. Vitamin D, which is produced primarily from exposure to sunlight, is also important for your bone health. Speak with your health professional about safe levels of exposure to sunlight to ensure your vitamin D levels are adequate. Visit Osteoporosis Australia for more information on calcium and vitamin D, including recommended exposure to sunlight. You can also use an online calculator to track your calcium intake.
• Maintain a healthy lifestyle by keeping physically active (e.g. take a daily walk).
• Avoid smoking and excess alcohol (> 2 standard drinks/day).
• Participate in balance training if you feel unsteady or fall over often – ask your health care professional for advice about how to start safe balance exercises.
• Have your vision checked.
• Speak to your GP about a management and monitoring plan for your bone health.

You may or may not experience pain with a diagnosis of osteoporosis. Pain typically occurs with a fracture and may last for several months. Your health professional can guide you in how to manage this acute pain using medicines and other strategies.

Some people continue to experience pain after a fracture has healed. Persistent neck pain, mid-back pain, and lower back pain can be common after a spinal fracture. It is important to talk to your health professional team about your pain and its impact on your function to make sure you are getting the best advice and treatment. Your medical professional may decide to do further imaging or tests to further look at your bones, joints and surrounding muscles. The principles of managing pain associated with osteoporosis/osteopenia are the same as those described throughout our pain management modules. Usually, a combination of strategies are appropriate, tailored to your needs.

You may also need more specific exercise and posture training, supports or other interventions to help manage your pain. For example, there are specific exercise guidelines available for people who have sustained osteoporotic spinal fractures^5,6, although evidence for the benefits of exercise therapy alone is low⁷.

You can ask your physiotherapist about these guidelines and they can advise on exercises suitable for your situation. For general guidance about exercise and osteoporosis, see the Too Fit to Fracture recommendations from Osteoporosis Canada.

Vertebroplasty is a procedure that has been used to treat painful spinal fractures due to osteoporosis. The procedure involves injecting medical-grade cement into a fractured vertebra through a needle. The cement hardens in the bone space to stabilise the fracture site.

Recent scientific trials, and a Cochrane Review have concluded that available evidence does not support the use of this procedure for reducing pain or disability or improving quality of life⁸. Importantly, serious adverse events have been reported. If you are considering this procedure, it is critical that you discuss this current evidence with your doctors.

For more information about osteoporosis/osteopenia and to access community support groups, visit Osteoporosis Australia and the Cochrane Summaries. The Primary Health Network in your area and your state/territory Council of the Ageing (COTA) may also have further information about community-based programmes for osteoporosis.

To check your risk of osteoporosis visit the Osteoporosis Australia Risk Factors website. Alternatively, if you wish to contact a Health Professional, we recommend you seek further assistance.