FAQs: Important words on the ‘silent disease’

Bones are active, living tissue made up of cells, blood vessels, protein and minerals. There are 206 of them in an adult skeleton, and together they form a scaffolding that holds us upright, protects our organs, and provides an anchor for our muscles to attach to. Our skeleton also works as our ‘bone bank’, providing essential calcium to our bloodstream which is vital for our muscles and nerves.

Peak bone mass usually occurs between the ages of 20 and 25. After this, the rate at which bone forms is often slower than the rate at which it is removed. If we don’t develop enough bone mass while we’re young, we have less in reserve to lose as we age, and this puts us at risk of developing osteoporosis – a condition that causes bones to become thin and fragile, making them more prone to fractures.

At least 1 in 3 women and 1 in 5 men will suffer a broken bone in their lifetime caused by osteoporosis (known as fragility fractures). Most people hear the words ‘broken bone’ and think ‘nuisance’. Some initial pain, an awkward few weeks in plaster, and having to shower with a plastic bag. Not many people think ‘life-threatening’. But for people who suffer from osteoporosis, a broken bone can mean a life changed forever – or a life lost. Some people die following fragility fractures.

Fortunately, building healthy bones early in life and maintaining them through adult life can help prevent the serious risks associated with osteoporosis in later years. A 10% increase in peak bone mass development is predicted to delay the development of osteoporosis by around 13 years.

Osteoporosis is often called the ‘silent disease’, because bone loss occurs without any symptoms. In fact, many people only become aware that there’s an issue with their bones when they break one – typically their wrist, shoulder, hip, or spine.

If you have had such a break, or you have known risk factors for osteoporosis, your Fracture Liaison Nurse or Doctor can carry out a bone health assessment and may refer you for a Bone Density scan. This is also known as a DXA (dual energy X-ray absorptiometry) and the results give a good indication of bone strength (or density). This scan is simple, painless and non-invasive and it takes about 20 minutes. The results will be sent to your GP and/or specialist, who will determine if you require treatment.

Early diagnosis, a bone healthy lifestyle, and medication can allow people with osteoporosis to remain fracture free. In New Zealand, we have some very effective medicines that can treat osteoporosis and reduce the risk of future fracture by as much as 30-50%. These medicines include bisphosphonates, hormone replacement therapy, teriparatide, and denosumab.

If you’re diagnosed with osteoporosis, you should be offered medication. Your doctor will prescribe the most appropriate one for you.

A well-balanced diet which includes all food groups is essential for overall good health – and that includes bone health. By ensuring you eat enough calcium and protein, get some sunlight to keep your vitamin D levels up, and maintain a healthy body weight, you can lower your risk of developing osteoporosis.

Calcium is an important nutrient for bone health. In New Zealand, the recommended daily dietary calcium intake is equivalent to about 500mg or 2-3 servings of dairy products (e.g. milk, cheese, yoghurt). Non-dairy sources of calcium include tofu, dark green vegetables (spinach, broccoli), tinned salmon and sardines (especially the bones), calcium rich nuts (almonds, Brazil nuts) and calcium-fortified dairy substitutes (e.g. almond or soy milk).

There are many milk substitutes that contain calcium such as soy, almond, oat and rice milk. We recommend checking the label for the calcium content and choosing appropriately.

Ideally, you should aim to do at least 30 minutes of weight bearing physical activity every day. The best exercises for bones are ones that work your muscles against gravity. These can be weight bearing exercises where you are on your feet and bear your own weight – for example walking, jogging, tennis, dancing, skipping, or resistance training which becomes more challenging over time (such as lifting weights or using gym equipment).

Maintaining muscle strength as we age is important as it helps keep us steady on our feet and reduce the risk of falling and breaking a bone. It’s rare to break a bone without sustaining a fall.

The four biggest risk factors are:

• Age (≥65 for women, ≥75 for men)
• Previous fracture
• Family history
• Low body weight

Having any of these risk factors means you are at high risk of developing osteoporosis.

Other risk factors include:

• Smoking
• Menopause (especially if early – 45 yrs or earlier)
• High alcohol intake
• Some medications
• Malabsorption conditions such as coeliac disease or inflammatory bowel disease.

Vitamin D is necessary for calcium absorption, bone development and regulating calcium levels in the blood. We absorb vitamin D through our skin from sunlight, and it’s present in small amounts in some foods including oily fish, milk, liver and eggs. Most of us will get enough vitamin D through our day-to-day sunlight exposure (hanging out the washing, walking to the shops, mowing lawns etc) especially over the spring and summer months. Vitamin D supplements are recommended for those that don’t get much sun exposure (for example, people who are confined indoors, have dark skin, or cover their skin for cultural reasons).

After menopause, bone loss is accelerated due to the rapid decline of oestrogen (the female sex hormone that regulates the balance between removal of old bone and formation of new bone). This means menopausal women are more at risk of developing osteoporosis and breaking a bone. A bone health assessment and bone density test is often recommended for menopausal women to establish bone strength.

If you want to know more about your personal risk of osteoporosis, just take a few minutes to complete the Know your Bones test. If Know your Bones indicates that you have some bone health risk factors, or you have questions or concerns, we encourage you to share your Know your Bones report with your GP.

In most cases, your General Practitioner will manage your bone health. If you have osteoporosis, they can make a diagnosis and recommend treatment. If you have complex medical issues or break bones while taking treatment for osteoporosis, your GP may refer you to a consultant (most likely an endocrinologist) who specialises in the management of osteoporosis.