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Osteoporosis Mate kōiwi
Osteoporosis is a condition that causes your bones to be thinner and weaker than normal. This means they can break (fracture) easily. Osteoporosis can occur in younger people but it is most common in older people. It affects 1 in 2 women and 1 in 3 men over the age of 65.
Symptoms of osteoporosis
There are usually no symptoms of osteoporosis in the early stages. Once your bones have been weakened by osteoporosis you might have signs and symptoms that include:
- back pain caused by a broken or collapsed bone in your spine (vertebral compression fracture)
- losing height over time
- a stooped posture
- a fracture of your wrist, hip, spine or other bone that happened more easily than it should.
Vertebral compression fracture
With severe osteoporosis, you can break a bone doing ordinary things like bending, lifting or just getting up from a chair.
Risk factors for osteoporosis
Some people are more likely to get osteoporosis than others. To find out about your bone health, you can do a simple test called Know Your Bones.
Know Your Bones — Bone Health New Zealandexternal link
You cannot change some of the risk factors that increase your likelihood of getting osteoporosis, such as your age and family history, but you can change others.
Risk factors you may be unable to change include:
- being female, although men can also develop osteoporosis
- getting older
- having a family history of osteoporosis, especially a hip fracture in a parent
- having certain conditions such as hormone problems, coeliac disease, diabetes, an eating disorder, rheumatoid arthritis, breast cancer and prostate cancer
- using some medications such as high-dose prednisone for more than 3 months or medications for epilepsy
- menopause, especially if before age 45
- having a hysterectomy or your ovaries removed.
You can reduce your risk of getting osteoporosis by strengthening your bones. You can achieve this by:
- keeping physically active and doing regular weight bearing and muscle strengthening exercises
- eating well
- maintaining a healthy weight
- getting enough vitamin D
- not smoking
- limiting alcohol to no more than 2 standard drinks a day with 2 alcohol free days a week.
Diagnosing osteoporosis
Your healthcare provider can assess your risk of osteoporosis from your medical history and by asking you about your lifestyle. They can look for physical signs of osteoporosis such as previous fractures, loss of height or a stooped posture.
They may suggest you have a bone density scan (also called DEXA scan) to assess your bone health.
Treating osteoporosis
Calcium and vitamin D are essential for maintaining good bone health. Calcium helps build strong bones and vitamin D helps your body to absorb calcium.
It is safer and more effective to get calcium from your diet rather than relying on supplements. There is no strong evidence that calcium supplements prevent fractures, and they may potentially cause heart problems, especially in postmenopausal women.
Your body makes most of the vitamin D it needs when your skin is exposed to direct sunlight. You can get some vitamin D from foods, but this is not enough by itself.
If you spend a lot of time indoors or you have naturally dark skin, you may have difficulty producing enough vitamin D. If you are at risk of having low levels of vitamin D or if you have osteoporosis, your healthcare provider may recommend you take vitamin D tablets such as colecalciferol.
Colecalciferol — My Medicinesexternal link
How to get your daily vitamin D
There are many other nutrients that also help to keep your bones healthy and strong. If you eat well and have a variety of foods you will probably get everything you need.
Medicines for osteoporosis work by slowing or stopping bone loss. The main types of medication used to treat osteoporosis are:
- bisphosphonates such as alendronic acid (Fosamax) and zoledronic acid (Aclasta)
- menopause hormone therapy (MHT), also known as hormone replacement therapy (HRT)
- selective estrogen receptor modulators (SERMs) such as raloxifene (Evista)
- other medications such as teriparatide (parathyroid hormone) and denosumab (Prolia).
Bisphosphonates
These medicines work on your bone‑making cells to slow bone loss. They significantly reduce the fracture rate in people with osteoporosis.
Bisphosphonates are available in daily or weekly tablets, such as alendronic acid and risedronate. They can also be given as an intravenous infusion of zoledronic acid — you would have an infusion every 18 to 24 months.
Alendronic acid — My Medicinesexternal link
Risedronate — My Medicinesexternal link
Menopause hormone therapy (MHT)
Levels of the hormone estrogen decrease after menopause, and this contributes to bone loss. MHT helps maintain bone density by replacing estrogen.
MHT is especially beneficial for postmenopausal women. It is safe to use for most women in their 50s or for the first 10 years after the start of menopause.
Selective estrogen receptor modulators (SERMs)
SERMS are medicines that act like estrogen and work to slow down bone loss. They help to reduce the risk of fracture, especially of the spine. Raloxifene is a type of SERM available for treating osteoporosis.
If you are postmenopause and cannot take estrogen you might be offered raloxifene.
Other medications
Other medications to treat osteoporosis include denosumab and teriparatide. They are generally only used if other treatment options have not been successful.
Self care for osteoporosis
Staying active is one the best ways to manage osteoporosis. It benefits your bones, muscles, mood, sleep and overall health.
Aim to include certain types of exercise each week.
- Weight-bearing exercises — activities like brisk walking, dancing, low-impact aerobics and gardening are excellent for bone health. These activities work directly on the bones in your legs, hips and lower spine, helping to keep them strong.
- Muscle strengthening exercises (also called resistance training) — doing at least 2 sessions a week will help you gain and keep muscle mass and bone strength. You can lift weights, work with resistance (stretchy elastic) bands or do exercises that use your own body weight, such as squats, wall push-ups, leg extensions and calf raises.
- Balance and flexibility exercises — activities like yoga, stretching and tai chi are great for improving co-ordination and balance, and preventing falls.
Find community strength and balance classes — Live Stronger for Longerexternal link
If you have severe osteoporosis you should avoid exercises that could lead to fractures. These include:
- very high-impact, fast-moving or jerky exercises, which can put excessive stress on bones
- movements involving forward flexion, such as bending over forwards with a rounded back or twisting the spine — these movements put large forces on your spine, increasing the risk of spinal fractures (vertebral compression fractures).
Before you start a new exercise routine, talk to your healthcare provider to ensure it is safe for you. They may refer you to a physiotherapist or registered exercise professional. You can also self-refer.
Eating a variety of healthy foods, especially calcium-rich foods, will support your bone health.
Maintaining a healthy weight is important for bone health. You are at greater risk of lower bone mass and have a higher risk of fractures if you:
- are underweight
- are very overweight
- lose weight very quickly
- repeatedly gain then lose weight.
If you need help managing your weight talk with your healthcare provider. They may refer you to a dietitian.
If you are in pain after a broken bone, it can be managed. What works for you may differ from what works for someone else. There are different ways to manage pain, including:
- pain relief medicines
- heat treatment, such as a warm bath or using a warm wheat bag or hot water bottle
- cold treatment, such as an ice pack wrapped in a towel held on the painful area (for no more than 15 minutes at a time)
- simple relaxation techniques, such as calming breathing, meditation or mindfulness
- gentle massage.
Pain relief medicines for adults
If you have been diagnosed with osteoporosis it can feel challenging. It is important to maintain your mental wellbeing, just as it is to manage your physical symptoms.
Your healthcare provider may be able to answer any questions you have about living with osteoporosis and can reassure you if you are worried. You may also find it helpful to talk to a trained counsellor or psychologist.
It might help you to be able to talk with other people who have osteoporosis. There are local strength and balance classes and support groups for people with osteoporosis.
Find community strength and balance classes — Live Stronger for Longerexternal link
A fall at any age can be dangerous, but falls are more common and more likely to cause injury after the age of 55.
If you have osteoporosis, you are more likely to break a bone if you fall. You might also need a long time to recover. Learning how to prevent falls can help you avoid broken bones and the problems they can cause.
The Nymbl app has been developed for people wanting to improve their balance and mobility and reduce their risk of falling.
Nymbl app — Healthifyexternal link