What is osteoporosis?
Osteoporosis is a chronic condition that weakens bones over time, making them thinner, more brittle and more likely to break, sometimes from a minor bump or simple fall.
What are the signs of osteoporosis?
Osteoporosis is a 'silent' disease because there are usually no signs and symptoms during the early stages.
However during the later stages, you may experience:
• Back pain
• Loss of height overtime, with a stooped posture usually associated with a rounded hump
• Low trauma fracture of the wrist, spine, hip or other major bones
You are at higher risk of osteoporosis if:
• You have a parent or sibling who has/had osteoporosis/ fractured a hip bone
• You developed early menopause before 45 years old
• You do not take enough calcium and vitamin D
• You are underweight
• You do not exercise regularly or are inactive for long periods
• You smoke or consume alcohol excessively
• You are on prolonged course of steroids (including those found in some traditional medications) or are on certain medications used for treating cancers
How will you know if you have osteoporosis?
Osteoporosis is diagnosed either by:
• Presence of a fragility fracture
• Bone Mineral Density (BMD) test.
It is painless and non-invasive, and usually takes less than 15 minutes
Osteoporosis Treatment Options
Bisphosphonate (Alendronate, Risedronate)What it does: Works by binding directly to the bone, preventing breakdown of bone material Routine: Once a week (Alendronate, Risedronate) / Once a month (Risedronate) Route: Oral • To take with a full glass of water in the morning on an empty stomach before breakfast. • Do not lie down after taking the medication for at least half an hour Common side effects: Heartburn, nausea, musculoskeletal aches, diarrhoea, belly ache Less common side effects: Worsening renal function, atypical femoral fracture, osteonecrosis of the jaw Cost: $ |
Bisphosphonate (Zolendronate)What it does: Works by binding directly to the bone, preventing breakdown of bone material Routine: Once a year Route: Intravenous. This is injected over 15-30 mins via a cannula through a vein Common side effects: Flu-like symptoms e.g. fever, malaise, headache, musculoskeletal aches, hypocalcaemia Less common side effects: Worsening renal function, atypical femoral fracture, osteonecrosis of the jaw Cost: $$ |
DenosumabWhat it does: Works by reducing bone resorption and increasing bone mass and strength of the bone Routine: Once every 6 months Route: Subcutaneous. This is injected usually into the fatty tissues of the abdomen Common side effects: Musculoskeletal aches, hypocalcaemia Less common side effects: Cellulitis, atypical femoral fracture, osteonecrosis of the jaw Cost: $$ |
TeriparatideWhat it does: Helps to regulate calcium metabolism, promotes the growth of new bone Routine: Once a day Route: Subcutaneous. This is injected usually into the fatty tissues of the abdomen Common side effects: Hypercalcemia Less common side effects: Osteosacoma Cost: $$$$ |
Rare but serious complications
Osteonecrosis of the jaw (ONJ) is very rare, affecting between 1 in 10,000 to 1 in 100,000.
To minimise the risk of ONJ:
• Undergo a dental examination before starting drug therapy
• Good oral care and regular dental checkups
• Brush your teeth twice a day
• Use dental floss or interdental brush to clean teeth at least once a day
• Clean the mouth, tongue and teeth after every meal
• Clean the mouth before sleep
• Cut down on sugary food and drinks
Atypical femoral fractures are rare but can happen after long term use of bisphosphonates. Pain in the thigh or groin may be present for several weeks or months before the atypical femoral fracture occurs.
Diet, lifestyle and bone health
Calcium and vitamin D are important for bone, muscle and nerve health.
Tips to increase calcium in your diet:
• Add skimmed milk powder or low-fat milk to soups, smoothies, milkshakes and sauces
• Select breads, cereals and juices that are calcium fortified
• Add cheese to your bread
Tips to get vitamin D:
• Just 15 minutes of daily sunlight exposure is all you need.
Sun exposure before 10am and after 3pm is recommended
Food rich in calcium
Smoking and alcohol are harmful to the bones
The nicotine in cigarettes slows the production of boneforming cells so that they make less bone. Smoking also decreases the absorption of calcium from the diet.
Limit your alcohol consumption to:
• Not more than 3 standard drinks a day (for men)
• Not more than 2 standard drinks a day (for women)
1 standard drink is:
Physical activity is important
Nutrition alone is not sufficient. Aim for 150 minutes of physical activity weekly for building and maintaining bone mass.
Contact us to find out more about individualised exercise plans by our physiotherapists.
Fall Prevention - Prevent Falls = Prevent Fractures
In people with osteoporosis, falls often result in fractures. Thus, reducing the risk of falls is important.
Keeping Safe in the Community:
Home Safety Checklist
The home is where you spend most of your time and a few simple steps can make your home safer:
Proper footwear gives sufficient support
• Choose well-fitting shoes
• Avoid heavy shoes
• Remember to replace shoes that are worn out and losing their grip
Regular follow-up
• Regular monitoring of calcium and vitamin D levels in the blood
• Regular monitoring of kidney function
• Repeating bone mineral density scan every 2-3 years to monitor for bone quality improvement
Regular eye vision check
Go for an eye check once a year to check your eyes. This can help ensure you have clear vision, are not wearing glasses with the wrong prescription, or suffering from any eye conditions such as glaucoma or cataracts.
Fracture Risk Assessment Tool (FRAX)
Your care team will be able to help estimate your fracture risk in the following manner:
You are likely at _____ % risk to develop a hip fracture and _____ % risk to develop a major osteoporotic fractures in the next 10 years.
My Healthier Bone Journey: Goal Setting
Discuss your goals with your care team, keeping in mind:
- What do you want to work on?
- What do you want to achieve?
- My treatment plan
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