Osteoporosis is something that only happens to ‘old ladies’. Even then, it’s not that common. Or maybe it is, but having weaker bones is just a natural part of ageing. Drinking plenty of milk will help!
You’ve probably heard all of the above and more about osteoporosis, a condition characterised by weakened bones that are more likely to fracture. If other serious health conditions – think heart disease or cancer – were as frequently dismissed with platitudes as osteoporosis is, we’d probably be shocked and outraged.
But osteoporosis flies under the radar in most people’s health consciousness, thanks to the fact that even those who have the condition aren’t usually aware of it until they break a bone. The statistics are truly shocking; 66 per cent of Australians aged 50-plus have some form of bone weakness, through osteoporosis or related conditions, yet 80 per cent of those cases are undiagnosed and thus untreated.
And even when a GP treats a fracture suffered by an older Australian, research by the Royal Australian College of General Practitioners found that healthcare professionals will often not undertake further investigation into whether their patient may have osteoporosis.
GP and healthcare consultant Dr Ginni Mansberg says there are a few reasons Australians, and their doctors, tend to underestimate the prevalence and seriousness of osteoporosis.
“It gives you no symptoms so, much like high blood pressure, you wouldn’t know you had it unless your doctor picks it up during a check-up,” Dr Mansberg says. “Unlike high blood pressure though, osteoporosis isn’t something that can be identified as soon as you arrive at your GP appointment; you need to make an appointment, go and get a scan. So it tends to be the sort of thing that we don’t think about, unless your GP is really proactive and pushing you to have a bone density scan.”
A bone density scan, also called a DEXA scan, is the only way osteoporosis can be diagnosed before a bone fracture or break occurs.
But Dr Mansberg points out that unlike other health checks such as breast screening, Australians don’t receive reminders to undertake a bone density scan.
“We get reminders to go and do a pap test if we haven’t done it,” she says. “We get reminded to do the poo test that comes in the mail, and we get reminders around breast screening. But you do not get reminders to go and have a bone density scan and that can allow us to buy into the idea that it can’t be that bad, because otherwise the government would be all over it.”
That’s despite the fact that if osteoporosis is diagnosed before a fracture occurs, the condition is manageable with treatment and changes to diet and exercise. Osteoporosis is still treatable after a fracture occurs, but further fractures are between two and five times more likely, Dr Mansberg says – as is clear in research published in the Annals of Rheumatic Diseases and Osteoporosis International.
An early osteoporosis diagnosis also gives people the chance to protect themselves against fractures by avoiding falls, Dr Mansberg adds. “A relatively minor bump when you have osteoporosis can give you a fracture,” she says. “So one of the things that we need to focus on is actually fall prevention.”
That’s why Dr Mansberg, who’s well known for covering health topics on the Seven Network’s Sunrise and The Morning Show programs, has pledged her support for The Big O campaign that aims to raise awareness of The Big O, clear up misunderstandings about the condition and encourage women to ask for a bone density scan. (The Big O website has a free, short online quiz that can tell you if you’re at risk of osteoporosis.)
“It’s much better if we pick it up earlier,” Dr Mansberg says. “So the main part of The Big O campaign is to say, ‘Don’t wait till you end up in hospital with hip fracture and need a hip replacement, let’s just get things sorted as soon as possible’.”
In fact, hip fractures are one of the most dangerous outcomes of having osteoporosis – 40% are still unable to walk independently and one in four of those people will die within a year. A hip fracture doubles the risk of premature death.
Some of the common understandings about osteoporosis are correct in part, but don’t reflect the reality of osteoporosis.
As Dr Mansberg says, “the reality is, the older you are, the more likely you are to have osteoporosis”. But what’s less well known is that women are advised to start being conscious of the possibility they may have osteoporosis when they start the transition into menopause, not when they’re already menopausal or after menopause. That’s because declining amounts of oestrogen can cause bone health to deteriorate quickly.
Meanwhile, platitudes such as ‘bones heal’ are correct too, but don’t take into account the way osteoporosis impairs the healing process, meaning fractures take longer than normal to heal, or the way osteoporosis impedes surgical repairs that require an implant to be attached to a strong, stable bone.
And while osteoporosis can be hereditary, that’s not always the case; lifestyle factors such as smoking, excessive alcohol intake, low levels of physical activity, low calcium intake and low levels of vitamin D, as well as body build and weight (being thin or being obese are both risk factors), can influence your risk of developing osteoporosis.
Other risk factors include having apparently unrelated health conditions such as diabetes, liver disease, kidney disease and rheumatoid arthritis, as well as some treatments given for breast cancer, asthma and even epilepsy.
Having a bone density scan done in Australia usually requires a referral from your GP and, as research has shown, some GPs may not recommend such a scan, even if you’ve already had a fracture. So if you are concerned about your bone health – even if you haven’t had any symptoms of osteoporosis, such as a fracture – Dr Mansberg recommends speaking to your regular doctor in depth about your concerns.
Doctors can find it off-putting if a patient demands a treatment that the doctor knows is unsuitable, she explains, so having a measured conversation about the reasons you feel you need a bone density scan is key.
Dr Mansberg acknowledges, though, that a GP isn’t obliged to make a referral simply on request, so if you’re refused a referral and still feel strongly about having a bone density scan, it may be time to seek a second opinion.
“If having that one-on-one chat in which you feel being heard is really important to you, then getting another opinion might be something that you decide to do,” she says.
“What I will tell you is that I don’t sit in my office and predict with any accuracy who will have a low bone density and who won’t. The only way you’re going to know what your bone density is, is to have a scan. And finding out earlier if you do have osteoporosis could save your life. So I applaud women who take this seriously and do more to protect their bones.”
IMPORTANT LEGAL INFO This article is of a general nature and FYI only, because it doesn’t take into account your personal health requirements or existing medical conditions. That means it’s not personalised health advice and shouldn’t be relied upon as if it is. Before making a health-related decision, you should work out if the info is appropriate for your situation and get professional medical advice.
If you’ve fractured a bone since turning 50, have a family history of fractures and osteoporosis, lost height, or experienced unexplained back pain, you could have osteoporosis. It’s serious but it’s also treatable. Ask your doctor about a bone density scan today. And say no to The Big O.