Osteoporosis is a condition that is caused by thinning of the bones, resulting in decreased bone density. Patients with osteoporosis have an increased risk of fracture. It is more common with increasing age, and is becoming an important health problem worldwide. In Australia, it is estimated that 1 in 2 women and 1 in 3 men over 60 years of age will eventually develop a fracture. Osteoporosis is diagnosed when patients have a fragility fracture, or by a bone density scan showing severe bone loss.

Osteoporosis does not cause symptoms until a fracture occurs. An evaluation for low bone density can be undertaken with the use of clinical risk factors and fracture risk calculators. A test known as a DXA scan is available to measure bone density.  DXA stands for dual-energy x-ray absorptiometry. Two low-energy beams are passed across areas of the body, and the differences in energy absorption are used to calculate the density of the underlying tissue. The lower spine, hips and forearm are the usual measured sites. These bone density readings are then used to generate an overall fracture risk profile. Our bone density scanner uses minimal radiation (only 10% compared to X-rays and 1% compared to CT scans). No preparation is required for the bone density scan. However it is best to wear loose clothing with no metallic objects around the waist or pockets. This will ensure that the measurements are as accurate as possible. All DXA scans are bulk-billed at our Centre.

Common Risk Factors for Osteoporosis include:

• Experienced a broken bone after a minor bump or fall

• Family history of osteoporosis (hip fracture in a parent)

• Height loss of 3 cm or more 

• Medications that affect bone strength such as corticosteroids (tablets or high-dose puffers), Aromatase Inhibitors for breast cancer, and Androgen Deprivation Therapy for prostate cancer

• Early menopause

• Low testosterone levels in men

• Coeliac disease

• Hyperthyroidism or hyperparathyroidism

• Chronic kidney or liver disease

World Health Organisation FRAX Fracture Risk Calculator

The FRAX tool has been developed by the WHO to evaluate the fracture risk of patients. It is based on individual patient models that integrate the risks associated with clinical risk factors as well as bone mineral density (BMD) at the femoral neck. The FRAX models have been developed from studying population-based cohorts from Europe, North America, Asia and Australia.

Management of osteoporosis requires a combined approach:

• Have foods which are high in calcium. These include milk, cheese, yogurt, tofu, and soy milk. The International Osteoporosis Foundation website has a useful calcium intake calculator. Calcium supplements are advised for those unable to meet the recommended intake of 1000 to 1300 mg daily.

• Sunlight exposure to maintain adequate vitamin D levels. The vitamin D level can be checked on a blood test. If the level is found to be low, most patients will require a supplement of at least 1000 IU per day.

• Weight-bearing exercise such as walking for at least 30 minutes, most days of the week.

• Avoid smoking. Limit alcohol intake to no more than 1 to 2 drinks a day.

• Avoid falls by reducing the chances of tripping, such as ensuring all rugs have a no-slip backing, tucking away electrical cords, and avoiding slippery floors.

• Consult your GP to check for medical conditions that will cause accelerated bone loss. These include: Rheumatoid arthritis, Chronic liver or kidney disease, Malabsorption problems (including coeliac disease), Thyroxine excess, Hyperparathyroidism, Steroid use or related disease, Low oestrogen (females) or testosterone levels (males).

• Medications for osteoporosis are recommended if bone loss is severe, associated with a fragility fracture, or shown to decline over time on a DXA scan.

Medications for improving bone density can be divided into oral and injection therapies. Currently the commonly used treatments are oral bisphosphonates (alendronate, risedronate), subcutaneous denosumab (Prolia), and intravenous zoledronic acid (Aclasta). These agents can reduce the fracture risk by approximately 50%. 

Oral Bisphosphonates: These are tablets that are usually taken weekly, or occasionally daily or monthly. The medications are best taken on an empty stomach, with a glass of water, and the patient should then remain upright and delay breakfast and other medications for at least 30 minutes. The medications are usually well tolerated. 

Zoledronic Acid (Aclasta): This is an intravenous bisphosphonate infusion given every 12 months. It is more convenient than tablets and usually results in systemic symptoms following the first injection, but much less in subsequent years.

Denosumab (Prolia): This is an injection given by the doctor every 6 months. It is administered under the skin of the abdomen. It is injected using a small needle and is almost painless. It is more convenient than tablets and has fewer side effects. 

Other Medications: Other pharmaceutical agents are available for treatment of osteoporosis. Newer agents include teriparatide and romosozumab. More information can be obtained from your treating doctor.

Yes, we do offer bulk billing. In order to be eligible for bulk billing at our facility, you must have a valid Medicare card and a referral from a doctor.