Australians urged to check bone density

After enduring three years of excruciating back pain caused by unidentified spinal fractures, Elaine, a 57-year-old Melbourne mother of three, grandmother of twin girls, and consumer advocate, was diagnosed with severe osteoporosis in 2019.

Elaine has an immediate family history of bone disease — her mum was diagnosed with osteoporosis at 70 years of age, while her sister has also experienced fractures.

“Despite my family history of bone disease, it never crossed my mind, nor was it even suggested to me, that I may be at risk for developing osteoporosis, even after going through menopause.

“Because I had never experienced any falls, no one suspected I was living with bone fractures. So I’m not actually sure how long I had been living with osteoporosis,” Elaine said.

Elaine is one of many Australians unknowingly living with poor bone health. In a recent survey of 88,000 Australians, one in two adults who have broken a bone reported having a bone mineral density test (BMD)¹ to investigate their bone health for the risk of fracture (broken bone), and presence of osteoporosis.

Even more concerningly, of those who have fractured a bone, the vast majority (86%) are not taking preventative osteoporosis medication.¹

The findings, among others from Healthy Bones Australia’s ‘Know Your Bones Community Risk Report, Second Edition 2021’, released on World Osteoporosis Day (October 20, 2021), call for earlier investigation and treatment to capture all adults with risk factors for poor bone health, and adults post-fracture.¹

Elaine feels heightened public awareness of bone health is urgently required to help curb the prevention of painful but unnecessary fractures.

“The disease has substantially impacted my life, and I want others to avoid the pain I have gone through,” she said.

Data shows 66% of Australians aged 50+ are living with poor bone health (osteoporosis or osteopenia)⁴. Osteoporosis is a painless disease leading to reduced bone strength and increased risk of fracture.^4,10,11 Once a fracture occurs, action must be taken to protect bone health, and bone density monitored to gauge improvement.^12,13

The new report summarises data from more than 88,000 Australians who have completed Know Your Bones to date — an online self-assessment tool developed by Healthy Bones Australia in partnership with the Garvan Institute of Medical Research, to help Australians understand their potential risk for developing osteoporosis and bone breaks. The test provides the respondent with personalised recommendations about their bone health, which they can share with their GP for further discussion.

According to Healthy Bones Australia Medical Director and Senior Staff Specialist Rheumatologist at Westmead Hospital, Associate Professor Peter Wong, Sydney, specific risk factors increase a person’s risk for developing osteoporosis, including prior fracture, family history, certain medical conditions or medications, early menopause or low testosterone, lack of calcium or vitamin D, smoking, and high alcohol intake.^2,3

The Healthy Bones Australia report found around 40% with a clinical risk factor for osteoporosis, while around 99% had at least one lifestyle factor.

“Given more than six million Australians over 50 years of age are living with poor bone health,⁴ we are encouraging adults to ‘Know Your Bones’, by completing our online self-assessment, to help curb the more than 183,000 fractures anticipated by 2022,”⁴ A/Prof Wong said.

Healthy Bones Australia Chair, Endocrinologist, and Head of the Department of Medicine, School of Clinical Sciences at Monash Health, Professor Peter Ebeling AO, Melbourne, said routine investigation of adults with risk factors for poor bone health is essential to secure an early osteoporosis diagnosis, protecting bone health and preventing unnecessary fractures.

“Breaking any bone due to poor bone health is a serious medical event. People who fracture from poor bone health have a two to fourfold increased risk of breaking another bone^.4,5 Fractures from poor bone health cause pain and disability, with patients commonly unable to work, drive or complete everyday household tasks.^6,7

“Concerningly, our new report reveals one in three Know Your Bones respondents aged over 70 years have not had a BMD test, which is reimbursed by Medicare in this age group. This simple test measures bone density at the hip and spine to identify poor bone health,”^1,8,9 Prof Ebeling said.

“Investigation rates of those with risk factors for poor bone health, or patients who have already broken a bone should be much higher, given this test is widely available and reimbursed.

“Early diagnosis of osteoporosis allows us to prevent unwanted fractures,” said Prof Ebeling.

Elaine encouraged everyone to use Know Your Bones and talk to their doctor about your bone health to prevent osteoporosis.

“Know Your Bones represents a simple first step for Australians to consider their bone health and can be performed in the comfort of their own homes,” said CEO of Healthy Bones Australia Greg Lyubomirsky, Sydney.

“Fractures place a huge burden on the cost of the healthcare system and account for the majority (69%) of the expected AU$3.85 billion,⁴ in 2022, including emergency costs, hospital stays, rehabilitation and community services. We need to educate the community about the risk factors for poor bone health and ensure adults with risk factors are investigated as part of a routine medical check-up.”

Image credit: ©stock.adobe.com/au/reineg

<sup>1. Healthy Bones Australia, Know Your Bones Community Risk Report – Second Edition 2021.
2. Australian Government Department of Health, National Strategic Action Plan for Osteoporosis. 2019 [June 2020]; Available from: https://www.health.gov.au/resources/publications/national-strategic-action-plan-for-osteoporosis-2019.
3. Pouresmaeili, F., et al., A comprehensive overview on osteoporosis and its risk factors. Therapeutics and clinical risk management, 2018. 14: p. 2029-2049.
4. Watts, J., Ambimanyi-Ochom, J, & Sander K, Osteoporosis costing all Australians: A new burden of disease analysis 2012-2022. 2013, Osteoporosis Australia.
5. Center, J.R., et al., Risk of subsequent fracture after low-trauma fracture in men and women. JAMA, 2007. 297(4): p. 387-94.
6. National Clinical Guideline Centre, National Institute for Health and Clinical Excellence: Guidance, in Osteoporosis: Fragility Fracture Risk: Osteoporosis: Assessing the Risk of Fragility Fracture. 2012, Royal College of Physicians (UK): London.
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10. Better Health Channel, Osteoporosis. [October 2021]; Available from: https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/osteoporosis.
11. Sözen, T., L. Özışık, and N.Ç. Başaran, An overview and management of osteoporosis. European Journal of Rheumatology, 2017. 4(1): p. 46-56.
12. Healthy Bones Australia, Bone Health Explained (Consumer Guide). 2021.
13. Royal Australian College of General Practitioners & Osteoporosis Australia, Osteoporosis prevention, diagnosis and management in postmenopausal women and men over 50 years of age. 2017.</sup>