Break a leg – Not good luck if it’s osteoporosis!

By Nina Klug, Project Manager, Healthy Bones Australia 

Source: APNA Primary Times Summer 2023-24 (Volume 23 Issue 2)

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Primary health care (PHC) nurses can play an important role in supporting patients with osteoporosis to manage their condition. More importantly, if they are aware of all the risk factors associated with osteoporosis, PHC nurses can assist with preventative measures to help their patients avoid fractures and poor bone health.  

Snapshot of poor bone health in Australia 

Poor bone health is common and many Australians are unaware of the risk factors for osteoporosis, a chronic disease that causes bones to become thin, weak and fragile.1 According to the Australian Institute of Health and Welfare, an estimated 924,000 Australians currently have osteoporosis. However, Healthy Bones Australia suggests the disease is underreported due to inconsistencies in minimal trauma fracture identification within the health system. 

In 2017, the total direct cost of osteoporosis in Australia was estimated to be $3.44 billion, and a large proportion of this cost was due to fractures.2 It is estimated over 183,000 fractures occur each year due to low bone density.3 Fractures are some of the most serious medical consequences associated with osteoporosis and can have significant impacts on an individual and their family.4 Hospitalisations for minimal trauma fractures in people aged 45 and over included fractures commonly occurring in the hip and the lower leg, including the ankle, in both men and women.1 Hip fractures, in particular, often result in reduced quality of life due to marked loss of independence.¹  

Unfortunately, the underlying causes of minimal trauma fractures that come to medical attention are not routinely investigated and more can be done to prevent these injuries. Undiagnosed osteoporosis places a person at greater risk of fracture and early investigation of any risk factors will help to diagnose osteoporosis, which can enable treatment of the disease and can help to prevent fractures. 

Greg Lyubomirsky, CEO of Healthy Bones Australia, says, ‘We can prevent many fractures by capturing patients early with an osteoporosis diagnosis. We encourage all health professionals to be active in raising bone health with consumers who may be at risk.’ 

In Australia, bone density testing is reimbursed for many risk factors and there are a range of effective treatment options for consumers diagnosed with osteoporosis.  

Common risk factors 

If your patients, predominantly those aged over 50 years, have any of the risk factors listed in Table 1, they should be investigated for osteoporosis. 

Healthy Bones Australia explains the link between many of these risk factors and their impact on bone health in a series of factsheets for consumers, which can be found at https://healthybonesaustralia.org.au/resource-hub/.  

 

Know Your Bones online self-assessment 

Another useful recommendation for consumers is the online self-assessment tool, Know Your Bones, which was developed by Healthy Bones Australia in conjunction with Garvan Research Institute, based on Australian research. The self-assessment asks a series of questions that can help identify an individual’s risk of osteoporosis and the report can be discussed with one’s doctor, if required.  

Data from the Know Your Bones program has been released in a series of Community Risk Reports with the latest report5 being launched in October 2023 in the lead up to World Osteoporosis Day. Over 104,000 completed assessments were analysed, with the majority (82%) of self-assessment completions in adults over 50 years of age. There were clinical risk factors present in over 35% of assessments and one-third of these assessments had 2 or more clinical risk factors. However, only half of this cohort reported having had a bone mineral density test (see Figure 1). This suggests that bone health status is not being routinely investigated. 

Lifestyle risk factors that can be detrimental for bone health were also common, with a significant majority of respondents reporting these risk factors, which include inadequate calcium, vitamin D and exercise levels, and excessive alcohol or tobacco use. 

Making the skeleton the focus 

Healthy Bones Australia has been targeting different health professional groups to improve awareness and raise the profile of osteoporosis. Associate Professor Peter Wong, Healthy Bones Australia’s medical director, is chairing a working group with the Royal Australian College of General Practitioners to update current clinical guidelines for osteoporosis.  

APNA has recently accredited ‘Osteoporosis for Primary Health Care Nurses’, an online education course that is available at the Healthy Bones Australia Bone Academy (https://hbaboneacademy.org.au/). This course aims to enhance the case-finding skills of PHC nurses. Upon completion, nurses should be able to: 

• Demonstrate understanding of how osteoporosis develops 
• Discuss the factors that increase the risk of osteoporosis and fracture 
• Summarise the diet and lifestyle factors essential to osteoporosis prevention and fracture risk reduction 
• Describe how osteoporosis is diagnosed and fracture risk assessed 
• Describe the pharmacological and non-pharmacological management options for osteoporosis 
• Explain the role of general practice coordinated care in the management of osteoporosis 
• Implement strategies for improving osteoporosis care in their practice. 

This online course, endorsed by APNA, can be completed in the participant’s own time over the duration of 6 months. Greg Lyubomirsky says, ‘It’s a collective effort to improve case finding.’ This course will assist PHC nurses in supporting preventative care for people with bone health risks and effectively managing their patients with diagnosed osteoporosis.  

 

Table 1. Risk factors for osteoporosis 

Personal history	Medical conditions	Medications
Previous fracture (from minor bump or fall)	Coeliac disease	Certain treatments for breast cancer
Family history of osteoporosis (parent/sibling)	Overactive thyroid or parathyroid	Certain treatments for prostate cancer
Loss of height (3 cm or more)	Rheumatoid arthritis	Glucocorticoids (steroids)
Smoking/excessive alcohol	Early menopause/low testosterone	Anti-epilepsy treatment
Inadequate calcium, vitamin D or lack of exercise	Chronic kidney disease or liver disease
Age 70 years and over	Diabetes

 

 

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Case study: Carole, aged 68, has been living with osteoporosis for over two decades 

My story has a common theme. In my early 50s I was diagnosed with very low bone density following a bone mineral density test. During the next decade, I broke many bones, including my sternum. These fractures were treated independently of my bone condition. Then something happened to my spine. I was in terrible pain for a long time, which was wrongly suspected as unrelated medical issues. This meant I lost valuable time visiting specialists, including several visits to hospital emergency departments where they couldn’t find anything wrong. Finally, I was admitted to hospital because the pain was too much, and it was found I had multiple fractures in my spine and resultant compression in many vertebrae and was diagnosed with osteoporosis. This led to a significant loss of height and constant pain. I now see my endocrinologist regularly and have been on medication that has improved my bone density and has helped me regain my confidence and mobility. I am passionate about raising the awareness about osteoporosis, especially with health professionals, because with an earlier diagnosis my story could have been different. 

 

Figure 1: Number of assessments with clinical risk factors by bone mineral density (BMD) test status. 
*Percentages are rounded.