Osteoporosis and ageing: how a bone density scan can measure your risk of suffering it, and how regular exercise can lower that risk

It is getting easier to talk openly about menopause – and that is good for women’s health, including their bone health.

Menopause can significantly speed up bone loss and increase osteoporosis risk. When the subject was taboo, it was not easy to make such connections.

Hong Kong physiotherapist Judith Anne Gould has noticed an increase in clients coming to her clinic with a diagnosis of osteopenia (low bone density), or osteoporosis (when new bone creation doesn’t keep up with the loss of old bone material).

Gould founded Prohealth Posture Plus in 2007 in Hong Kong’s Central district. Two years ago, she set up a bone density clinic. Such is the demand that recently the clinic expanded.

Physiotherapist Judith Anne Gould opened a clinic in Hong Kong dedicated to bone health after seeing a rising number of clients with osteoporosis and osteopenia. Photo: Edmond So

While menopausal women are at higher risk, bone weakening may affect men, too, and people of all ages.

The non-profit Switzerland-based International Osteoporosis Foundation (IOF), the world’s largest NGO dedicated to osteoporosis and fracture prevention, recommends a five-step approach to bone health:

Have a nutritious, balanced diet that includes enough calcium, protein and vitamin D

Stop bone-damaging habits such as smoking and drinking too much alcohol

Maintain a healthy body weight (being underweight, with a BMI below 19kg/m², is a risk factor)

Exercise regularly

Know your personal risk factors, and get a bone density scan – also called a bone mineral scan, bone densitometry, DEXA or DXA – if a doctor recommends it

Gould suggests having an online IOF fracture risk assessment to get more information about whether you are at risk of fractures. You can do that test for free at osteoporosis.foundation/patients.

Despite recent research highlighting the benefits of exercise in improving bone density, it is often overlooked. At a regional osteoporosis conference in Hong Kong in October, Gould said there was just a passing mention of the value of exercise. The focus was instead on medication.

At the conference, she presented a poster highlighting four rather unusual cases of osteoporosis, three of which probably would not have been referred for a bone density scan (DXA) to screen for it: a young man with a brain tumour, a young woman, a 50-year-old peri-menopausal woman and a 58-year-old breast cancer survivor.

The medication given to breast cancer patients is known to affect bone density, so probably only the cancer patient would have been screened.

A bone density exam can flag the risk of osteopenia or osteoporosis. Photo: Shutterstock

In Hong Kong, the government will pay for a DXA scan for those over 65. But waiting until that age means that if you do have bone weakening or loss, you will have lost valuable time in addressing the issue.

And the statistics are alarming. According to the IOF, globally one in three women and one in five men over the age of 50 will suffer a broken bone because of osteoporosis.

“Get a DXA done at 30. If it’s good, great, then you don’t need to do it for 10 years,” says Gould.

Gould’s bone density clinic offers Onero, an exercise programme supported by science that is designed to prevent fractures by stimulating bone development and preventing falls.

Developed in Australia, Onero was formulated based on findings from randomised controlled trials conducted at Griffith University in Queensland under the supervision of Professor Belinda Beck. The results were published in the Journal of Bone Mineral Research in 2018.

One, referred to as Liftmor (for Lifting Intervention For Training Muscle and Osteoporosis Rehabilitation), involved post-menopausal women with low bone mass; it found high-intensity resistance and impact training (HiRIT) enhances bone strength and functional performance.

Professor Belinda Beck supervised the development of the Onero exercise programme at Griffith University, in Queensland, Australia. Photo: Griffith University

The other, Liftmor-M (for men), involved men over 45 with low bone density. It also found HiRIT was well tolerated and improved bone, function and fracture risk.

“The results were overwhelmingly positive with significant improvements in bone mineral density and functional measures for balance, muscle strength and posture over an eight-month period,” says Gould.

“Even more importantly, they were able to decrease the number of falls compared to the previous 12 months, and very few minor injuries were reported.”

The potential progression of osteoporosis and vertebral fractures as a woman ages. Illustration: Shutterstock

The programme has three focus areas: high intensity resistance, which involves lifting adequate but suitable amounts of weight; impact, which involves loading the bone in different ways, from stomping your feet to jumping, and; preventing falls by improving balance.

Gould notes that you do not need to visit her clinic to tap Onero’s benefits; it is available online, at onero.online, to do in the privacy of your own home for about A$5 (US$3.35) a week.

Gould is passionate about bone health and getting the message out about the benefits of exercise.

She is collecting data from her clients – using the DXA scan as a baseline measurement and then testing again after a year on the Onero programme, as well as doing functional tests, testing for balance, muscle strength and posture.

She plans to present her findings at the next regional osteoporosis conference.

“People are becoming more aware of how their bone density can affect their quality of life, and when there is a problem they are looking for a way to actively combat bone loss,” says Gould.

“This is not something that just affects women; men are impacted as well.”

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