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Do You Have Osteoporosis or Osteopenia?

Understanding Bone Health!

Posted Monday, Jun 16, 2025 by Dr Cloe Crowhurst (Osteopath). Filed under Conditions

Key Takeaways

Osteoporosis and osteopenia are "silent diseases" that typically show no symptoms until a fracture occurs, making early detection crucial for prevention
66% of Australians aged 50+ have poor bone health, with over 144,000 osteoporotic fractures occurring annually across the country
DEXA scans are the gold standard for bone density testing, with Medicare rebates available for those 70+ and specific at-risk groups
Prevention is the best management strategy - high-impact, weight-bearing exercises and resistance training are key to maintaining bone strength
Genetics play a significant role - having a first-degree relative with osteoporosis can increase your fracture risk by up to 400%
Early intervention works - with proper diagnosis, medication, lifestyle changes, and exercise, individuals can significantly reduce fracture risk and maintain quality of life

How Common Are These Conditions?

Diagnosis

What's the Difference Between Osteoporosis and Osteopenia?

Symptomology of an Osteoporotic Fracture

Anatomy and Physiology

Risk Factors: Genetics and Lifestyle

Prognosis: Can It Be Managed?

Management Options

Conservative Management

Prevention: The Best Management

References

FAQ

Osteoporosis and osteopenia are often termed “silent diseases”.

This is because they typically cause no pain until a fracture occurs. However, vertebral fractures which are a common complication can lead to significant back pain, height loss, and spinal deformities, severely affecting mobility and quality of life.

How Common Are These Conditions?

Prevalence in Australia: Approximately 66% of Australians aged 50 and over have poor bone health, with 77% having osteopenia and 23% osteoporosis.

Fracture Statistics: Over 144,000 osteoporotic fractures occur annually in Australia, leading to significant long-term disability.

66% of people over 50 have poor bone health

Diagnosis

The gold standard test for measuring bone density is known as a DEXA scan. The DEXA scan produces a T score and a Z score.

T score - compares your result to healthy young adults in the age group of 20-35.
Z score - compares your result to people of the same gender and age as you.

Does Medicare cover DEXA scans?

Medicare provides rebates for DEXA scans under specific criteria. Patients aged 70 and over are eligible for an initial screening study. Depending on the severity of bone density loss, follow up scans may be covered once every 2-5 years, or more often if medically necessary when referred by a GP.

What is the difference between Osteoporosis and Osteopenia?

The only difference between a diagnosis of Osteoporosis and Osteopenia is the degree of bone density loss.

Osteoporosis is defined as a T score of less than -2.5
Osteopenia is defined as a T score between -1.5 and -2.4

Stages of Osteoporosis

Symptomology of an Osteoporotic fracture

Pain: Often absent until a fracture occurs.
Fractures: Common sites include the spine, hip, and wrist.
Other Symptoms: Loss of height, stooped posture, and limited mobility.

Anatomy and Physiology:

Understanding Bone Structure and how Osteoporosis happens.

Healthy bone has a thick, dense outer layer of cortical bone, with and inner spongy layer of interconnected plates known as trabecular bone.

Bone is a dynamic tissue undergoing continuous remodelling. Resorption (breakdown of bony tissue) by osteoclasts and formation of new bone by osteoblasts is constantly underway, allowing bones to repair and adapt to increases and decreases in load.

However, in osteoporosis, this balance of resorption and formation is disrupted, leading to thinning of the cortical layer and disconnection within the trabecular bone, increasing fracture risk.

Basic bone health

Risk Factors: Genetics and Lifestyle

In postmenopausal women, decreased estrogen levels accelerate bone loss. In men, lower testosterone levels and other factors contribute to bone density reduction. Genetic factors also play a significant role, with studies indicating that 46% to 92% of bone mineral density loss may be genetically linked.

Having a first-degree relative with osteoporosis can raise your osteoporotic fracture risk by up to 400%.

Lifestyle factors also play a big role in the risk of developing osteoporosis. These include:

Poor diet (low in calcium and vitamin D),
physical inactivity,
smoking, and
excessive alcohol consumption.

Prognosis: Can It Be Managed?

While osteoporosis is a chronic condition, it is manageable. With early diagnosis and appropriate treatment, including medications, calcium and vitamin D supplementation, and lifestyle modifications, individuals can reduce fracture risk and maintain quality of life.

Management Options

Conservative Management

Conservative management is the first line of therapy and consists of non-invasive changes such as;

Physical therapy

Leisure activities like walking, swimming and cycling do not improve bone density.
Regular and diverse high intensity resistance training is required to modify bone density. However, this is not possible in patients with a high fracture risk.
Progressive balance training is important to reduce the risk of falls regardless of the patient’s fracture risk.

Falls prevention

Your GP will conduct a comprehensive falls risk assessment if there have been 2 or more falls in the past year or if there are significant balance difficulties.
A multidisciplinary fall prevention program can then be implemented based on this assessment. This may include nurses, physical therapists (such as chiropractors, osteopaths & remedial massage) and occupational therapists.
In low fracture risk patients fall reduction strategies may still be beneficial.

Lifestyle modifications

Modifying diet
Smoking cessation
Reduction of alcohol intake

Medical Treatment

Bisphosphonates, selective oestrogen receptor modulators (SERMs), and other medications can help increase bone density and reduce fracture risk.

Surgical Intervention

In cases of severe fractures, surgical procedures may be necessary to stabilise bones and relieve pain.

Prevention: The best management

For young, healthy individuals reading this blog, for perimenopausal women or for those with a family history of Osteoporosis this is for you! Now is the time to begin engaging with activities to prevent bone density loss and avoid a diagnosis of Osteoporosis.

Prevention of osteoporosis hinges on optimising bone remodelling through mechanical loading, particularly via ground reaction forces (GRFs) generated during weight-bearing and impact-loading activities.

Bone is a dynamic tissue that responds to mechanical stimulation through a process called mechanotransduction. Where there is strain or load on the bone, activity of osteoblasts (bone-forming cells) and osteoclasts (bone-resorbing cells) will adapt to maintain or enhance bone mass suitable for those increased pressures.

According to Rosengren et al. (2021), brief, targeted high-impact exercises that generate large GRFs are effective in improving bone mineral density (BMD) in postmenopausal women. This is supported by Turner (1998), who emphasised that the magnitude and rate of force application are key determinants of bone adaptation, and that bones respond more favourably to intermittent higher intensity loading than to continuous, low-intensity activity. Furthermore, a systematic review by Nikander et al. (2010) concluded that exercise interventions incorporating high loading are most effective for enhancing site-specific bone strength.

In other words, activities with high ground reaction force, such as:

Running
Dancing
Jumping

Or with high resistance, such as:

Free weights
Weight machines
Body weight exercise – calisthenics or MAT Pilates
Reformer Pilates

Are the key to preventing the development of osteopenia and osteoporosis.

Activities with high ground reaction force such as running

Understanding osteoporosis and osteopenia is crucial for early detection and prevention. Regular screening, especially for individuals over 50 or those with risk factors, can lead to timely interventions and better outcomes. If you are concerned about your bone density, consulting with your GP can be a great first step. However, for those wanting to be proactive in caring for their bone health, check in with your personal trainer or allied health professional to build a plan to keep your bones strong.

References

Healthy Bones Australia. (2024). Osteoporosis and fractures in Australia: A burden of disease analysis.
Nikander, R., Sievänen, H., Heinonen, A., Daly, R. M., Uusi-Rasi, K., & Kannus, P. (2010). Targeted exercise against osteoporosis: A systematic review and meta-analysis for optimising bone strength throughout life. BMC Medicine, 8, 47. https://doi.org/10.1186/1741-7015-8-47

Noncoding RNAs: the crucial role of programmed cell death in osteoporosis - Scientific Figure on ResearchGate. Available from: https://www.researchgate.net/figure/Bone-homeostasis-and-osteoporosis-In-normal-bones-bone-formation-by-osteoblasts-and_fig2_380823625 [accessed 22 May 2025]

Verywell Health. (2022). Is Osteoporosis Genetic?

Verywell Health. (2022). Osteoporosis: Prognosis, Complications, and Treatment.
Rosengren, B. E., Peterson, M. D., & Karlsson, M. K. (2021). High-impact exercise and bones—Time to up the game? Journal of Science and Medicine in Sport, 24(9), 826-831. https://doi.org/10.1016/j.jsams.2021.04.004

Turner, C. H. (1998). Three rules for bone adaptation to mechanical stimuli. Bone, 23(5), 399-407. https://pubmed.ncbi.nlm.nih.gov/9823445/

UpToDate. (2025). Overview of the management of low bone mass and osteoporosis in postmenopausal women.

Dr Cloe Crowhurst

This article was written by Dr Cloe Crowhurst, Osteopath at Brunswick Chiropractic, who is passionate about helping patients understand about osteoporosis and osteopenia and how we can prevent it.

READ ABOUT CLOE or BOOK NOW

Frequently Asked Questions (FAQ) About Osteoporosis and Osteopenia?

Q. Can osteoporosis be reversed or only managed?

A. While osteoporosis cannot be completely "reversed" to restore bones to their original strength, it can be effectively managed and progression can be slowed or stopped. With proper treatment including medication, exercise, and lifestyle changes, many people can increase their bone density and significantly reduce fracture risk. The key is early detection and consistent management - this is why prevention and early intervention are so crucial.

Q. What exercises are safe if I have osteoporosis or osteopenia?

A. Weight-bearing and resistance exercises are generally beneficial, but the intensity and type should be tailored to your condition severity. High-impact activities like jumping may be appropriate for osteopenia but not advanced osteoporosis. Safe options typically include walking, stair climbing, light weights, and resistance band exercises. Always consult with a qualified healthcare provider to develop a safe, personalised program.

Q. Are there any warning signs before a fracture occurs?

A. Unfortunately, osteoporosis is often called a "silent disease" because there are typically no symptoms until a fracture occurs. Some people may experience gradual height loss, changes in posture, or back pain from small spinal compression fractures, but many fractures happen without warning during routine activities. This is why regular screening and prevention are so important - waiting for symptoms often means the condition has already progressed significantly.

Q. How can Brunswick Chiropractic help with osteoporosis management?

A. Our multidisciplinary team can support your bone health through safe, appropriate exercise guidance, posture education, and fall prevention strategies. While we don't diagnose or medically treat osteoporosis, our chiropractors, osteopaths, remedial massage therapists and myotherapists can work alongside your GP and specialists to help maintain mobility, improve balance, and provide gentle manual therapy when appropriate. We can also help address musculoskeletal pain that might limit your ability to exercise safely, supporting your overall bone health management plan.

Blog articles filed under: Conditions

Do You Have Osteoporosis or Osteopenia?

Do You Have Osteoporosis or Osteopenia?

Understanding Bone Health!

Key Takeaways

Table of Contents

How Common Are These Conditions?

Diagnosis

Does Medicare cover DEXA scans?

What is the difference between Osteoporosis and Osteopenia?

Symptomology of an Osteoporotic fracture

Anatomy and Physiology:

Understanding Bone Structure and how Osteoporosis happens.

Risk Factors: Genetics and Lifestyle

Prognosis: Can It Be Managed?

Management Options

Conservative Management

Prevention: The best management

References

READ ABOUT CLOE or BOOK NOW

Frequently Asked Questions (FAQ) About Osteoporosis and Osteopenia?

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