The Silent Disease That Affects 1 in 4 Australian Women Over 50
Osteoporosis is a condition in which bones become weak, fragile, and prone to fracture. It is called the “silent disease” because most people have no symptoms until they break a bone — often from a minor fall or even simply bending or lifting. By the time a fracture happens, significant bone loss has usually already occurred.
In Australia, osteoporosis affects roughly 1 in 4 women and 1 in 5 men over the age of 50. Each year, around 173,000 Australians experience an osteoporotic fracture — a fracture that occurs from a fall from standing height or less. These fractures cause pain, disability, and in some cases — particularly hip fractures in older adults — they can be life-changing or life-shortening.
The good news: osteoporosis is preventable, treatable, and the screening test is widely available. Most people with osteoporosis can dramatically reduce their fracture risk with the right combination of lifestyle, nutrition, and medication.
How Bones Lose Strength
Bones are living tissue that constantly remodel — old bone is broken down and replaced with new bone throughout life. Up to about age 30, bone formation outpaces bone breakdown, so bones grow stronger and denser. After age 30, the balance shifts: we slowly lose more bone than we make.
For women, bone loss accelerates dramatically at menopause due to the drop in oestrogen, which normally protects bone. Within 5–10 years of menopause, women can lose up to 20% of their bone density. Men lose bone more gradually but the cumulative loss over decades still puts many at risk.
Risk Factors for Osteoporosis
Non-modifiable Risk Factors
- Female sex
- Age over 50
- Postmenopausal status (especially early menopause)
- Family history of osteoporosis or hip fracture
- Caucasian or Asian ethnicity
- Small or thin build
- Previous fragility fracture
Modifiable Risk Factors
- Low calcium intake
- Vitamin D deficiency
- Sedentary lifestyle, particularly lack of weight-bearing exercise
- Smoking
- Excessive alcohol (more than 2 standard drinks per day)
- Low body weight (BMI under 19)
- Excessive caffeine
Medical Conditions That Increase Risk
- Long-term corticosteroid use (more than 3 months of oral prednisolone)
- Rheumatoid arthritis
- Coeliac disease and other malabsorption disorders
- Hyperthyroidism
- Hyperparathyroidism
- Type 1 diabetes
- Chronic kidney or liver disease
- Eating disorders
- Early menopause (before 45) or surgical menopause
- Hypogonadism in men (low testosterone)
- Long-term use of certain medications (proton pump inhibitors, some anti-seizure drugs, aromatase inhibitors)
When to See a GP About Bone Health
You should discuss osteoporosis with your GP if any of the following apply:
- You are a woman over 65, or a man over 70 (routine screening recommended)
- You are a postmenopausal woman with one or more risk factors
- You have had a fracture from minor trauma after age 50
- You have lost height (more than 3 cm over time, or 1 cm in a year)
- You have developed a stooped posture or rounded upper back
- You take long-term oral steroids (3 months or more)
- You have early menopause or premature ovarian insufficiency
- You have a family history of osteoporosis or hip fracture
- You have a chronic condition known to affect bone density
How Osteoporosis Is Diagnosed
The standard test for osteoporosis is a DEXA scan (dual-energy X-ray absorptiometry). It is quick (about 15 minutes), painless, and uses very low-dose X-rays to measure bone mineral density at the hip and spine.
Results are reported as a T-score:
- T-score above -1.0 — normal bone density
- T-score between -1.0 and -2.5 — osteopenia (low bone density, increased fracture risk)
- T-score of -2.5 or below — osteoporosis
Your GP will also assess your absolute fracture risk using a tool such as FRAX or Garvan, which combines bone density with other risk factors to estimate your 10-year risk of major fractures.
Medicare Coverage for DEXA Scans
Medicare bulk-bills DEXA scans (item 12320) for several groups, including:
- People over 70 (routine screening)
- Anyone who has had a fragility fracture
- People on long-term corticosteroids
- People with conditions associated with bone loss
Your GP will determine your eligibility and provide a referral.
Prevention and Treatment
Lifestyle Foundations (Everyone)
- Calcium — adults need 1000–1300 mg/day. Best sources: dairy products, fortified plant milks, sardines and salmon (with bones), tofu, leafy greens, almonds. Most Australians do not meet daily requirements through diet alone
- Vitamin D — essential for calcium absorption. Aim for 600–800 IU/day. Sunlight exposure is the main source; supplements are recommended for many older Australians, particularly in winter or for those who cover up or stay indoors
- Weight-bearing exercise — walking, jogging, dancing, hiking, tennis. At least 30 minutes most days
- Resistance training — 2–3 sessions per week. Builds muscle and stresses bones in a way that triggers bone formation
- Balance exercises — tai chi, yoga, or specific balance training to reduce fall risk
- Quit smoking
- Limit alcohol to no more than 2 standard drinks per day
- Maintain a healthy body weight
Medications for Osteoporosis
If you have osteoporosis (or high fracture risk based on FRAX/Garvan), your GP will discuss medication options:
- Bisphosphonates (alendronate, risedronate, zoledronic acid) — first-line treatment. Available as weekly tablets or annual IV infusion. PBS-subsidised for eligible patients
- Denosumab (Prolia) — 6-monthly injection. Highly effective. Important: must not be discontinued without alternative therapy as bone loss can rebound
- Hormone therapy (HRT) — for postmenopausal women, particularly if also managing menopausal symptoms
- Teriparatide — for severe osteoporosis or those who have failed other treatments. Builds new bone
- Romosozumab — newer option for women at very high fracture risk
- Raloxifene — selective oestrogen receptor modulator (SERM)
Treatment is typically continued for 3–10 years depending on the medication and individual risk profile, with regular review of effectiveness and side effects.
Falls Prevention
Even with treatment, preventing falls is critical. Most fractures in older adults happen because of falls — and many falls are preventable. Practical steps include:
- Annual eye tests and updated glasses
- Review of medications that cause dizziness or sedation
- Blood pressure check (orthostatic hypotension is a major fall risk)
- Home safety: remove loose rugs, install grab rails, improve lighting
- Wear supportive, non-slip footwear
- Treat foot problems and consider podiatry assessment
- Regular balance and strength exercises
- Vitamin D supplementation if deficient
Frequently Asked Questions
Can men get osteoporosis?
Yes. About 1 in 5 Australian men over 50 will have an osteoporotic fracture. Men are often under-diagnosed and under-treated. Risk factors include low testosterone, long-term steroid use, smoking, excessive alcohol, and chronic illness. Men over 70 should ask their GP about bone health.
How much calcium should I get from supplements vs food?
Diet first. Aim for the bulk of your calcium from food (dairy, fortified plant milks, sardines, leafy greens, tofu). Supplements should only fill the gap. Excessive calcium supplementation has been linked to other health risks and is not necessarily better for bone health.
I take vitamin D. How do I know if I’m getting enough?
A simple blood test measures your vitamin D level. Your GP can check it as part of a routine check or if you have risk factors. Optimal levels are usually 50–75 nmol/L or higher. Older adults, those who cover up for cultural or medical reasons, and those with darker skin are at higher risk of deficiency.
Are bisphosphonates safe?
Yes, for the majority of patients. Side effects are uncommon but include reflux (with oral forms), muscle pain, and rarely jaw or femur problems. The benefits far outweigh the risks for people with osteoporosis. Your GP will weigh up your specific risk profile.
If I’m on medication, do I still need calcium and vitamin D?
Yes. Osteoporosis medications work best when combined with adequate calcium and vitamin D. Your GP will monitor your levels and recommend supplements if needed.
Can I do anything about osteoporosis if I’m under 40?
Absolutely — and this is the best time to act. The bone you build before age 30 sets the foundation for your bone health for the rest of your life. Weight-bearing and resistance exercise, adequate calcium and vitamin D, no smoking, and moderate alcohol all help build peak bone mass. Anorexia, eating disorders, and excessive exercise without adequate nutrition can cause early bone loss.
Talk to Your GP About Bone Health
If you are over 50 and have not had a bone density scan, or have any risk factors for osteoporosis, book an appointment with your local Family Doctor GP. A simple discussion can determine whether testing is appropriate, and if you do have low bone density, treatment is straightforward and effective.