Osteoporosis is one of the most underdiagnosed conditions in Australia.
More than one million Australians have osteoporosis. Most don’t find out until something breaks. The Endocrine & Wellbeing Clinic helps you understand your current and future fracture risk — and what to do about it.
Or call (02) 9870 3256
This is the assumption most people carry, and it is why osteoporosis is so often found late. Osteoporosis has no symptoms until someone fractures. Bone can thin quietly for years, and the first sign is frequently a fracture — a wrist from a minor fall, a hip from nothing dramatic at all. By then the condition is well advanced.
The significance of a hip fracture is not widely understood. Around one in five women aged 65 and over who fracture a hip die within the following year, and that risk climbs steeply with age. Of those who survive, fewer than half return to their previous level of independence. Osteoporosis is both detectable and treatable long before any of that happens, but bone density is often only tested after something has already broken.
Once you have had one fragility fracture, the risk of the next rises sharply. Preventing a first fracture is a much better outcome than recovering from one.
After a DEXA scan showing bone loss, the standard advice is usually to take calcium and vitamin D, walk more, try Pilates, and be careful. This advice whilst not dangerous, is unlikley to result in significant improvement in bone density. Walking builds fitness, not bone. It is low-load exercise — the mechanical force reaching the skeleton is below the threshold that triggers a bone-building response. Standard Pilates is the same: useful for balance and flexibility, but not a stimulus for bone density.
Furthermore, whilst calcium and Vitamin D are important for bone health, taking supplements alone is unlikley to increase bone density, especially if no pre-existing deficiency.
What does build bone is progressive resistance and impact training, prescribed and supervised by an Exercise Physiologist working in bone health. Sometimes combined with medication, this is what shows up as measurable change on a repeat DEXA scan.
Denosumab, sold as Prolia, is a six-monthly injection that builds bone density and works well for decreasing fractures. What is important to know about Prolia, is that it only works while the injections continue. If even a single dose is missed, bone density returns to baseline within twelve months, and years of gains can be lost. This rebound is specific to denosumab — bisphosphonates stay bound to bone long after stopping, so they do not reverse the same way. If you have missed a dose, or are about to, call the clinic on (02) 9870 3256 for a specialist review rather than waiting until your next appointment.
If you are on Prolia, do not stop it on your own — any change needs to be planned and other medications prescribed to prevent rapid bone density decline. What is worth adding alongside Prolia is targeted exercise — resistance and impact training prescribed by an Exercise Physiologist supports bone density alongside the medication rather than replacing it.
Prolia is commonly prescribed in General Practice but is important patients are aware of the limitations in that it is generally committing to lifelong therapy which may increase rare risks such as osteonecrosis of the jaw and atypical femoral fractures.
Furthermore, if a fracture does occur on Prolia, even if the patient is eligible on the PBS for anaboolic treatments, they may not be able to used as the risk of ceasing the Prolia would outweigh the benefits.
If you have just been diagnosed with osteoporosis or are unsure which is the right osteoporosis treatment for you, come and see us for a discussion on long term planning for your bone health with potential sequential therapies rather than a one size fits all approach. If you started Prolia in the last two and a half years — that is while the choice is still open to consider safely changing treatments. After that, staying on Prolia is usually the right option.
An important part of managing osteoporosis is screening for secondary causes of low bone density — conditions such as malabsorption, calcium and parathyroid disorders, and hormonal diseases can all drive bone loss, and unless they are identified and treated, medication for the bone alone will not resolve the underlying problem.
A specialist also has the full range of treatment options. Some of the most effective osteoporosis medications, including the bone-building agents, can only be prescribed by an endocrinologist. Which one suits you depends on your bone density, fracture history, age and other conditions, and on the sequence in which agents are used. Your medication is then coordinated with the exercise program run by our Exercise Physiologist on site, so the two work together.
You leave with a plan built around your situation, in writing, and a letter goes to your GP for complete care
What you get is a plan built around your situation rather than a general one, and you leave with it in writing. A letter goes to your GP so your care stays joined up.
Our goal is for you to understand what is driving your bone loss, which medication suits your situation now and what may be appropriate in the future.
You will have have a written plan to take home and a letter going to your GP to keep them updated on your care.
We want you to feel confident your medication treatments is appropriate, you’re doing the right strength exercises and your risk of falls and fractures is decreasaing.
When it comes to osteoporosis, you should have a plan for for the next ten years, not just the next six months and this is our goal for you.
Our endocrinologists consult on all forms of osteoporosis and calcium disorders, including postmenopausal bone loss, osteopenia, glucocorticoid-induced bone loss, calcium disorders, parathyroid conditions, recurrent or unexplained fractures, and pregnancy and lactation-related bone loss.
Dr Isobelle Smith (FRACP)
Endocrinologist. MBBS, FRACP in Endocrinology, with sub-speciality training in bone and calcium disorders at St Vincent’s Hospital and the Garvan Institute.
Dr Naomi Even-Zohar (FRACP)
Endocrinologist. MBBS, FRACP in Endocrinology. Trained at St Vincent’s Hospital and the Garvan Institute.
Dr Thaw Dar Htet (FRACP)
Endocrinologist. MBBS, FRACP in Endocrinology. Trained at St Vincent’s Hospital and the Garvan Institute.
All three endocrinologists are Fellows of the Royal Australasian College of Physicians (FRACP) and accept referrals for osteoporosis and calcium disorders.
After the Medicare rebate, specialist consult fees typically range from $180 to $265, depending on the length and complexity of your appointment. Our reception team can give you an exact quote when you book.
If you don’t have these yet, your GP can help you gather them.
Call (02) 9870 3256
GP referrals by fax to (02) 7241 7040, or via HealthPathways Sydney
In-person appointments at our Balmain clinic. Telehealth specialist consults available for patients anywhere in Australia.
The Endocrine & Wellbeing Clinic
Shop 2R, 100 Elliott Street, Balmain NSW 2041
References
Lo JC et al. Trends in mortality following hip fracture in older women. Am J Manag Care (cohort of 13,550 women aged 65 and over; one-year mortality 22.8%, rising with age).
Tran T et al. Hip fracture incidence and post-fracture mortality in Victoria, Australia: a state-wide cohort study. Arch Osteoporos, 2023.
Bone HG et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol, 2017.
Watts NB et al. Invasive oral procedures and events in postmenopausal women with osteoporosis treated with denosumab for up to 10 years. J Clin Endocrinol Metab, 2019.
This page is general information, not individual medical advice. Book a consult for assessment specific to your situation.
All future appointments will be at 100 Elliott Street Balmain 2041
