Bone health in Australia: the costs, the risks and the role of health professionals

  • 2 out of 3 Australian adults over the age of 50 have osteoporosis osteopenia or poor bone health

Dairy Australia and Professor Belinda Beck, head of the Griffith University Bone Densitometry Research Laboratory and Co-Founder of The Bone Clinic, have collaborated to produce the white paper, Lifestyle Management of Bone Health, designed to help keep health professionals up to date with the latest nutrition and bone health recommendations.

In Australia, almost two thirds of adults over the age of 50 have osteoporosis or osteopenia (low bone mass that is not as severe as osteoporosis), which equates to almost five million individuals, a number that is predicted to rise to over six million by 2022. A diagnosis of osteoporosis increases the risk of fracture two- to three-fold.

By 2022, the annual financial cost of osteoporosis and osteopenia to Australians is expected to reach $3.84 billion. It has been estimated that merely eliminating calcium and vitamin D deficiencies in Australia would reduce the direct costs of osteoporosis by over $400 million a year.

There is a great personal cost of osteoporotic fractures too. Chronic pain, deformity, loss of height, disability, loss of independence and premature death are tangible consequences for millions of Australians.

Some risk factors for osteoporotic fracture include: increasing age, female sex, family history of low bone mass, physical inactivity, insufficient serum vitamin D, low intake of calcium, low body weight, smoking, excessive alcohol consumption, prolonged corticosteroid use, and reduced circulating oestrogen. Unfortunately, the occurrence of a fracture greatly increases the risk of subsequent fractures.

Genes also play a dominant role in determining the size and strength of our bones; however, lifestyle practices, including diet and exercise, are highly influential. Indeed, for many, it is likely that osteoporosis can be prevented by making appropriate behavioural choices across the full course of the lifespan.

With so many risk factors and elements to consider, how do time poor health professionals provide the right recommendations to ensure they are helping patients maintain strong bone health and protect their patients from bone disease? There are a number of simple recommendations to keep patients on top of their bone health; these include weight bearing exercise, calcium rich foods and safe vitamin D intake.

Your lifestyle can have a high impact on your bone health. Exercise is a vital stimulus for bone, however, only certain forms of physical activity are notably effective. Weight bearing exercise that includes rapid impact and strenuous muscle contractions is key. Exercises such as swimming, cycling and other seated exercises are beneficial for improving muscle strength rather than bone.

It is recommended that at least three servings from the dairy food group, including milk, cheese, yoghurt and/or alternatives, are consumed to achieve 1,000-1,300 mg of calcium per day.

However, the minimum recommended varies according to your age, sex and life stage; for example, women over 51 years need four serves a day, as their calcium requirements are high.

Key findings of the Australian Health Survey: Consumption of Food Groups indicated that Australians over the age of two years consumed an average of only one and a half serves of dairy per day, with only 10 per cent meeting the recommended number of serves (7.2 per cent of females and 12 per cent of males). There is also evidence to suggest higher fruit and vegetable consumption has beneficial effects on bone density in elderly men and women.

The most effective source of Vitamin D is exposure to sunshine, as vitamin D is produced in the skin in response to UVB light. The relative difficulty of obtaining adequate vitamin D from the diet (from, for example, oily fish, beef liver, butter, eggs or mushrooms) and the equivocation in respect to optimum supplementation suggests appropriately conservative sun exposure is the most effective strategy to obtain enough levels of the vitamin.

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