Osteoporosis is defined by the World Health Organisation (WHO) as a disease characterized by low bone density and a deterioration of the bone tissue leading to bone fragility and as a consequence, increased risk of fracture. It is typically known as a “silent” disease because it is often not diagnosed until after a broken bone (fracture) has occurred following a minor incident.

• In Hong Kong, 50% of postmenopausal women have osteoporosis.

• Osteoporosis affects 45% of women who are 50 years of age or older.

• This is not a disease which only affects women – a study done by the Chinese University of Hong Kong in 2001 showed that over 22% of men in Hong Kong aged 65 and over suffered from osteoporosis.

Osteopenia is a lower than normal bone density. It is considered a “warning” zone for action to halt the loss or even to improve bone density.

Healthy bones are an indication of and affect your general health. The personal cost of osteoporosis in terms of risk of injury, pain, quality of life and rehabilitation time as well as the financial cost to the community as a whole is significant.

Research by the Osteoporosis Society of Hong Kong predicts that the number of hip fractures caused by osteoporosis alone will triple over the next 30 years. As Hong Kong has a rapidly aging population with a relatively high life expectancy, they urge people to be tested and to start appropriate “healthy bones” interventions early. DON’T WAIT!

Bone growth is rapid during childhood and adolescence and we reach a peak bone mass around the age of 30.

After that there is a steady rate of age-related loss of bone for both men and women. For women, there is a significant increase in the rate of bone loss following menopause for a period of 5-7 years after which the rate levels off. By the time women reach 80 years of age they have lost up to 40% of their peak bone mass. For men the lifetime loss of peak bone mass is around 25% and is a relatively steady decline, however, the rate of loss accelerates after 70 years of age.

The key factor is to build bone mass in childhood prior to reaching skeletal maturity (25 years of age). We should aim to have the best peak bone mass possible at 30 years of age in order to offset the natural decline in bone density over our lifetime.

The most common fracture sites caused by Osteoporosis are the hip, spine and the wrist. “Fragility” fractures occur from seemingly minor incidents such as:

• Falling from a standing height
• Coughing
• Sneezing 

There are many risk factors which can increase your chances of suffering from osteoporosis – some we can’t change – for example genetics – if either of your parents have been diagnosed with osteoporosis, gender, race or previous use of steroids. Then there are some risks we can change – inactivity, smoking, drinking more than 2 units of alcohol daily and a diet low in calcium.

To determine your risk of breaking a bone, please visit the Healthy Bones Australia website and fill out this questionnaire

To diagnose osteoporosis and assess your potential risk of fracture, you can have a scan which measures your Bone Mineral Density (BMD). It is most commonly performed using a dual-energy x-ray absorptiometry scan (DXA). It is a quick and painless test and there is a very low level of radiation.

There are several pathways to preserve or even improve your bone density. Some or all may be relevant to you.

If you are have been diagnosed with osteoporosis then your Doctor may suggest that you start on a course of medication. Your Doctor is the best person to discuss which medication is best for you and to help you understand the pros and cons. Broadly speaking the medication either stimulates bone production (builds up bone) or as in the majority of medications, suppresses bone resorption (decreases the loss of bone).

A healthy balanced diet including Calcium, Vitamin D and K as well as protein is recommended.

As bone is mostly made up of Calcium Phosphate, increase your intake of calcium rich foods such as milk, eggs and cheese. Remember that caffeine increases calcium loss so when combined with a diet low in calcium this has the potential to adversely affect your bone health.

Vitamin D helps the bone absorb calcium. A minimum of 10 minutes sun exposure on exposed skin in summer and 20 minutes in winter is recommended. Vitamin K is also important as it helps to make sure that calcium is deposited into the bones rather than into the soft tissue or organs.

Protein is essential for optimal bone mass gain during childhood and adolescence and also for preserving bone and muscle mass with aging.

A nutritionist/dietician is the best person to assist you in finding bone healthy foods that you enjoy eating. They may also advise you to take Calcium, Vitamin D or K supplements and what dosage is appropriate to improve your bone health.

Your diet may be balanced but if your ability to absorb the nutrients is suboptimal then you are at risk. Speak with your Doctor about your digestive health.

Look back at the risk factors which you can control: diet, smoking, alcohol, lack of activity and low BMI. Ask for help to improve these risk factors.

Exercise can help improve bone health but not all exercise is created equal.

The Bone Health Asia clinic at Prohealth Sports And Spinal is licensed to safely deliver the Onero^TM Programme, a research-based exercise programme which prescribes high intensity loads and impact training.

Onero means to “load” or “burden” in Latin and this is what is required to stimulate bone so as to maintain or improve our bone density.

Bone loading exercises need to be done in a specific way and to be done safely, you need close supervision from health providers who have specific training.

The most important aspects of Onero ^TM are the following:

• How you lift: The way you move ensures that the load is transferred to the areas which need it the most.
• How much you lift: The weight has to be of a sufficient amount so as to stimulate the bone and strengthen muscles.
• Progression of load: The speed of progression is important to ensure safety.

The initial session involves a detailed assessment of your general health as well as understanding your specific bone health risk factors. We also conduct tests for balance, strength and flexibility. These measurements along with your bone scan results will dictate the starting point and speed of your progression on the programme.

In each 40 minute treatment session you will perform different types of “lifts” with varying loads, impact training, balance work and other specific exercises that are prescribed for you.

Bone growth is slow. It takes at least 6 months for new bone to be laid down and the imaging results lag even further behind. Research results have shown that Onero ^TM helps both men and women with low to very low bone mineral density. The results have shown significant increases in bone mineral density, muscle strength, and balance as well as a decreased number of falls after a period of 8 months of training.

The original study which Onero ^TM is based upon, took a group of individuals with low to very low bone density and put them through training for 30 minutes 2 times a week over an 8 month period. Bone production and resorption never stops so you must continue to load your bones. After our peak bone mass is achieved, our bone density tends to decline with age. So, the old saying is true – if you don’t use it – you will lose it!

To find out more, book an appointment with our Onero ^TM Certified Physiotherapists.

Through this programme, our physiotherapists provide one-on-one sessions to build better bone health. Our clinic is the first one in Asia that is licensed to safely deliver the Onero™ programme.

1. Watson SL, Weeks BK, Weis L, Horan SA, and Beck BR (2015) Heavy resistance training is safe and improves bone, function and stature in postmenopausal woman with low to very low bone mass: Novel early findings from the LIFTMOR trial. Osteoporosis International, 2015, DOI 10.1007/s00198-015-3263-2.
2. Beck BR, Weeks BK, Weis LJ, Harding A, Horan S, Watson SL: Restoring Standing Height: Yet Another Benefit of Exercise for the Osteoporosis. ASBMR 2015 Annual Meeting, Seattle, Washington, USA, Oct 9-12, 2015.
3. Resource: The Chinese University of Hong Kong Jockey Club Centre for Osteoporosis Care and Control.
4. Resource: International Osteoporosis Foundation (IOF).
5. Resource: Healthy Bones Australia.