Donna Todd's osteoporosis diagnosis has been "life-changing". Photo / Bevan Conley
A life-changing diagnosis of osteoporosis came as a huge shock for Donna Todd.
The Whanganui woman’s unexpected news came after she signed up for a three-month Massey University School of Food and Nutrition study on bone health, looking at the parts exercise, diet and gut microflora play in preventing osteoporosis.
Keen to do something to benefit others, Todd registered her interest after seeing a call for volunteers in the Whanganui Chronicle, and was accepted.
”You had to do two things: walk every day for 12 weeks - at least 7000 steps – and the second variable was taking a supplement.
“It was looking at the impact of weight-bearing exercise and gut health by taking a specific pre- and pro-biotic.”
Before the study started, participants’ bone health and some other factors were checked. The density (strength) of their bones was assessed by a Dexa scan, which Todd had in June.
“About a month later, Massey contacted me personally because my bone scan showed up that I already had osteoporosis, and they said I needed to see my GP,” Todd said.
“I was shocked, incredibly shocked. I felt I was in really good health - but also because I had always kept so fit. For more than 30 years, I either walked, rode my bike or did some indoor rowing for most of those days. I did more than a million steps during the Massey study. I had really looked after my health.
“I’ve never had a fracture. That’s how most people find out they’ve got osteoporosis.”
Todd sent all the information from Massey to her GP and he phoned her the same day to discuss the results.
“Aramoho Health have a ‘bones nurse’,” Todd said.
“She got in contact with me, and I made an appointment to speak with her to get the lie of the land. We talked about treatment, change of diet, etc.”
Todd also had a consultation with Dr Deborah Gardiner, an anaesthetist who has set up the Whanganui Menopause Health Centre to provide menopause/mid-life health care for women. Although Gardiner is not a specialist in osteoporosis, she has professional contacts around the world.
“Deborah sought out answers to my questions - and I had many questions which I’d sent to her before my appointment,” Todd said.
“She was very helpful and supportive. I felt she understood. It’s a life-changing diagnosis.”
Todd then had to inform herself about what she needed to do differently.
“Aramoho Health helped me with diet – it’s a major change, with having to eat so much calcium every day.
“You have to be very careful about how, mechanically, you are using your body. Posture is important. I’m so careful now on how I sit. Every minute of the day you have to think about how you use your body, how to pick things up – even if it’s just a piece of paper on the floor [or] how to use the weedeater.
“You have to learn about what you can do to improve the situation.”
Exercise is key, but it needs to be the right type of exercise.
“You have to review your regime and it has to be adjusted for the new situation with your bones. It’s about weight-bearing exercise. Walking is good, but you also need to build strength.
“The best thing about my diagnosis was, I joined the gym. I got a programme that would strengthen me. It helps physically and mentally. You feel less vulnerable if you do the proper exercise.
“I’ve had to give up some stuff. I’m aware all the time about having accidents - for example, being careful on a pedestrian crossing when it’s raining. You have to work on balance because you’re trying to prevent falls.”
Nymbyl, which is funded by ACC, is a free app Todd uses to help improve her balance. ACC also funds the Live Stronger For Longer programme for community strength and balance classes around the country.
“For me, it’s about keeping physically fit, doing the right exercise,” Todd said.
“Living a normal life but being aware of using my body correctly, and sticking with the changed diet forever.
“You don’t want it to rule your life, so you need to get that focus and then go on with your life.”
Osteoporosis literally means “porous bone”. The condition causes bones to become weak and fragile so they can break easily, even after a minor fall, bump, sneeze or sudden movement. The disease has no obvious symptoms, so many people don’t know they have osteoporosis until they have a fracture. Both women and men suffer from osteoporosis – two-thirds of hip fractures worldwide occur in women and one-third in men. Generally, osteoporosis and the fractures it causes occur in people aged 50 years and over. However, some younger people develop osteoporosis due to specific medical conditions or as a side effect of taking certain medicines. The most common fractures caused by osteoporosis are hip, spine, wrist and shoulder (humerus) fractures.
New Zealand is in the international spotlight for its commitment to improving bone health.
Osteoporosis New Zealand (ONZ) executive director Christine Gill says the country is “leading the world in a unique space at the moment” as it works toward a nationally consistent approach to quality of care and fracture prevention and aims for a world-class standard.
“An osteoporosis diagnosis is often a shock for most people,” Gill said.
“Awareness is low. The first thing people have is a break. It makes people feel more frail. It’s one of the conditions of ageing.
“Our aim is for everyone who has a fracture to make that their last one. 80 per cent of refractures occur within five years, and generally in 12 months.”
Falls and fragility fractures sustained by people over 50 were a key contributor to increasing demand on the health system, Gill said.
A fragility fracture is defined as a fracture resulting from low trauma, such as a fall from standing height. ACC says every year, around 30,000 fragility fractures occur in New Zealand, predominantly among people aged 50 years or older.
In 2020, ACC estimated that claims for falls and fracture-related injuries for over-65s cost $195 million, an increase of 47 per cent since 2013. It estimated the costs of doing nothing would reach $400m by 2035, placing huge pressure on the health system.
In December 2020, ACC partnered with ONZ on a programme to support best practice fragility fracture care and prevention, including implementation of world-class Fracture Liaison Services (FLS) throughout the country. The aim is for the services to achieve International Osteoporosis Foundation ‘Capture the Fracture’ accreditation by mid-2024.
“We surveyed the whole country on fragility fracture care, followed by workshops with all the DHBs, and did a plan with each of them,” Gill said.
“Whanganui has applied and got a silver star that measures all patient level outcomes. We’re trying to get a nationally consistent approach across the country.”
New clinical standards for fragility fracture care were published in September, 2021, and a Fragility Fracture Registry was launched in March, 2022. 19 of New Zealand’s 21 FLS’ are now using the registry.
“It enables teams to benchmark the care they are providing in real-time,” Gill said.
In a multi-disciplinary approach, a toolbox of resources is available to help streamline services and an experienced clinical nurse specialist is visiting all the FLS’ around the country to help them improve. Education is provided every month for fracture liaison co-ordinators and clinical leads, and a programme will begin on December 1 for service administrators.
The next stage of the strategy will be to target high-risk people who haven’t had a fracture, Gill said. Later stages will focus on adults with healthy bones at various ages, and then children with healthy bones.
‘Ultimately, we want to be teaching bone health in the curriculum for Year 9-10 science,” she said.
New Zealand was “very lucky” in having such a level of investment in osteoporosis.
“No-one else has been able to get government support. ACC is a fantastic partner to provide funding in these areas,” Gill said.
Whether you’re two or 92, it’s never too early or too late to think about your bone health, Gill says.
You replace almost your entire skeleton every 8-10 years. This means building healthy bones early in life can reduce the serious risks associated with osteoporosis in later years.
Stop smoking, limit alcohol intake because it impedes skeletal turnover, stick to a balanced diet, and get vitamin D through a bit of sun exposure (or a supplement if you don’t get outside).
“We don’t recommend calcium supplements in New Zealand,” Gill said. “We recommend dietary intake for calcium, either through dairy or calcium-fortified products if you don’t consume dairy.”
Body mass index (BMI) is important – “having weight on your bones is actually quite beneficial”.
What people do up to the age of 30, when we reach peak bone mass, has a massive impact on later life – food exclusion diets, inactivity or too much exercise can all have a negative impact on bone health. The good news is that most risk factors for younger people can be rectified, which Gill says is important as “those kids are going to be living to 100″.
Age Concern Whanganui is one of the local providers of the Live Stronger for Longer programme, running strength and balance classes for the community with the aim of preventing falls.
Co-ordinator Janet Lewis, who has 22 groups involved in Age Concern’s Steady As You Go programme throughout the region, runs the classes with the help of volunteer peer leaders.
“The groups work really well in hopefully preventing falls,” Lewis said.
The exercises were developed using aspects of the Otago Exercise Programme, the Train the Trainer programme and tai chi principles, and are done by hundreds of groups around New Zealand.
“We do the exercises to a CD,” Lewis said.
“They’re low-impact and you do what you can. We start with a warm-up, then standing exercises which involve balance, then sitting down exercises. People can use ankle weights if they want to. We do walking exercises, and then a warm-down and exercises for the eyes and inner ear. You just feel good afterwards, and there’s always time for a natter.”
The groups also provided a sense of community and camaraderie, she said. Some were specialised - for example, for people with Parkinson’s disease.
Although the groups sometimes had younger members with particular medical conditions, they were generally for people 65-plus, Lewis said. The oldest person currently attending a Whanganui group is 96.
The Bone Health New Zealand website www.bones.org.nz contains fact sheets and FAQs, as well as the fracture risk calculator Know your Bones.
Live Stronger for Longer (www.livestronger.org.nz) includes details of strength and balance community classes as well as exercises to do at home.
Age Concern Whanganui’s Steady As You Go classes - for more information or to enrol, contact Janet Lewis; phone (06) 345 1799.
Comment: Planting a range of trees will give fruit at different times of the year.