It's about Osteoporosis, Exercise and You:
Exercise is a valuable tool that can be used for maintaining bone health and either preventing or slowing the progression of osteoporosis.
Here in Canberra, we specialise in prescribing exercise for those with Osteoporosis.
What is Osteoporosis? It is a condition resulting in weak and brittle bones due to the breakdown of tissue exceeding the level of new bone production.
It is a condition that is more likely to develop as you age and become less active, and more so common in women. When your bones are weaker, they are more likely to fracture in the unfortunate event of a trip or fall.
“Osteoporosis effect 1 in 4 women and men over the age of 75”
Solution and Osteopenia
But what is Osteopenia? This means that your bone mineral density is lower than it should be but not yet at the stage considered to be osteoporosis. If you are not already partaking in at least two resistance training sessions weekly, then now is the perfect time to start!
Not only will exercise help your bone health, but it is associated with several other benefits including weight management, improved cardiovascular health, better mental health and gives you an overall decreased risk of developing chronic conditions including, diabetes and heart disease.
Over 70 years of age? You are eligible to receive a bone mineral density scan to determine whether or not you have osteoporosis. Ask your GP at your next check up. Until then, use the most convenient and easy to access tool…. Exercise!!!
Book in for a 1 on 1 chat or Exercise Session today, or join one of our group classes!
The Best Resources for Osteoporosis and Exercise In Canberra
They fracture more easily than normal bone. Even a minor bump or fall can cause a serious fracture. Half of all women and one-third of men over 60 in Australia will have a fracture due to osteoporosis. Osteoporosis and fractures are major causes of injury, long-term disability and even death in older Australians.
WHAT IS OSTEOPOROSIS?
Osteoporosis is a disease in which the bones become fragile and brittle. They fracture more easily than normal bone. Even a minor bump or fall can cause a serious fracture. Half of all women and one-third of men over 60 in Australia will have a fracture due to osteoporosis.
Osteoporosis and fractures are major causes of injury, long-term disability and even death in older Australians. One fifth of people who suffer a hip fracture will die within six months. Of those who do not die, 50 per cent will be unable to walk without help or stay in their own homes. Some may even need full-time nursing care.
Osteoporosis is often called a silent disease, as there are usually no signs or symptoms until someone has a fracture. Any bone can be affected but the most common are bones in the hip, spine, wrist, ribs, pelvis and upper arm.
WHAT CAUSES OSTEOPOROSIS?
- The health of your bones depends on:
- your genes (60-80%)
- the level of hormones in your body. In women this hormone is oestrogen; in men it is the hormone testosterone.
- how physically active you are
- what you eat
These things affect how well bones form in early adulthood when your bones are at their strongest. After the 30s, it is important to maintain bone strength and prevent bone loss.
MENOPAUSE AND OSTEOPOROSIS
Menopause means the time around which a woman has her last period. Most Australian women reach menopause between the ages of 45-55, but it can happen earlier.
From about the age of 45 years, women may begin to lose bone at the rate of about 1-2% per year. This is because womens bodies usually make less oestrogen at this age. After menopause, oestrogen levels keep decreasing, and this speeds up bone loss to about 2-4% per year, especially in the first 5-10 years after menopause. This stage of bone loss caused by menopause may last up to 15-20 years. All women lose bone at menopause. The amount varies, but some can lose as much as 30% of their bone during those years. If you have an early menopause for some reason, you will begin to lose bone at an earlier age.
MEN AND OSTEOPOROSIS
The male hormone, testosterone, does not decrease suddenly like oestrogen does in women during menopause. Instead, testosterone gradually decreases from about 50 years of age in men. However, mens bone density tends to stay the same until they are much older. But after 75 years of age, both men and women lose more bone, especially in the hip. This is part of the ageing process.
RISK FACTORS FOR OSTEOPOROSIS
Risk factors for osteoporosis and fractures caused by osteoporosis are similar in women and men. They include some things that you can change, and some that you can not.
RISK FACTORS YOU CAN CHANGE
- You have a higher risk of having a fracture due to osteoporosis if you:
- Do little or no physical activity
- Are a smoker
- Have a high alcohol intake
- Have low body weight
- Have low calcium intake
- Frequently fall
RISK FACTORS YOU CAN NOT CHANGE
- You have a higher risk of having a fracture due to osteoporosis if you:
- Have a parent or grandparent who has osteoporosis or who has had a fracture caused by osteoporosis.
- Are female
- Are Caucasian or Asian
- Have a small body build
- Had delayed puberty or early onset of menopause
- Had anorexia which caused loss of periods
- Have already had a fracture caused by osteoporosis
- Are over 60 years of age
- Have rheumatoid arthritis, chronic liver disease or kidney failure
- Have a history of over-active thyroid or parathyroid glands, or have been treated with thyroid hormones in the past
- Are a male with low levels of testosterone
- Have had long-term drug treatment with corticosteroids (such as prednisone)
PREVENTING OSTEOPOROSIS – REDUCE YOUR RISK
Preventing osteoporosis is important. Although there are treatments for osteoporosis, there is no cure. You can reduce your risk of developing osteoporosis and having a fracture by:
- Having a balanced diet rich in calcium and vitamin D. For most people, three serves of dairy foods daily will provide enough calcium
- Vitamin D to help the body absorb calcium. Vitamin D is in small amounts in foods such as dairy products fortified with vitamin D, egg yolks, salt water fish and margarine. The best source of vitamin D is from safe sunlight exposure.
- Weight-bearing, high impact and strengthening exercises (such as walking, tennis, dancing and weight training)
- Having a bone density test, if appropriate
- Asking your doctor if you need medication
- Asking your doctor if any medicines you take may be causing bone loss
- Not smoking
- Drinking less alcohol
ARTHRITIS FOUNDATION OF THE ACT Arthritis & Osteoporosis ACT is a non-profit organisation that aims to improve the quality of life of people in the ACT who are suffering from arthritis, osteoporosis and other musculoskeletal conditions.
At Back in Strength Canberra, we can help you strengthen your bones, as well as your muscles. Specific exercises can prevent bone thinning, reduce falls and help you manage any pain. It is reassuring to realise that bone is a living tissue and it can be improved through some types of exercise.
Causes of Osteoporosis
- Bone loss slowly increases as a normal part of ageing. It is more rapid in women for several years after menopause. Bone loss can lead to osteoporosis and an increased risk of fractures.
- The three main reasons why people develop osteoporosis are genes, age and gender.
- Other risk factors include smoking, drinking more than three units of alcohol a day and not being active.
- At Back in Strength Canberra, we can help you strengthen your bones, as well as your muscles.
- Specific exercises can prevent bone thinning, reduce falls and help you manage any pain.
- It is reassuring to realise that bone is a living tissue and it can be improved through some types of exercise. We can work with you to find activities that suit your needs and that will strengthen your bones.
- Sometimes a compression fracture, when bones in the spine collapse, can produce pain. Physiotherapy can help to manage this pain.
- Osteoporosis is more common in older people and often the reason why they fall. If you are at risk of falling, we can help you improve your balance.
Arthritis ACT is a non-profit organisation that aims to improve the quality of life of people in the ACT who are suffering from arthritis, osteoporosis and other ...
Arthritis ACT is a non-profit organisation that aims to improve the quality of life of people in the ACT who are suffering from arthritis, osteoporosis and other musculoskeletal conditions
Arthritis and Osteoporosis ACT offer membership for those suffering from, or caring for someone with, a musculoskeletal condition. Their services include:
- Information sheets and resources
- Support groups
- Dietetic clinic
- Exercise programs
- Counselling services
Osteoporosis is a condition in which the calcium from the bone is not replaced when it is removed.in Canberra, ACT offers treatment for osteoporosis.
Osteoporosis and Fall Prevention
Bone is a growing tissue composed mainly of calcium and proteins. Constant reformation of bone takes place as calcium is absorbed by your body.
Osteoporosis is a condition in which the calcium from the bone is not replaced when it is removed, forming “porous bones” which cause the bones to become brittle and weak.
Therefore, if you have osteoporosis and you fall, you are at a higher risk of breaking a bone. If osteoporosis is not prevented or treated it can progress without any symptoms until a bone breaks (fracture). Fractures associated with osteoporosis may take a very long time to heal or even cause permanent disability.
Some factors which can contribute to osteoporosis are:
- Excessive thyroid hormone
- Smoking and alcohol
- Low calcium in diet or reduced calcium absorption by the body
- Low levels of estrogen after menopause
Osteoporosis has no symptoms and is often referred to as a “silent disease”; therefore, you may not be aware of the decrease in bone density. Falls are very dangerous for patients with this condition as it often leads to a fracture and limits an individual’s daily activities during the healing phase of the fracture.
The underlying factors that influence whether a fracture occurs from a fall include:
- The force and direction of the fall
- The fall itself
- How fragile your bones are
Prevention of falls is very important in people with osteoporosis.
Some common causes of falls include indoor and outdoor hazards that may occur during normal day to day activities.
Certain safety tips to prevent falls include:
Outdoor safety tips
- When the ground is slippery or wet due to rain or snow, warm boots with rubber soles can be used for added traction and to prevent numbing of your feet.
- Use a walker or a cane for added stability during bad weather.
- Stop at the curbs and check their height before stepping up and down. Be careful at curbs that have been cut away to allow access for wheelchairs or bikes.
- Grasp the handrail as you step onto an escalator or moving walkway.
- Floor surfaces in public buildings are usually highly polished and might be slippery. Low heeled shoes with rubber soles can be worn for such floorings.
- Identify community services that can provide 24 hour delivery with pharmacies and grocery stores that take orders over the phone or internet in bad weather.
- Talk to your doctor about hip padding for added protection in case of a fall.
Indoor safety tips
- Place items you use most often within your reach so that you can avoid a lot of bending. You can also use a tool called a “grabber” to reach items.
- Remove all the loose wires from the floors and keep the floor clutter free.
Check that all carpets are skid proof or tacked to the floor
Make sure the furniture is in its usual place
- Use anti-skid mats on the floor in the kitchen near the sink and stove and clean up spills as soon as they occur.
- Keep the light switches within reach of your bed in the bedroom and always have a night light between the bedroom and bathroom. You can also keep an emergency light on your bedside for safety.
- Install grab bars on the walls of the bathrooms and use non-skid rubber bath mats in the shower or tub.
- Keep the staircase of the house well lit and install sturdy handrails.
Taking care of all these steps can help you enjoy a healthy and active life. Talk to your physical therapist about ways to reduce the risk of falling.
Osteoporosis is a condition where bones become thin, weak and fragile, such that even a minor bump or accident can cause a broken bone (minimal trauma fracture). Osteopenia is a condition when bone mineral density is lower than normal but not low enough to be classified as osteoporosis.
The Bone Clinic is a health service dedicated wholly to bone, muscle and joint health. The Bone Clinic is the first of its kind in Australia (actually the world), and provides inclusive care from physical evaluation, to practical treatment, including bone density tests, supervised exercise programs, dietary guidance and ongoing education, all in one convenient location.
Those who are at risk, or suffer from poor bone health, including osteoporosis, will find evidence-based treatment options at The Bone Clinic based on ground-breaking research conducted in Queensland.
‘Osteo’ means bone and ‘pore ‘means hole – it can be explained simply by ‘holes in the bone’.
Osteoporosis is a bone disease where there is loss of minerals and break down of the normal healthy bone structure so the bones become fragile and brittle.
"Over the next 10 years, the total cost of osteoporosis and associated fractures is estimated to be $33.6 billion." - Osteoporosis Australia
Did you know that by the time you are 35 your skeleton would have remodeled 5 times?
Over a 7-year period cells called ‘osteoclasts’ break down and clean out old bone tissue and cells called ‘osteoblasts’ build new bone. This is due to the mechanical stresses and strains on the skeletal system by gravity and muscle activity.
The process is also influenced by other factors such as genetics, age, hormones, medication (corticosteroids for example), excessive alcohol intake, smoking and nutrition (adequate vitamin D and calcium for example) and conditions such as diabetes and rheumatoid arthritis and prolonged inactivity.
After the age of 35, bone reabsorption starts to exceed bone deposition and we start to lose up to .5 to .75% of bone density per year. Men generally lose bone density at a slower rate until the age of 65 when the rate of bone loss equals that of women.
This is thinning of the bone and a precursor to osteoporosis. Having osteopenia does not mean you will get osteoporosis but without intervention you are at high risk of progressing.
What does ‘Osteogenic’ mean?
Osteogenic describes something that is important for building and maintaining bone density.
Some interesting and relevant facts
- Currently 4.75 million Australians over 50 have osteoporosis or Osteopenia.
- This figure will increase over the next 10 years to 6.2 million.
- There is one fragility fracture every three and a half minutes – this figure is also likely to increase.
- It is estimated that fractures related to osteoporosis occurs once in every four fractures for men and twice in every five for women over 50. One of the most serious outcomes of osteoporosis is a fracture of the hip.
- In 2011-12 19,000 people over 50 were hospitalized for an osteoporosis related hip fracture. 72% were aged 80+ and 72% were women (Australian Institute of Health and Welfare).
What do bones do?
- They provide attachment for ligaments, tendons and muscle (ligaments join bone to bone and tendons join muscle to bone).
- They Support and protect internal organs eg heart, lungs, bladder, brain.
- Red and white blood cell formation occurs in bone marrow.
- They provide a storehouse for minerals.
Bone density in women
A decline in bone density is a normal part of the ageing process – like getting wrinkles! This bone loss is accelerated in menopausal women who may lose 20-30% of bone over a five-year period. This is thought to be due to the decline in oestrogen during this period of their life. Oestrogen is a stimulant for bone, tendon and muscle health and function. As soon as a woman has reached a plateau in menopause symptoms (usually marked by a resolution of hot flushes and other symptoms) the bone reabsorption will tend to stabilise.
Bone density and smoking
It is important to mention here that smoking causes leaching of calcium from the bones because smoking causes less calcium to be absorbed from the diet. AS calcium is required for many other functions in the body the bone then becomes a source. Women who smoke also tend to have lower oestrogen levels and experience earlier menopause and weaker bones than non-smoking women.
Normal bone loss vs excessive bone loss
During the ageing process we lose muscle, skin tone and bone – this is normal. What many people don’t realise is that just as we can do things to protect and improve our skin condition as we age, we can also be proactive in minimizing the loss of bone and muscle mass through exercise, diet and lifestyle choices.
We know from research that bone remodelling occurs at different rates during different stages of life. As a child your bones are rapidly remodeling responding aggressively to exercise and growth hormone with peak bone density (90%) occurring at around 20 years of age. A further 10% increase in bone density can occur in the next 15 years to age 35. The more active you are as a child the greater the peak of bone density at age 35 and the lower the risk of developing osteoporosis later in life.
Testing for Osteoporosis
The Gold Standard test for detecting osteoporosis or osteopenia is the DEXA (bone densiometry) scan.
As osteoporosis advances the bony bridges within trabecular become thinner and break down and the ‘holes’ become bigger. The bone becomes more fragile and susceptible to deformation or fracture with what was once ‘normal loading’.
Did you know we have two types of bone in our body?
- Cortical bone – long heavier bones, like in your arms and legs – make up 80% of skeletal mass but only 20% of total bone turnover occurs in these bones. They are less likely to develop significant osteoporosis due to the nature of the bone being denser.
- Trabecular or ‘spongy’ looking bone makes up 20% of skeletal mass and yet 80% of bone turnover occurs in this bone, which is more susceptible to fracture. This spongy looking bone is lighter and reduces skeletal weight and is highly responsive to metabolic rates and stress. It is found in the vertebral bodies of the spine and neck and in the ends of long bones such as the end of radius at the wrist. These areas are much more susceptible to fragility fractures wills.
T – Scores
- T-scores compare your bone mineral density (BMD) with that of young healthy adults of the same sex.
- Osteoporosis is diagnosed when the T-score is -4 (or less) to -2.5 standard deviations (SD’s) below that of a young healthy adult of the same sex. This indicates porous bone that can lead to fractures.
- A T-score of -1 or higher is considered normal compared to an average 30 year old of the same sex.
- A T-score of -2.5 to -1 is considered ‘borderline’ and a warning sign where life style management is important to reduce further loss even of no increase occurs.
- A T-score indicating Osteopenia would be -2.5 to -1. This is considered a ‘high risk’ zone and again a very important signal to become proactive in management.
Z – Scores
Z-score compares the patient’s BMD with that of adults of the same age and sex. It is the number of standard deviations (SD’s) of the BMD measurement above or below that of adults of the same age and sex. Z-score is a useful indicator of possible secondary osteoporosis. Whereas Primary osteoporosis is considered directly related to aging and accelerated at menopause, Secondary osteoporosis has a direct cause. This type of osteoporosis is ‘secondary to’ or caused by, something else. For example, osteoporosis caused by the use of prednisone is a very common form of secondary osteoporosis.
A Z-score of -2.0 or below should trigger investigations for underlying disease to exclude other causes of bone mineral loss. Medications such as anti-depressants and anti-coagulants such as warfarin can also predispose to secondary osteoporosis.
Do medications help
Do Medications Help Certain medications such as bisphosphonates (Fosomax, Boniva, Actone) inhibit the activity of the osteoclasts, which clean out old bone. They are believed to help reduce fragility fractures in up to 30 to 50% of those who have already experienced one fragility fracture. The results vary according to each study and have more recently been challenged.
There are side effects of these drugs – informed decision is always required when deciding the best option for you. A ‘load management’ approach is a more proactive and less invasive approach.
It may be worthwhile considering a change in lifestyle and taking up osteogenic exercise for a year. You should of course discuss this with your doctor. The more informed you are the better you can make the right decision for you.
Exercise for bone health
We know from research that two types of exercise are ‘Osteogenic’ – meaning important for building and maintaining bone density:
- Weight bearing or exercises on land against the resistance of gravity (anti-gravity) that help build stronger bones; tennis, power walking, jogging or running, stair climbing, dancing and team sports such as netball (high impact weight bearing exercise).
- Muscle strengthening or resistance exercise such as weight or resistance band training, functional exercises that lift your own body weight are also osteogenic and provide the stimulus of both ‘compression’ on the bone from gravity and ‘traction’ on the bone from the attached muscles to promote stronger and healthier bones; heel lifts, lunge squats, weight bearing yoga, resistance based Pilates.
These exercises also improve overall quality of life as we get older by making the normal activities of daily living – such as getting in and out of bed or a chair or car, climbing stairs, vacuuming and cleaning – easier and with a reduced risk of injury.
Poor bone and muscle condition as well as poor balance are associated with increased risk of falls. If you are unable to stand on one leg for greater than 10 seconds you have a very high risk of falling. Test yourself!
Some kinds of exercise DO NOT help bone health
It may surprise you to learn that low impact weight bearing exercise such as walking, while better than no exercise, has minimal effect in maintaining bone density. When high impact exercises are contraindicated for any reason (for example sub optimal pelvic floor strength, illness etc) low impact exercises combined with some resistance work is recommended.
Swimming and cycling, while good for cardio-vascular health, are not osteogenic and swimming, due to it being ‘weightless’ may have a detrimental affect on bone density – astronauts return from time in space with significant bone loss due to a prolonged period of weightlessness.
How much exercise do you actually need?
The current Australian Guidelines (see link below) regarding exercise to promote bone health is that it must be regular, progressive and varied. The following tips are also recommended;
- Regular smaller bursts of exercise each day are better than one long session a day.
- Lifting heavier weights are better – if you can lift a weight for 10 repetitions comfortably then the weight is too light to be osteogenic.
- Lifting weights quickly may be more beneficial than slowly (there is some controversy about this).
- Rapid short bursts of movement such as jumping or skipping are more beneficial than slow ones. You may need to address any pelvic floor issues before taking up these higher impact activities.
- Variety is important – change of direction, altering sequencing, avoiding routine is important and maximizes the physiological effects of exercise.
- For those with suboptimal pelvic floor strength or those who have had a fragility fracture – you will need to be guided by your doctor or physio as high impact exercise may be contraindicated and you will need a graduated resistance training program.
The age factor
When we are young we tend to be more physically active and this level of activity declines as we age. Knee and hip pain in older individuals will often inhibit exercise and it becomes a real struggle to maintain bone density and independence.
Did you know that more than 80% of joint stability comes from the surrounding muscles?
Yet the usual response to pain is to avoid using these muscles with the outcome being further instability, uncontrolled shearing forces and further damage to the joint.
Exercise is of vital importance as we age to reduce loss of muscle function and bone and reduce overall loss of function and risk of injury from falls etc. In 2012 the estimated incidence of osteoporosis (most likely underestimated and didn’t include osteopenia) was 25% of women over 50 and 6% of men over 50.
The Osteoporatic spine
With low bone mass we need to think about precautions when exercising. Forced movements into flexion (bending forward), side bending and rotation can place excessive anterior loads on the fragile vertebrae resulting in ‘squashing the bone’ or a ‘wedge fracture’. Wedge fractures tend to occur at the front of the spine. Compression fractures can occur when lifting heavy weights, even carrying a lot of body fat. The downward pressure causes the fragile vertebrae to flatten.
The Vertebral bodies most at risk are T6, 7 and 8 – right between the shoulder blades. These vertebra are most at risk with flexion such as toe touches, crunches etc. Such exercises can be very dangerous if not done in a very careful way. That’s where Clinical Pilates can help. In clinical Pilates exercises are modified and varied according to pathology. Touching toes forcefully is not a good idea without good muscular control and lengthening the spine in the process. Clinical Pilates emphasizes controlled extension activities.
Osteoporosis is often called the silent disease because fragility fractures can happen over time in the spine and may not be detected – or detected incidentally when a more serious fracture such as a hip fracture occurs.
Once one vertebrae changes shape into a wedge – the following cascade effect occurs.
- Progression of a kyphotic (rounded) spine.
- Reduced height, stiffer rib cage and reduced volume of breath.
- Reduced appetite and discomfort in the abdomen.
- Poor elimination – constipation.
- Poor neck posture resulting in neck tension and headaches.
- Shoulder problems due the change in position of the bones that form the shoulder joint and abnormal loading of the supportive muscles all resulting in shoulder pain and impingement.
Good balance reduces the risk of falls
Apart from appropriate strength training for healthy bones it is also important to improve your balance to minimize your risk of falling and sustaining a fracture.
If you are unable to stand on one leg for 10 seconds or more – lightly touch a wall or bench and gradually withdraw this assistance as able.
Once you can balance unsupported for 30 seconds or more close your eyes and repeat the exercise until you can balance for over 10 seconds.
Gradually progress to more challenging balancing exercises with guidance from your physiotherapist. Balance exercises can be done incidentally throughout the day for example, when cleaning your teeth, waiting for the kettle to boil, or while talking on the telephone.
Maintain the correct posture
Good erect posture can minimise the effect of gravity on your spine.
We all tend to slouch at times particularly with a more sedentary lifestyle. This leads to postural changes such as; rounded shoulders, poke chin, sway back and rounding of the spine. These changes cause our centre of gravity to move forward resulting in more compressive loads on the spine, shoulders and head due to gravity. This increased compressive load can be enough to cause wedge fractures of the thoracic spine. There are many exercises that, over time, can realign your spine and restore healthy posture.
Exercises that work your spine in extension should be a part of your healthy bones routine.
Risk Factors for Osteoporosis. Poor bone health is common. Many Australians are not aware of the risk factors which should be discussed and investigated by ...
Poor bone health is common. Many Australians are not aware of the risk factors which should be discussed and investigated by your doctor. Review common risk factors and if any apply to you or a family member take action to protect bone health.
Arthritis Foundation of the ACT (Incorporating Osteoporosis ...
Two thirds of the people in the Australian Capital Territory who suffer from Arthritis are of working age or below, including 3 year old Canberra boy Ronan.
At 2 years and 8 months of age Ronan was diagnosed with Juvenile Idiopathic Arthritis, an autoimmune type of arthritis. As a baby he screamed and cried much more than was normal, he experienced tummy upsets, fevers, rashes and was unable to crawl. Now that he can talk, he now says ‘the bees are stinging’ or ‘the sharks are biting’ to describe his joint pain. His treatment involves the use of powerful drugs, some of which involve injections and infusions into his bloodstream. A lot of pain for a little boy!
The Arthritis Foundation of the ACT supports sufferers of arthritis of all ages including Ronan’s family by providing community services including regular community education programs, support groups, advocacy for better services, exercise programs and self management courses.
With the end of financial year fast approaching I invite you to give generously to our “Tax Time Appeal” so we can continue to provide valuable services to the people of the Canberra region.
Arthritis ACT is a non-profit organisation that aims to improve the quality of life of people in the ACT who are suffering from arthritis, osteoporosis and other musculoskeletal conditions. It was established in 1977 and is affiliated with Arthritis Australia and other State and/or Territory Arthritis Foundations.
Our Mission is to be a dynamic, credible and viable organisation providing quality services, contributing to research, and improving the health and wellbeing of people in the ACT and surrounding regions with arthritis, osteoporosis and related conditions.
In order to promote the role of Arthritis ACT and be able to sustain relevant, quality services to the community, we need the support of people in the Canberra Region.