Osteoporosis

Bones are living tissues that go through a continual process of removing old bone and replacing it with new bone material. When we are younger, the amount of bone material the body builds is more than the amount it loses, and as a result, “bone mass” (the total amount of bone material in our bodies measured as bone density) increases. Peak bone mass is reached in women between the ages of 16 to 20 years old, and in men, between 20 to 25 years old. As we age, the process that makes new bone is not as efficient, and we gradually lose bone. Osteoporosis happens when we remove old bone faster than it can be replaced. As we lose bone mass, all of our bones become fragile, not just the bones in our spine, hip or wrist. Bones become so fragile that something as simple as a strong hug or falling from a standing height can cause a fracture; these types of fractures are called fragility fractures. Bones can also fracture in the spine even when there is no history of trauma. Preventing our bones from fracturing is a main goal of treating osteoporosis to prevent chronic pain, long-term disability and even death.

What Causes Osteoporosis?

Even though anyone can develop osteoporosis, it occurs more frequently in women than in men. When women go through menopause, their bodies stop making the hormone estrogen, and estrogen plays an important part in reducing bone loss. By the time a woman reaches the age of 70, she may have lost nearly one-third of her total bone mass.

There are many factors that can increase your risk of developing osteoporosis. Some factors can be changed or worked upon. There are others that cannot be modified.

Factors that you may not be able to change include the following:

• If you are 65 years of age and older
• If you are female
• If you have a family history of osteoporosis or osteoporosis-related fractures
• If you have a small, thin build
• If you began menopause early, either naturally or as a result of having your ovaries removed surgically

Lifestyle factors are factors that you may be able to change. The following may increase your chances of developing osteoporosis:

• Not getting enough exercise, either because of an inactive lifestyle or not being able to move
• Cigarette smoking
• Consuming too much alcohol
• Low calcium and vitamin D intake either from low intake through diet or poor absorption through your gut

In addition, having some other medical conditions may make you more susceptible to developing osteoporosis, such as rheumatoid arthritis, diabetes, hyperthyroidism, anorexia, bulimia, chronic bronchitis, and emphysema.

If you have undergone surgery to reduce the size of your stomach or bypass part of your intestine, the reduced surface area may limit your ability to absorb nutrients such as calcium. You can discuss further with a dietitian to see how your body can maximize the absorption of these nutrients.

Also, taking certain medicines such as steroids used to treat asthma and arthritis, certain medications used for seizures, some diuretics, some treatments that deplete sex hormones, and medicines that contain aluminum, can increase your chances of developing the condition. Taking too high a dose of prescribed thyroid hormone is another contributing factor.

To understand your risk of developing osteoporosis, consult with your healthcare provider. By identifying and recognizing these risk factors, together with your healthcare team, you may be able to take steps to prevent this condition and/or treat it before it becomes worse.

Are There Any Signs and Symptoms?

It is unfortunate, but osteoporosis does not announce its appearance with early warning signs. Some of us realize that we have osteoporosis when we have a fracture. Your best defense against this “silent” disease is to be aware of your fracture risk and talk with your healthcare provider. Once osteoporosis has become advanced, you may notice that you seem to be getting shorter, your abdomen begins to protrude, or there is some evidence of spine, wrist or hip fractures. Eventually, you may notice that you are developing a stooped posture.

How is Osteoporosis Diagnosed?

A quick, painless bone density test can measure the density of bones in your spine, hip and wrist. When this test is repeated over time, your healthcare provider can track your rate of bone loss. Discuss with your healthcare provider to see if this test is appropriate for you.

Prevention of Osteoporosis

By far the best way to manage osteoporosis is through prevention. There are simple things that you can do to reduce your risk of developing osteoporosis or to slow its progress if you catch it in the early stages.

• Calcium and Vitamin D: Make sure you are getting enough calcium, roughly 1,000 to 1,200 mg daily, by eating a healthy, balanced diet. The daily calcium requirement depends on your age.

Your body can only absorb approximately 500 - 600 mg of calcium at one sitting. Therefore, plan your diet accordingly. Good sources of calcium include dairy products, some seafood, and some green vegetables. For people watching their weight, skim milk, low-fat yogurt and cheeses are good choices.

If you don't get enough calcium from your diet, you may want to consider a supplement. Here are a few guidelines to keep in mind:

• Look for the amount of elemental calcium in the supplement; that is the amount your body can actually use. For example, a tablet that contains 1,250 mg of calcium carbonate only provides 500 mg of elemental calcium.
• Calcium carbonate contains a higher percentage of elemental calcium than other forms of calcium such as calcium citrate.
• Calcium carbonate should be taken with food to increase the body's ability to absorb it.
• If you are getting enough calcium from your diet, you do not need a calcium supplement.

The body also needs vitamin D. Vitamin D has been shown to increase the absorption of calcium. Vitamin D also helps improve muscle function, which results in improved balance and a lesser chance of falling. No matter how good your diet is, it is difficult to get adequate amounts of vitamin D. According to Osteoporosis Canada, daily vitamin D supplements are recommended for all Canadians throughout the year. Vitamin D 800-2,000 IU daily is suggested for men and women over the age of 50.

If you have any questions about calcium and vitamin D supplements, your pharmacist will be happy to answer them.

• Being physically active: Weight-bearing exercises such as walking and low-impact aerobics, and resistance/strength training, can help bones stay healthy. Also, exercises such as Tai Chi or yoga can improve balance and coordination to help prevent falls. Activities that improve flexibility and posture can also help. Check with a kinesiologist before beginning any exercise program to make sure that the activity you are going to participate in is appropriate to your health and level of conditioning.
• Become smoke-free Stop smoking. Cigarette smoking can weaken your bones and increase your risk of developing osteoporosis.
• Avoid excessive alcohol and caffeine Limit the amount of alcohol and caffeine you consume.

Treatment of Osteoporosis

There are a number of different types of medication your doctor can prescribe to slow bone loss and, in some cases, to reverse the process of bone loss. Because each person is different, it is important to discuss treatment options with your healthcare provider. Some people respond better to one medication than another.

Living with Osteoporosis

If you have osteoporosis, it is very important that you do everything you can to prevent falls, because falling will lead to broken bones and immobility.

Here are some tips that may help decrease your chances of falls:

• Use a shower stall instead of a bathtub when you have a choice—or equip your bathtub with handrails and be very careful when stepping into or out of the tub.
• Use handrails whenever they are available in public places such as on stairs or along hallways.
• Make sure your home is well-lit and that walkways are uncluttered.
• Use elevators instead of stairs or escalators when you have a choice.
• Wear comfortable shoes that are easy to walk in and that stay securely on your feet.
• Do not climb on chairs or ladders. If you need help in reaching something, ask someone for assistance. Squat down to pick things up from the floor rather than stooping or bending over, and never try to lift heavy things.
• When possible, avoid medicines that affect your balance. Ask your pharmacist about the medications you take. If any of them affect balance, there may be other medication choices available.