What is Osteoporosis

Osteoporosis is a silent thief. It is a life altering, disabling and potentially deadly disease. It is a condition in which ongoing loss of bone leads to thin fragile bones that break easily. The bone loss may continue to the point where the bones can no longer provide the points of attachment for the muscles and tendons or protection for the body’s organs. One of the most devastating issues is the fractures and collapse of the spine. This can lead to significant postural changes that affect your breathing and digestive system as well as your quality of life and that of your families.

• Preventing and treating excessive bone loss is possible given today’s understanding of osteoporosis.

Preventing Bone Loss

It is important to strengthen your bones with a diet rich in calcium, vitamin D, exercise and where appropriate medication. Preventing excessive bone loss is possible given today’s understanding of osteoporosis. With the goal of building the strongest bones possible, a very basic understanding of how bones grow and develop from childhood to young adulthood, leads to a choice in lifestyle behaviors for a bone healthy diet and exercise. An understanding of the risk factors for osteoporosis and osteoporotic fracture will make you aware of how your choices affect bone health. Be aware that low bone density alone becomes important as you age. If you are under age 60 in particular you are not facing an emergency but a reason to plan ahead.

• Making simple life changes can have long standing effects on bone health.

Fracture Risk and Treatment

Clinical Assessment: can easily be completed with your doctor to assess your level of risk and need for a lifestyle change or prescribed treatment. It would include a discussion and assessment of:

1. Osteoporosis risk factors: age, diet, exercise, family and medical history and medications you are taking
2. Fracture risk factors: risk of falling – sight, hearing, balance, muscle weakness, use of medications; previous low trauma fractures; family history of osteoporotic fractures.
3. Bone Mineral Density test (preferably DXA) if required you cannot show bone loss unless you do a DXA at least twice over a four years or once every two years to establish risk of osteoporosis and fracture.
4. FRAXtm test or CAROC test – assess your risk of fracture in the next ten years at www.FRAX.com

Treatments: in all cases we should ensure we are at the optimum for dietary calcium, vitamin D and strengthening and weight-bearing exercises. Sometimes this will mean taking a medication. There are several different options so work with your doctor and pharmacist to identify the one that best fits your needs.

Frequently Asked Questions

What is the difference between osteoarthritis and osteoporosis? My friend is 66 and has just been diagnosed with osteoporosis. She looks fine. Could I have osteoporosis? Do men get osteoporosis? How much daily intake of calcium do I need? Can I take too much calcium? What type of calcium should I buy? Should I take magnesium along with my calcium? How much vitamin D do I need? Can I take too much vitamin D? I walk for 30 minutes almost every day. Will that keep my bones strong? What is a bone mineral density (BMD) test? What is a DXA test? What is a Z-score and how is it different than a T-score? What is the difference between osteoarthritis and osteoporosis? Osteoarthritis affects the joints and osteoporosis affects the bones. The word “osteoarthritis” means inflamed joints. It is a progressive deterioration of the cartilage in a joint that is often brought on with age, obesity, overuse or repetitive motion over many years. “Osteoporosis,” which means thin bones, occurs when there is a loss of bone mass, making a person susceptible to fractures. My friend is 66 and has just been diagnosed with osteoporosis. She looks fine. Could I have osteoporosis? Yes. Osteoporosis is known as the silent thief. Age, especially for women over 50, is a significant risk factor for osteoporosis. As we age, we eventually lose more bone then we build. Other factors can also affect our bone health, such as genetics, lifestyle, medical condition and medications. For the first five or six years of menopause, a woman can lose 2-5% of her bone density each year. Ideally, you should talk with your doctor about your bone health during your annual physical examination. A proper osteoporosis and fracture risk assessment can be easily done. If you have some risk factors, a Bone Mineral Density – DXA is usually recommended. Do men get osteoporosis? Yes. By age 60 men have a one in four chance of breaking a bone as a result of weak bones. There are any number of reasons why we may get osteoporosis. We may be genetically predisposed. We may have had poor calcium and vitamin D intake while growing up, resulting in less than optimum bone strength or peak bone mass. We may have a lifestyle of poor bone health habits such as smoking, excessive alcohol intake or little regular exercise. Women have a decline in their hormones as they age. Women naturally lose bone at the time of menopause, when estrogen production changes. However, men too have a decline in their hormone testosterone as they age. It is not as dramatic a decline as women experience, but, over a few decades, the impact on bone and there overall feeling of well-being can be significant. How much daily intake of calcium do I need? It is important to know that calcium alone cannot prevent osteoporosis, but it will help slow the progress of bone loss. Generally, the combined total of dietary and supplemental calcium on a daily bases should be 1000mg for men and women under age 50 and 1200mg – 1500mg for men and women over the age of 50. Do not forget to include the calcium in your multi-vitamins as well. Can I take too much calcium? Yes. The upper safe limit for the vast majority of people is 1500mg-1800mg per day. With calcium, more is not always better. It is best to stick within the guidelines unless your doctor has advised otherwise. Excessive calcium may cause excess concentration of calcium in your blood known as hypercalcemia. What type of calcium should I buy? Calcium carbonate and calcium citrate are the forms of calcium that are best absorbed by the body. Calcium carbonate has the highest percentage of elemental calcium at 40%, but is one of the hardest forms for the stomach to break down. It should be taken with a glass of water and food. It tends to be less expensive than other forms. Calcium citrate has a low percentage of elemental calcium at 21%, but is a high ability to be absorbed. Unlike calcium carbonate, calcium citrate can be taken on an empty stomach. Should I take magnesium along with my calcium? Magnesium is a mineral needed by most cells in the body. Magnesium is good for bone health. However, most experts feel you can get your suggested daily requirement of 200mg-400mg per day through a well- balanced healthy diet, provided you are absorbing the nutrients. How much vitamin D do I need? Few natural foods contain vitamin D, so supplementation is often needed. The recommendation from the national osteoporosis organizations is that people over 50 need 800IU – 2000IU of vitamin D per day. Some experts feel the tolerable upper limit may be a little higher. The research into vitamin D and all its benefits is ongoing. Various factors can influence the amount of vitamin D supplements you may need. One factor is where you live and how much sunshine you get at any one time of the year. In Northern Canada, for example, it may be sunny, but at 40 below you have all your skin covered and you are not getting the benefit of the sun’s rays. If you live near the equator, the sun is very hot and you are at increased risk of skin cancer, so you apply a strong sunscreen over your skin to reduce exposure to the sun’s rays and, therefore, to vitamin D. Other factors include skin color and age. People with darker skin or who are older do not process vitamin D as well as people with lighter skin or as well as they did when they were younger. Can I take too much vitamin D? If you stay within the recommended guidelines, then excessive or toxic levels of vitamin D supplements is possible but rare. If diagnosed with a vitamin D deficiency, often seen after a fracture, some doctors may suggest a large loading dose of 50,000 IU per day or weekly of vitamin D 2 for a short period of time. I walk for 30 minutes almost every day. Will that keep my bones strong? Walking is fundamental to good bone health. Walking also has a number of other health benefits. The impact on bone as you walk will help stimulate bone development. You may wish to include upper body strengthening as well. As you walk, your legs, and to some extent your spine, will feel the benefits, but your arms and upper body may need some attention. You might try swinging your arms or “pole walking” to increase your arm involvement, but be careful not to trip over the poles. What is a bone mineral density (BMD) test? A BMD test is a measure of the amount of bone material in a defined area. It is used to assess your fracture risk. There are several bone mineral density tools. The most common test is a DXA. What is a DXA test? DXA stands for a Dual-Energy X-Ray Absorptiometry. It is a very accurate Bone Mineral Density test that measures with low radiation (X-ray) exposure. The DXA machine provides a T-score, which is a specific measurement from a database for a DXA machine. For a person age 50 compared to an average person age 30 a T-score of -1SD means you have 10-15% less bone and the risk of fracture is considered low. A T-score of -1.0SD to -2.4SD means you have up to 25% less bone and are at a four times greater risk of fracture. A T-score of -2.5 SD or lower means you have a minimum of 25% less bone and at an eight times greater risk of fracture compared to that of an average young person. What is a Z-score and how is it different than a T-score? A Z-score cannot be compared to a T-score. A T-score is matched to people who are around 30 years old and is considered to be a better guide for post-menopausal women. A Z-score is matched to people your own age and thought to be better indicator for pre-menpausal women and for men. The draw back of a Z-score is that is only useful where adequate data exists for comparison. What do you recommend for the prevention and treatment of loss? The long term goal for bone health is to prevent fractures and maintain or improve our quality of life. Everyone needs to make sure they have enough calcium and vitamin D intake on a daily bases. As well, we all need regular and appropriate weight-bearing, strengthening and balance exercises. Depending on your T-score, there are a number of good options for both prevention and treatment of bone loss. If you have low bone loss or high bone loss the choices are easier. Given your medical history of low bone loss, calcium, vitamin D and regular exercise may be enough to slow the rate of bone loss. If you will not adjust your lifestyle or need a little extra help in slowing the bone loss, a hormone therapy or Selective Estrogen Receptor Molecule (SERM) may be considered. If you have high bone loss and are diagnosed with osteoporosis, you must consider medication. There are several different options, from bisphosphonates to RANK Ligands to parathyroid hormones and others that may be considered. The challenge comes when you have moderate bone loss. You will have to work with your doctor and as well as do your own research with your pharmacist and other reliable sources, such as national organizations, to assess your 10-year fracture risk and possible effects of a fracture on your quality of life. Be sure to consider your 10-year fracture risk and possible effects of a fracture on your quality of life.