Osteoporosis: What You Should Know

Fall 2003 CSANews Issue 48  |  Posted date : Apr 25, 2007.Back to list

Osteoporosis is one of the major health conditions which afflicts persons over 50, especially women, and its prevalence is increasing. It is estimated that in Canada, one in four women and one in eight men have osteoporosis.

Osteoporosis is a skeletal disease characterized by a thinning of the bones and loss of strength resulting from a loss of mineral density, as well as deteriorating bone quality. The causes are not all known, but there are factors that contribute to the likelihood of the condition. Osteoporosis can be prevented or lessened through a number of measures, including an appropriate intake of vitamin D and calcium, a healthy lifestyle without smoking or excessive alcohol use, weight-bearing exercise and, in some cases, medication.

The major threat to those with osteoporosis is a fractured hip or vertebra. Fractures of the vertebrae or compression fractures of the spine not only lead to pain and immobility, but also to permanent bodily changes including loss of height, curving of the shoulders and back and an increase in the waistline. The devastating consequences of hip fractures are well known, with more than 50 per cent of women who will be unable to function without being continually dependent on assistance with daily living, and one in five requiring long-term care.

But the good news is that doctors are now taking this condition more seriously, investigating the possibility of osteoporosis development at an earlier age, and initiating remedial measures to avoid or arrest further deterioration. Newer diagnostic tests and treatments have made this a largely preventable disease. Men and women over the age of 50 should now be assessed for the presence of risk factors for osteoporosis, including low calcium intake, low body weight, physical inactivity, a fracture history, various drug treatments and a family history of osteoporosis. It is now recommended that all persons identified at risk, as well as women over the age of 65, have a baseline bone mineral density test (BMD) to determine the diagnosis of osteoporosis and the risk of future fracture. This is a safe, non-invasive test covered by most provincial health plans. A low reading indicates a low bone mass requiring specific treatment, in addition to the general measures in the prevention of the disease.

It has been estimated that the average dietary intake of calcium and vitamin D is probably one-third of the recommended daily amount. In women over 50, not on hormone replacement therapy, 1,500 mg/day is recommended. In men over 50, the same dose is recommended. The vitamin D requirement is 800 IU per day for both men and women over 50 years of age. Accordingly, a combination pill on the order of 1,000 mg of calcium and 600 IU of vitamin D should be taken daily.

Exercise appears to have a beneficial effect in reducing the likelihood of hip and spinal fractures in men and women. Brisk walking, hiking, dancing, stair-climbing, moderate jogging, tennis and other impact exercises reduce bone loss and risk of fracture.

Smoking and excessive alcohol consumption have an increased effect on bone loss, in addition to their more commonly known hazards.

Medication is now commonly used in the treatment of osteoporosis, confirmed with BMD testing. The provincial health plans vary in their coverage for these recognized drugs. In Ontario, one of the original drugs, Didronel is covered by the drug benefit plan, but the newer drugs, considered to be more effective and in some cases easier to take, are not covered other than under very restrictive circumstances.

The first three drugs are from the same family of pharmaceuticals and work by preventing bone resorption. While all three increase bone density, it appears that Fosamax and Actonel are better at reducing the risk of hip fractures.

Evista is effective, much like estrogen, in slowing bone loss. It likewise is effective in reducing vertebral fractures, but has not yet been shown to be effective in reducing other fractures. There are fewer restrictive rules in the taking of this drug as compared with the first three, and there may be beneficial reductions in the level of LDL (bad) cholesterol.

Although hormone replacement therapy is known to prevent osteoporosis in women to some degree, recent studies have suggested that the risk of other conditions offsets the benefit, especially following five years of use after menopause.

Newer therapies are being introduced as more research is done. A new treatment called percutaneous vertebroplasty involves injecting a special liquid cement into the fractured vertebral sections and holes in the spinal column caused by osteoporosis. This has been found to be very effective in some patients who have not responded well to conventional treatments.

Osteoporosis should no longer be considered a normal part of aging. The personal and public health impacts of ignoring the preventable measures are far too great. Early identification of those at risk, and aggressive testing and treatment may have a significant impact on one's future. For those who have already been diagnosed with osteoporosis, in addition to the treatment recommended, professional education and advice is essential in reducing the risk of fractures, the majority of which occur at home.

According to conservative estimates, a 50-year-old Caucasian woman has a remaining lifetime risk of 40 per cent for hip, vertebra or wrist fractures. This risk is too high to ignore. Follow the conservative dietary and lifestyle recommendations to reduce that risk and, if your bone mineral density confirms the diagnosis, medication will further reduce your chances of fracture and deformity.

Snowbirds not confined to the indoors in winter have more opportunities to follow these guidelines.

Finally, don't forget the Internet. Whether you are personally computer-literate and can search the Web for more information, or have a friend do so and print the material, the Internet provides a wealth of up-to-date educational material on this and other diseases.

Treatment

  • A balanced diet with proper amounts of calcium and vitamin D
  • An active lifestyle including weight-bearing exercise
  • No smoking, and avoidance of excessive alcohol intake
  • Prescription medication when indicated

The most common medications include:

  • Etidronate (Didronel)
  • Alendronate (Fosamax)
  • Risedronate (Actonel)
  • Raloxifene (Evista)

In the U.S., the National Osteoporosis Foundation recommends the following guidelines to avoid bone fractures. Check it out and see if your summer and winter homes are in compliance.

  • Wear sturdy, low-heeled, soft-soled shoes; avoid floppy slippers and sandals.
  • Ask your doctor whether any medications you are taking can cause dizziness, light-headedness or loss of balance. If so, ask how these effects can be minimized.
  • Minimize clutter throughout the house.
  • Secure all rugs; avoid using small throw rugs that can slip and slide.
  • Remove all loose wires and electrical cords that can cause tripping.
  • Make sure that treads and handrails are installed on staircases and that they remain secure.
  • Keep halls, stairs and entries well lighted
  • Use nightlights in the bedroom and bath.
  • In the bathroom, use grab bars and non-skid tape in the shower or tub.
  • In the kitchen, use non-skid rubber mats near the sink and stove.
  • Avoid using slippery waxes; watch out for wet floors; clean up spills immediately
  • When driving, wear seat belts and adjust seat properly.