WHAT IS OSTEOPOROSIS?
'Osteo' means bone, and 'porosis' thinning or becoming more porous, so osteoporosis literally means 'thinning of bone.' It is commonly confused with the word osteoarthritis, which is a form of arthritis that results in breakdown of the cartilage covering the ends of bones. In contrast, osteoporosis is a condition where bone itself breaks down. Bones then become thin, brittle and easily broken. For example, sneezing can cause a person's rib to break or stumbling can lead to fracture of one of the bones in the spine.
The bones most commonly affected by osteoporosis are those in the hip, wrist and back (the vertebrae - pronounced ver-te-bray), particularly those in the mid-back. As vertebrae become thin, they are prone to collapse from relatively minor forces. Usually the fronts of the vertebrae break, leading to a state called wedging, which causes a person to stoop forward and develop a hump-like deformity on the upper spine. Those people who do not develop wedging may notice a progressive loss of height as bone collapse occurs.
Hip fractures are also common in people with osteoporosis, and can lead to immobility and hospitalization.
HOW COMMON IS OSTEOPOROSIS?
- Osteoporosis affects over 800,000 (1 in 37) Canadians
- Women develop osteoporosis four times more often than men.
- It usually appears in people after age 40.
WHAT ARE THE WARNING SIGNS OF OSTEOPOROSIS?
If you have osteoporosis there may be a long period of time, perhaps many years, during which you have no symptoms while your bones are becoming gradually thinner. Most people are diagnosed with osteoporosis after having sharp pain in the mid to low back that seems to have come on for no reason. Others experience fractures of the bone in the thigh (femur bone - pronounced fee-mer), hipbone, or the lower arm bone above the wrist (the distal radius - pronounced ray-dee-us) during what seems like relatively minor falls or accidents.
Over time you could have a gradual loss of height due to collapsing of your vertebrae. These compression fractures could also cause you to develop a stooped posture as your mid-spine rounds forward. Where significant compression fracturing has occurred, your lower ribs may begin to catch on the upper edges of your pelvic bones. This will be most noticeable when you bend to the side.
WHAT CAUSES OSTEOPOROSIS?
There are many factors that are involved in causing osteoporosis. Having a combination of factors present increases a person's risk of bone loss and osteoporosis:
Aging
Bone is a living tissue that is continually growing and being removed. Bones usually reach their maximum mass when people are in their mid-thirties. At about age 40, more bone is removed (about 1% per year) than is made, and so the bones start to become weaker. In women the bone loss may reach 3 - 5 % per year during the first five to six years after menopause.
Family History
Some people with osteoporosis have other family members with it, which suggests that heredity may be a factor. Heredity also plays a role in a person's body type; having a small frame and bone structure may increase the chances of getting osteoporosis and fractures.
Lack of Exercise
Because bone is a living tissue it needs exercise to stay strong. Normally through the activities of daily living such as walking, bending, stretching, and exercising, forces are imposed upon the bones. Bone responds to these forces by restructuring itself and becoming stronger. If you are not active your bones will become weaker over time because there is nothing for them to respond to. For example, if you had to wear a cast on a broken leg, the complete inactivity or immobility of that leg could result in rapid bone loss in the area. If you do not engage in regular activity and exercise throughout your life you could be more at risk of developing osteoporosis.
Hormone Changes
Osteoporosis can also be linked to changes in hormones. Hormones are substances produced by the body that help different organs run normally.
Certain hormones, such as estrogen, allow women to get pregnant. Estrogen is also a hormone that is important to maintaining bone strength. Once a woman enters menopause her estrogen levels fall. This affects how her bones process calcium and may lead to a more rapid loss of bone. For the first five or six years following menopause a woman can lose 3% to 5% of her bone density each year. Women who enter menopause earlier than usual (before age 50) have an even higher risk of osteoporosis. This may occur when the ovaries are removed surgically or they stop working due to extreme weight loss. In men, low levels of the hormone testosterone may have the same effect.
Diet
Bones need nourishment from calcium, vitamin D, and phosphorous. A poor diet lacking foods that contain these vitamins and minerals contributes to bone loss. Foods rich in calcium are especially necessary to maintaining healthy bones. Dairy products are a good source of calcium. Our bodies make vitamin D when we are exposed to the sun. Low levels of vit D may be cause by low exposure to sun, for example with sunscreen use, sun avoidance or location in a northern community.
Excessive use of alcohol or caffeine-containing products such as tea, coffee or some sodas can stop your body from absorbing calcium. Smoking also contributes to bone loss.
Medication
Some medications, when taken in high doses, can influence how your body deals with calcium and so contribute to bone loss. These medications include cortisone/corticosteroids, anticoagulants, thyroid supplements, and some anti-convulsive drugs.
Other illnesses
Other illnesses or diseases, such over-active thyroid, diabetes and rheumatoid arthritis may also cause bone loss. A disease such as anorexia nervosa or bulimia can cause changes in a person's estrogen level and lead to osteoporosis.
WHAT CAN YOU DO ABOUT OSTEOPOROSIS?
Preventing osteoporosis is much easier than curing it. Recognizing that this condition can occur, young people should take measures to prevent osteoporosis. If a person builds excellent quality bones when young, he or she will have bone reserves that may be able to withstand changes that can occur later in life, such as taking medicines, inactivity, etc. The critical age to be building good bones is between 10 and 30 years of age. It can be much more difficult to start improving bone health later in life.
If your doctor thinks you have osteoporosis, he or she will perform a physical examination. To confirm the diagnosis certain tests, such as x-rays and blood and urine tests, may be ordered. Other tests may be done to measure the density of your bones, such as a bone mineral density test or BMD. Correct diagnosis is important as there may be other medical conditions causing your symptoms, or that are contributing to the osteoporosis.
If you have osteoporosis, treatment will focus on reducing the rate of your bone loss and building up new bone as well as preventing fractures. Your active involvement in developing your treatment plan is essential.
Diet
To find out whether you are getting sufficient calcium, you can get calcium tables and checklists from your doctor, dietician, public health office or the local chapter of the Osteoporosis Society of Canada. Your calcium intake should be at different levels depending on your age:
| Child (ages 1-12) |
800 mg/day |
| Teen (ages 13-18) |
700 – 1200 mg/day |
| Adult |
700 - 1000 mg/day |
| Pregnant woman |
1200 mg/day |
| Woman during & post menopause |
800-1500 mg/day |
Foods rich in calcium are milk and milk products such as cheese and yogurt. Other calcium rich foods include canned salmon with bones, sardines, almonds, dark green leafy vegetables, and broccoli.
If you are not getting enough calcium as a result of the foods you eat you might need to take calcium supplements. These come in a variety of forms. Calcium carbonate, a source of calcium, can be found in products like Tums, Calcite 500, Caltrate, Os-Cal and others. Check with your doctor first to see if these products are appropriate for you. Some people, such as those with a history of kidney stones, may not be able to take calcium supplements.
Exercise
Bones respond to exercise by increasing in strength and mass. Weight-bearing activities such as walking, dancing, low-impact aerobics and stationary cycling can contribute to strong bones. Remember that your spinal bones will get strong when you exercise the upper body through lifting, carrying and exercises such as cross country skiing, rowing, push ups and sue of free weights.
In addition to preventing bone loss or rebuilding bone, exercise can also strengthen muscles. Having strong muscles will help you have better balance and be more flexible. This can assist in preventing falls that could cause bone fractures. Balance exercises like yoga, tai chi or pilates should be included in your exercise plan.
Your choice of exercise might be more limited if you have osteoporosis that also causes you pain. However, it is still important that you exercise. Swimming or other exercises done in the water can reduce impact on your bones and may be less painful.
Always consult your doctor before beginning an exercise program. He or she may also be able to refer you to a physical therapist who can advise you of the forms of exercise that are likely to be helpful, and those that could be harmful.
Medecine
Bisphosphonates have shown to be helpful in rebuilding bone. They are often given to women with osteoporosis who cannot or do not want to take hormone replacement therapy. Bisphosphonates can also be useful in treating osteoporosis that has resulted from steroids, such as found in other types of medication.
Calcitonin is a hormone that occurs naturally within the body. It helps increase bone density by affecting the levels of calcium in the blood. It can also relieve pain resulting from spine fractures. To treat osteoporosis it is usually given in doses much higher than normally occurs within the body. Often calcitonin from eel or salmon is used, as it is many times stronger than the human form. It is administered through a nasal spray.
SERMs are estrogen like medications, which has a positive effect on bone. It can cause more severe menopausal symptoms in some women. (may not be covered in Guides – JH to provide more info)
Hormone replacement therapy can involve taking estrogen alone or a combination of estrogen and progesterone at varying dosages. Currently hormone replacement therapy is only recommended for the short term treatment of post-menopausal symptoms and not to treat osteoporosis.
You may find general information on our Guide to Medications [PDF] even if your disease is not specifically addressed.
Osteoperosis Canada
For more information on osteoporosis, please contact Osteoporosis Canadaat:
1090 Don Mills Road, Suite 301
Toronto, ON, Canada M3C 3R6
Phone: 1-800-463-6842 (toll-free)