• 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.

'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.

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.

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.

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. In men, low levels of the hormone testosterone may have the same effect.

Engaging in strenuous training and sporting activity can also induce hormonal changes. Despite the building of bone that occurs naturally during exercise, the hormonal changes caused by very strenuous activity may result in net bone loss.

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.

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.

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. 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. Your active involvement in developing your treatment plan is essential.

Medicine

Hormone replacement therapy can involve taking estrogen alone or a combination of estrogen and progesterone at varying dosages. Hormone replacement therapy acts by reducing the rate of bone destruction. Other possible benefits include a reduction in heart disease and stroke, control of the symptoms of menopause, prevention of bladder infections and improvement in memory. In women, side effects can include a return of menstrual flow, breast tenderness and bloating, and a possible increased risk of breast cancer in those who have a family history of the disease. 

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.

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: 

CMSG members review the best available literature to determine the best evidence to support specific arthritis treatments. They explore the evidence for and against the effectiveness and appropriateness of treatments (medications, surgery, education, etc) in specific circumstances. The results are medical reviews that are then included in The Cochrane Library and made available to health professionals around the world.

For members of the public who also want to be informed about the evidence concerning health care practices and decisions in their lives, the Cochrane Musculosketal Review Group have summarized their reviews into consumer fact sheets. For the Cochrane consumer reviews related to osteoporosis, visit www.arthritis.ca/cochrane.

Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis. Here are a few:

• The Arthritis Self-Management Program (ASMP) is a unique self-help program offered by The Arthritis Society to help you better control and manage your arthritis.
• The Open Forum within this Web site is an opportunity to discuss and share information with other visitors - people who, through their own experiences, may be able to offer some useful insights.

Of course, there are many other valuable resources for people with arthritis. If you're unclear about where to look for help, be sure to call The Arthritis Society at 1-800-321-1433.

 For more information on osteoporosis, please contact:

Osteoporosis Canada
1090 Don Mills Road, Suite 301
Toronto, Ontario, Canada
M3C 3R6
1-800-463-6842
http://www.osteoporosis.ca/