doctor's orders: osteoporosis treatment can 'prevent a lot of injury and disability'
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osteoporosis is often called a “silent thief” because bone deterioration can happen over time without any symptoms. then when affected bones fracture or break, the disease is already fairly advanced and more challenging to treat, according to osteoporosis canada, the national advocacy organization for osteoporosis prevention and treatment.
estimates suggest more than 2.3 million canadians are living with the disease, which is the main culprit behind about 80 per cent of fractures in people age 50 and over. in fact, as many as one in three hip fracture patients, for example, will experience a re-fracture within a year. and heads up, because both women and men start to lose bone in their mid-30s, early bone-building prevention is key.
healthing spoke with dr. lianne tile, medical director of the university health network (uhn) osteoporosis clinic at toronto general hospital. she is a leading expert in osteoporosis and fracture research, treatment and care.
what is osteoporosis?
dr. tile: osteoporosis is a disorder of weak bones — an impairment of less bone density, which is the mineralization or the minerals making up the bone. it can also be problems with the quality of the bone, which can happen with certain underlying diseases or medications that lead to impaired bone strength and increased risk for breaking a bone — even with a simple fall from your own height.
what are the signs of osteoporosis?
dr. t: we really focus on assessment for risks for osteoporosis because by the time people actually have signs of osteoporosis, we’re beyond the opportunity for prevention and onto treatment. so in terms of signs, people might have a broken bone, of course, that’s quite overt. they might have sudden or severe back pain that might indicate a fracture. but if somebody hasn’t actually had any broken bones, osteoporosis can be quite silent.
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sometimes people develop a big curve of the upper spine, which is what we call kyphosis [commonly known as buffalo hump]. osteoporosis can weaken the spinal bones, and you can get some collapse of those bones. sometimes it can happen without much provocation, say if you lift something heavy or you lift it the wrong way — lifting a baby is always a bad one for older people — you could get that compression in the spine.
how do people develop osteoporosis? what are the risk factors?
dr. t: as people grow and develop, they accrue bone through childhood, adolescence and early adulthood. and after that, it’s a very gradual process of bone density loss. after the age of 50, and for women, especially after menopause, are at risk of more rapid bone density loss. we know that genetics are a risk factor, so osteoporosis can run in families. if you have a parent who might have had a fractured hip, that’s definitely a risk factor for you having osteoporosis.
i see patients in the osteoporosis clinic, so by the time they get to me, usually they have a diagnosis. but family doctors would look at all the risk factors, including certain medications that put people at higher risk for bone density loss, like corticosteroid medications like prednisone [to relieve swelling, redness and allergic reactions]. there are also certain medical conditions that can put people at risk. for example, having early menopause or an overactive thyroid gland or diseases of malabsorption, like celiac disease, inflammatory bowel disease or kidney problems. if people have those risk factors, usually the next step would be to do a bone mineral density test, which is something that should be done probably in anybody over the age of 60 or younger people who have risk factors.
even if you’re in your 50s and you fall and break your wrist, that is a signal that maybe your bones aren’t as strong as they should be. getty
having a fracture is sometimes the earliest warning for osteoporosis. even if you’re in your 50s and you fall and break your wrist, that is a signal that maybe your bones aren’t as strong as they should be. there are a few initiatives across the country and with osteoporosis canada to bring more awareness of osteoporosis into fracture clinics. anybody who’s had a fracture from a fall from their own height after about the age of 40 should have a bone density test and be assessed for osteoporosis. there’s treatment that’s really effective to strengthen the bones, improve bone density and reduce risk of fractures.
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are there lifestyle choices that can help prevent osteoporosis?
dr. t: there are lifestyle factors that we talk about, like high alcohol intake, cigarette smoking, low physical activity or inactivity and also low intake of calcium and vitamin d deficiency. those are all things that can put you at risk.
how is osteoporosis generally treated?
dr. t: for everybody, we talk about the non-drug treatments, so making sure that people have adequate calcium through their diet and supplements if needed. the current thinking is that calcium through diet is really preferred, and getting adequate vitamin d usually with a supplement, especially in the winter in canada. the recurrent recommendations are 800 to 2,000 units of vitamin d per day. and then making sure you have good nutrition with adequate protein.
regular exercise is the other really important part of this. so regular weightbearing, balance and resistance exercise for both strengthening muscles and protecting bones, but also reducing risk for falls. for people who are at high risk for fractures, based on bone mineral density or if people have had more than one fracture with low trauma, or a hip fracture or a spine fracture — generally those are people who would benefit from an osteoporosis medication. it’s not necessarily medication for everybody and it’s not necessarily medication forever, but we need to assess it. the most common osteoporosis medications would be a pill that you take once a week or potentially once a month. and we do have some injection medications that we can use for more severe cases.
what’s one piece of advice for someone with osteoporosis?
dr. t: i would say fall prevention, so the importance of regular exercise, muscle strengthening and balance exercises. with appropriate treatment, i think we can potentially prevent a lot of injury and disability, particularly in older adults.
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i started in this area because i have an interest in women’s health. traditionally, a lot of osteoporosis work has been in women. we now know that it’s not only a disease of women by any means, but it does affect women. and i think there’s still a treatment gap in terms of recognizing and treating osteoporosis. so for me, it’s really important to raise awareness. we want to identify people at risk and if we can reduce the risk of serious fractures like hip fractures, it can be life-changing.
for more information about osteoporosis, visit osteoporosis canada.
doctor’s orders is a bi-monthly column that helps you make the most of the time you have with your doctor. writer karen hawthorne asks a medical professional about a health condition, getting expert insights on what you should watch for, management and prevention — information you can take with you to your next appointment.
do you have a health issue that you’d like to get some expert insights on? email info@healthing.ca.
karen hawthorne is a toronto-based writer.
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