Osteoporosis: Causes, Risks, and Treatment

What is osteoporosis?

Osteoporosis refers to a deterioration of the bones due to bone loss. People with osteoporosis are therefore at greater risk of fractures, and these fractures can occur following a minor injury or even a simple activity such as stretching, coughing, or sneezing. These fractures are known as fragility fractures.

In many cases, the disease can appear without any symptoms, and is only detected when the person suffers a bone fracture. In people aged 50 and over, more than 80% of fractures are caused by osteoporosis. The most common osteoporotic fractures occur in the hip, spine, wrist, or shoulder.

Fractures due to osteoporosis are not a rare occurrence. In fact, in Canada, they are more common than heart attack, stroke, and breast cancer combined!

After suffering an osteoporotic fracture, some people will need a wheelchair or walker to get around, while others may no longer be able to live alone and may have to move out of their home. What’s more, 22% of women and 33% of men who suffer a hip fracture associated with osteoporosis will die within one year.

It is therefore important to know what you can do to maintain or regain bone health and avoid falls, to reduce your risk of a fracture.

Osteoporosis causes and risk factors

Our bones reach their peak mass at around age 30. By the mid-thirties, bone mass in women and men alike starts to diminish. Bone loss accelerates in women around menopause and in men around age 65.

While we still don’t know the exact causes of osteoporosis, several factors have been identified as increasing the risk of developing the disease or suffering a fracture.

The good news is that many of these factors can be avoided or corrected!

Risk factors you can change:

• Not getting enough calcium in your diet
• Not getting enough vitamin D
• Not being physically active
• Smoking
• Drinking more than three alcoholic beverages per day

Risk factors you can’t change:

• Being over the age of 65
• Suffering a previous fall: Falling multiplies by three your risk of suffering another fall
• Suffering a fragility fracture after the age of 40
• Having a family history of osteoporosis, especially of hip fracture in a parent
• Suffering height loss: A loss of height can be an indication of a spine fracture that went undetected (in 66% of cases, these fractures cause no pain)
• Suffering from certain diseases, such as rheumatoid arthritis, malabsorption syndrome, sex hormone deficiency (estrogen in women and testosterone in men), chronic kidney disease, liver disease, or diabetes
• Taking certain drugs that can have a negative effect on bones (e.g., prednisone) or that increase the risk of falling, for example, because they cause drowsiness or dizziness

Osteoporosis: Not just a women’s disease!

While osteoporosis affects women more frequently, men, too, are at risk of developing the disease. One in five men (20%) will suffer an osteoporotic fracture during their lifetime. In women, the rate is one in three (33%). In other words, men, too, need to look after their bone health.

ASSESSING THE RISK OF FRACTURES

After the age of 50, it is recommended you have your fracture risk assessed by a health professional. The risk factor takes into account your overall state of health as well as your osteoporosis risk factors.

You may need to have a bone mineral density (BMD) test done to determine your fracture risk more precisely. This test assesses the mineral density of your bones and can confirm whether there are any signs of bone loss. Bone density that is lower than normal for one’s age is referred to as osteopenia. When bone loss is very significant, the diagnosis will be osteoporosis.

If your fracture risk is…

• Low: No drug treatment is recommended. Your fracture risk should be reassessed in 5 to 10 years.
• Moderate: Your doctor will discuss with you the pros and cons of drug treatment. If you decide not to begin treatment at that time, you will need to undergo another risk assessment in 5 years.
• High: Drug treatment is recommended.

TREATING OSTEOPOROSIS

While there is no cure for osteoporosis, it is possible to prevent or slow bone loss and reduce the risk of fractures. In addition to getting enough calcium and vitamin D in your diet or through supplements (see below), you may also be prescribed one of several drugs to prevent or treat osteoporosis. Treatment is personalized to take into account fracture risk, overall health, and any other drugs you may be taking. 

Bisphosphonates are the most prescribed drugs for osteoporosis. They help strengthen bones and reduce the risk of fractures.

In some women who also have symptoms of menopause, hormone replacement therapy may be prescribed both to relieve symptoms of menopause and for its benefits on bone health.

There are also other treatments, including injections, that are used in specific circumstances, for example, after a fracture.

Osteoporosis itself usually doesn’t cause pain. However, certain fractures caused by the disease may be associated with chronic pain. Generally speaking, these kinds of pain are treated with painkillers and rest.

BETTER SAFE THAN SORRY!

By adopting a healthy lifestyle, you can help reduce your risk of suffering a fracture.

Exercise regularly

Osteoporosis experts recommend that you partake in functional, balance, and muscle-strengthening exercises at least twice a week. These kinds of exercise have the greatest benefits for reducing the risk of falls, and the subsequent risk of fractures. Other activities such as aerobic or weight-bearing activities can also be enjoyable, and are beneficial to your overall health, provided they are adapted to your fracture risk.

What is functional training?

The goal of functional training is to reduce the risk of injury and to maintain or improve one’s ability to carry out activities of daily living. Various exercises are used to develop strength, power, and reaction time, as well as joint mobility and stability.

Don’t smoke, and limit your intake of alcohol

If you need help to quit smoking or reduce your alcohol intake, ask a health professional for advice.

Get enough calcium

Calcium plays an important role in bone health and the proper functioning of a number of organs in the body. When your diet is not rich enough in calcium, your body will take the calcium it needs from your bones, making them more fragile. Fortunately, there are plenty of foods that are rich in calcium, to ensure your body gets enough to stay healthy.

Recommended daily dietary allowance of calcium (Osteoporosis Canada and Health Canada) :

• Women age 50 and over: 1200 mg/day
• Men age 51 to 70:1000 mg/day
• Men over 70:1200 mg/day

Ideally, your daily dietary allowance of calcium should come entirely from your diet, which means you should eat foods rich in calcium every day. If your diet does not meet all your calcium requirements, your health professional may recommend complementing your intake with a calcium supplement.

A few dietary sources of calcium :

Get enough vitamin D

Vitamin D plays an important role in the absorption of calcium and in muscle health. It is produced by the body via a reaction between the skin and sunshine. Given our northerly climate and the measures taken to protect skin from the harmful effects of the sun, it can be difficult for some Canadians to get enough vitamin D.

Recommended dietary allowance of vitamin D (Osteoporosis Canada and Health Canada) :

• Men and women up to age 70:600 IU/day
• Men and women 71 and over: 800 IU/day

Since vitamin D is not widely present in food, it is not always possible to meet the recommended allowance through diet alone. As a result, Health Canada and Osteoporosis Canada recommend that all adults over the age of 50 take a daily vitamin D supplement of 400 IU. In people at risk of vitamin D deficiency, e.g., those taking certain medications, or those with diseases that interfere with the absorption or formation of vitamin D, it may be necessary to take a higher dose of vitamin D.

Managing medication, calcium, and vitamin D 

Some drugs, including bisphosphonates used to treat osteoporosis, must not be taken together with foods containing calcium or with calcium supplements, as this prevents them from being properly absorbed by the body.

It is therefore essential to follow your pharmacist’s directions regarding how and when to take your medications, for maximum efficacy.

A FEW TIPS FOR PREVENTING FALLS

While everyone is at risk of falling, for people with osteoporosis, the consequences of a fall can be much more dramatic. As a result, they must remain alert to situations that can put them at risk of a fall.

Following are a few precautions to help reduce your risk of falling:

• Make sure your home is safe. Keep rooms uncluttered and well lit and avoid area rugs or carpets that can be tripped over.
• If you are in the habit of getting up at night, use a nightlight to help light your way.
• Wear comfortable and solid shoes with slip-resistant soles.
• If need be, don’t hesitate to get a walking aid, such as a cane or walker.
• Hold onto the banister when going up or down stairs.
• Get up slowly from a seated position, to avoid dizziness.
• Have safety bars installed in the bathroom, or use a bench in the bath or shower.
• Watch out for icy patches in the winter, and be careful while walking over uneven ground, such as lawns.
• Use extra caution if you’re taking medications that affect alertness.
• Have your eyes checked every year by an optometrist, and make sure you wear glasses that are adjusted to your vision.

Your pharmacist is there to advise you on the proper way to take calcium or vitamin D supplements, and to ensure that your osteoporosis treatment is effective and well tolerated. Be sure to reach out to them if you have any questions!