Osteoporosis, the silent thief

Osteoporosis is a loss of bone mass, which makes the bones become porous and fragile. It occurs most often in weight-bearing bones such as the hips or spine but can affect any bone in the body. The humped back – or dowager's hump – is its most well-known sign. Among Canadians over the age of 50 today, 1 in 4 women and 1 in 8 men have osteoporosis. However, osteoporosis can affect someone at any age.

Osteoporosis is called the silent thief because of the slow, quiet way it creeps up on people. You can't feel the bone loss as it's happening and, often, you're not aware of what's going on until the damage has been done.

Most people know that the highest-risk groups include older women and those who have gone through menopause. But there are others who are at risk as well, including men and women who:

  • are older than 65 years
  • take corticosteroid therapy continuously for more than 3 months
  • have had a fracture with minimal trauma after age 40
  • have a family history of osteoporotic fracture (especially a parent who has had a hip fracture)
  • are or were malnourished (including people with anorexia or bulimia) or had a very low calcium intake
  • smoke
  • use alcohol excessively (consistently more than 2 drinks a day)
  • drink too much caffeine (coffee, cola, tea)
  • had an early menopause (before age 45)
  • have hypogonadism (a condition when the sex gland [gonads in men; ovaries in women] produce little or no hormones)
  • have certain medical conditions, such as rheumatoid arthritis, primary hyperparathyroidism, and hyperthyroidism
  • have medical conditions that inhibit absorption of nutrients (such as celiac disease or Crohn's disease)
  • weigh less than 60 kg or have lost more than 10% of their body weight since age 25
  • have undergone treatment for cancer with aromatase inhibitors or androgen deprivation therapy
  • have a spinal fracture seen on X-ray or a vertebral compression fracture

The more of these risk factors you have, the greater your risk of developing osteoporosis.

Osteoporosis can have a major negative impact on your quality of life. It can lead to fractures, causing pain and make moving about difficult, which can limit your independence. If you are at risk of osteoporosis, as indicated by the list above, you are also at higher risk of having a fracture. But there are ways to tackle bone loss early on in order to avoid the most damaging effects of osteoporosis. Read "Battling bone loss" to find out more.

Battling bone loss

Osteoporosis isn't called the silent thief for nothing. Unfortunately, unless you or your doctor have any reason to suspect that your bones may be thinning, there's no way of telling that it's happening until the damage has been done. People with osteoporosis are more likely to get fractures and these can cause pain, make moving around difficult and affecting your quality of life.

By keeping an eye on certain risk factors, however, doctors can identify and monitor people who have a high risk of having a fracture or osteoporosis. Certain tests can be done to see if there is bone loss happening in people who are at risk. For example, if you are taking high doses of corticosteroids, your doctor may suggest that you undergo bone mineral density (BMD) testing to check out the strength of your bones before something happens. A "baseline" test, one that's done before bone loss is suspected for comparison with later tests, makes it easier for your doctor to monitor your bone health.

The tests for osteoporosis are painless and non-invasive. Dual energy X-ray absorptiometry, or DXA, is the most common because it can measure both the hip and spine density, the areas where osteoporosis-related fractures are most frequent. As you lie on a table, a machine scans you and calculates how much of the X-ray beam passes through you. Although the thought of having an X-ray beam going through your body might seem like cause for concern, the amount of radiation that's used is even less than what you would be exposed to during a chest X-ray.

Some institutions may do a single photon absorptiometry, or SPA, but this can only tell the density of the bones in the forearm or heel. There are other types of scans as well, but they aren't used as frequently.

If you're told you have osteoporosis or are at risk of having a fracture, your doctor may recommend one or more of the following medications:

  • calcium and vitamin D supplements
  • bisphosphonates (e.g., alendronate, etidronate, risedronate, or zoledronic acid)
  • calcitonin
  • denosumab
  • raloxifene
  • teriparatide

Which kind of therapy you'll be offered will depend on whether you are a man, a premenopausal woman, or a postmenopausal woman, and the extent of the bone loss. If you are experiencing symptoms of menopause as well as osteoporosis, your doctor may also offer you the treatment option of estrogen therapy, which can treat osteoporosis and menopause symptoms. Be sure to discuss your personal risks and benefits of estrogen therapy with your doctor before making a decision on treatment.

It's important you understand how to take your medications, and that most medications require long-term use – usually several years. If you have any questions, consult your doctor or pharmacist.

Bone building blocks

An estimated 2 million Canadians are living with osteoporosis. While the disease can strike at any age, it is most common over the age of 50; in that age group, some 1 in 4 women and 1 in 8 men suffer from it.

With numbers like these, it's easy to believe that osteoporosis is an inevitable part of aging. The good news is that it's not! Bone loss can often be prevented or slowed down – even if it's already begun. It may take some lifestyle changes and adjustments, but the results will be well worth it.

First, check your bad habits at the door. Stop smoking, limit caffeine intake, and start exercising. Weight-bearing and muscle-strengthening exercises can prevent bone loss and help strengthen the bone mass you still have. This can mean taking an aerobics or dance class, lifting weights, or playing a weekly game of tennis, for example. Exercises that focus on balance, such as tai chi, can help people who are at risk of falling. Of course, you should always check with your doctor before beginning any new exercise program.

If you can't participate in regular or organized exercise, keeping active around the house or with friends can be just as effective. Going for daily walks, using the stairs, gardening, jogging, and even doing housework are all ways to get your body moving.

Second, eat well. It's never too late to start following a healthy diet. Getting enough protein, calcium, and vitamin D is essential to bone health, and can easily be done by eating the right foods. And by increasing your calcium intake, you're also going to be taking in other nutrients, which can make all-round improvements in your health.

How much calcium do you need?

Osteoporosis Canada recommends the following for daily calcium intake:

Age and gender Total recommended daily intake of calcium (from diet and supplements)

19 to 50

1000 mg each day

Above 50

1200 mg each day

Women 18 years and over who are pregnant or breast-feeding

1000 mg each day

Foods that contain calcium

In this table, you can see that three glasses of milk and some vegetables will bring you to almost a full daily amount of calcium:

Food Calcium

250 mL (1 cup) low-fat milk

300 mg

125 mL (½ cup) cooked kale

49 mg

250 mL (1 cup) calcium-fortified orange juice

300 mg

105 grams (½ can) canned salmon, with bones

240 mg

125 mL (½ cup) cooked broccoli

33 mg

3 cm cube mozzarella cheese

200 mg

Other foods that include calcium are sardines (with bones), calcium-enriched tofu, mustard greens, oranges, figs and kidney beans – among many others.

How much vitamin D do you need?

Keep in mind that while you're increasing your calcium, you also need enough vitamin D for the calcium to be absorbed effectively. Osteoporosis Canada recommends 400 IU to 1000 IU of vitamin D for healthy adults between 19 and 50 years of age and 800 IU to 1000 IU for adults over 50. Larger doses may be required for people of any age if they have conditions associated with low vitamin D levels. Doses of up to 2000 IU are considered safe.

You can get vitamin D from the sun (remember to use sunscreen to reduce damage from the sun's rays), from supplements, and from foods like vitamin-D-enriched milk, cod liver oil, beef liver, and sardines.

Keep moving, keep living

Keeping active is your best defence against brittle bones. Exercise will encourage healthy bones and prevent loss of bone mass. Try to get 20 to 30 minutes of weight-bearing exercise on most days of the week, and 30 to 60 minutes of muscle-strengthening exercise 3 times per week. If you have osteoporosis, you might have to take a few extra precautions in order to keep active, especially in situations where you risk falling and having a fracture.

Taking daily walks in the winter can be invigorating, but you need to be extra careful while walking outside. If you need extra support, use an adapted cane or make sure you walk with a companion you can hold on to if the going gets rough. Wear boots with a good tread and take small, even steps. If possible, try to have someone clear your walkway before you go out.

Other times of the year, watch for anything that can make you trip or slip. Avoid puddles of water, wet grass, and piles of wet leaves, and steer clear of cracked or lifted sidewalks.

Caring for your house, cooking, and participating in hobbies are all ways to stay active indoors, too. It helps to take precautions at home, and it might help to have someone go through the house with you with a critical eye. Many things we take for granted can be hazardous. Some culprits include:

  • scatter rugs
  • items left on stairs
  • children's toys
  • pet toys or even pets themselves
  • shower stalls or bathtubs

By keeping the floor as clutter-free as possible, you limit your chances of tripping and falling. Make sure items you need are within reach – try not to climb on chairs or stepladders. Also, keep in mind that most accidents occur in the bathroom and kitchen, so be sure to wipe up spills on the floor as soon as they happen and be a bit more careful just after the floor has been washed. If you need a grab-bar in the shower or bath, have one installed. It will give you a good grip and help you get in and out without losing your balance. A seat in the shower is another good idea.

If you get the right medical therapy, eat a calcium-rich diet, and keep active safely, osteoporosis doesn't have to get in the way of a full and vigorous life.