HOW DO YOU GET OSTEOPOROSIS & ARE YOU AT RISK?

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Have you ever heard of brittle bone disease?  My guess is probably not.  It is actually a disorder that affects two million Canadians and the root cause of 80% of all fractures in people above 60 years of age.  Believe it or not, it costs the Canadian health care system 1.9 billion dollars annually.

 

While most have probably never heard of “brittle bone disease”, nearly everyone has become accustomed to the word “osteoporosis.”Osteoporosis is a condition in which the bone mineral density or BMD in the body is reduced. This occurs when an imbalance between the rate of bone resorption (bone breakdown) and bone formation exists. In normal bone, bone breakdown and formation occurs constantly and at equal rates-at any one point in time, up to 10% of all bone mass may be undergoing a remodelling process.  However, in someone with osteoporosis, the rate of bone resorption far outweighs that of bone formation, leading to gaps or holes in the bone’s architecture.  It is said that the interior of an osteoporotic bone is similar to that of an Aero chocolate bar.

Although osteoporosis is more commonly seen in postmenopausal women, men are also affected, but to a much lesser degree: one in every four women above 50 are said to have osteoporosis compared to one in eight men in the same age category.

Unlike most other bodily diseases and disorders, osteoporosis is often referred to as the “silent thief” as it has no specific warning signs or symptoms.  Its main consequence is the increased risk of bone fractures.  Someone who sustains an “osteoporotic fracture” is said to have broken a bone in a situation where a healthy bone would not break. Common sites of theses fractures include the bones of the spine (or vertebrae), the wrists and the long bones of the thigh (femur).  When multiple spinal bones are broken, the individual will have a tendency to take on a stooped posture (similar to that of a “hunch-back”) with resultant pain, reduced mobility and impaired function.

Risk factors for osteoporosis

There are many factors that predispose a person to osteoporosis.  Some are preventable or modifiable, whereas others are out of our control.  General lists of the main ones include:

  1. Advanced age.
  2. Greater than 3 months of continuous use of glucocorticoid therapy such as Prednisone.
  3. Medical conditions that inhibit the proper absorption of nutrients and hence decrease bone health such as Celiac disease, Crohn’s disease, Anorexia Nervosa and Bulimia.
  4. Hyperparathyroidism: this causes increased levels of parathyroid hormone (PTH) to be present in the blood which in turn increases the rate of bone breakdown and leads to bone loss.
  5. Low testosterone in men or low estrogen in women.
  6. Early menopause: referring to menopause before the age of 45.
  7. Rheumatoid arthritis.
  8. Hyperthyroidism.
  9. Prolonged use of anticonvulsants.
  10. Prolonged use of Heparin.
  11. Low body weight (less than 60 kg).
  12. Low calcium intake.
  13. Excessive caffeine consumption: consistently drinking more than 4 cups of coffee, cola or energy drinks per day.
  14. Excessive alcohol intake: consistently drinking more than 2 alcoholic beverages daily.
  15. Smoking: tobacco inhibits the activity of the osteoblasts which are the cells responsible for bone production.
  16. Vitamin D deficiency.
  17. High protein diet: studies have shown an association between diets high in animal protein and increased urinary calcium loss.
  18. Inactivity: in active individuals, bone remodelling occurs in response to physical exertion and weight-bearing exercises.  In fact, bone mass may increase by up to 1-2% as a result of regular physical activity.  Consequently, inactivity will do the very opposite-leading to a loss in bone remodelling and bone mass.

The most reliable means of diagnosing osteoporosis is made by a conventional radiograph or X-ray and by measuring the bone mineral density.

Treatment

Many treatment approaches have been established in the treatment of osteoporosis.  Often times a combination of options may be employed depending on the person’s individual needs.

  1. Drug therapy: the principal aim of the medication(s) is to reduce fractures.  Many medications are available and may even be used in combination.  Some commonly known ones are: Biophosphonates, SERM’s (Selective Estrogen Receptor Modulators), HRT (Hormone Replacement Therapy), Calcitonin & Testosterone, Denosumab, Parathyroid Hormone.
  2. Calcium and Vitamin D: a diet rich in calcium and Vitamin D is very important for maintaining strong and healthy bones. Proper daily doses of calcium and vitamin D ensure that the bone remodelling process remains balanced (equal rates of bone breakdown and bone formation).
  3. Physical Activity: physical activity is very important in both the prevention and treatment of osteoporosis.  The reason for this is quite simple: physical activities place a load or force on our bones.  It is thought that these loads stimulate the bones and may even cause gains in bone density. What is known for a fact is that exercise not only helps to make us feel better, but also helps improve muscle strength and coordination, balance and posture.  All of which lead to a reduction in the risk of falls and the resulting fractures that ensue.

Although osteoporosis is a manageable disorder, it is not curable.  That is why it is absolutely necessary to decrease as many “risk factor” behaviours in your life and maintain a proper level of physical activity.  Doing so will help to prevent the lifetime of pain and suffering that this condition can cause.

 

Kelly Cappadocia, BSc PhT

After graduating from McGill University in 2002 with a degree in Physiotherapy, Kelly began her career working as a physiotherapist in the hospital setting and one year later joined one of Montreal’s largest private physiotherapy clinics. During her time there, Kelly attended over 30 post-graduate courses, taught several physiotherapy classes and was responsible for mentoring all new recruits. In the fall of 2004, she became a Credentialed McKenzie Therapist, making her a specialist in back and neck care.

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