Tuesday, 25 February 2014

Screening - Osteoporosis

Osteoporosis is a disease where the bones become too thin and porous on the inside. Thin porous bones  are much more likely to break. In fact 80% of all fractures in Canada in people over age 30 are caused by osteoporosis (Osteoporosis Canada - Facts & Stats).

Osteoporosis is a common diagnoses. Osteoporotic fractures are more common than heart attack, stroke and breast cancer combined  (Osteoporosis Canada - Facts & Stats). One in three women and one in five men will experience an osteoporotic fracture in their lifetime (Osteoporosis Canada - Facts & Stats). Each year in Canada there are 30,000 hip fractures. In addition to this people also suffer wrist, shoulder and spine fractures (Osteoporosis Canada - Facts & Stats).

Osteoporosis is responsible for some of the highest costs to the health care system. The 2010 estimate for treating osteoporosis in Canada was $2.3 billion (acute care, home care, medications, indirect costs). Each hip fracture costs the system $21,285 in the first year of care or $44,156 if the patient had to be  institutionalized (Osteoporosis Canada - Facts & Stats).

Equally important is the cost to the people who have the disease. Twenty-eight per cent of women and 37% of men who experience a hip fracture will die within the following year (Osteoporosis Canada - Facts & Stats). People with osteoporosis are not just susceptible to fracture. They can also experience disfigurement, reduced mobility, and decreased independence and self-esteem as a result.

Osteoporosis can affect both men and women and can start at any age. Sadly many people don't know they have osteoporosis until they break a bone. How then do we screen for osteoporosis? It's very easy. There is a test call a Bone Mineral Density (BMD) test. Your health care provider will do a risk factor assessment to determine when you should start having BMD tests. BMD's are safe, painless, and accurate. You will lay on a table for several minutes while an X-ray scans your spine and hips. You can usually get a scan done locally (e.g. BMD testing is available at Campbellford Hospital).

To calculate your own risk you can use the Osteoporosis Canada risk calculator - click here to go to calculator.

In general regular BMD testing begins for all women and men at age 65 years. Let me just repeat that. ALL women and men 65 years or older should have a BMD. Your risk assessment will determine if testing needs to start earlier than that. It is a myth that osteoporosis is a woman's disease. Men get osteoporosis too. A quarter of all osteoporotic hip fractures are in men. And if a man fractures a hip he is much more likely than a woman to die as a result within one year of fracture (Osteoporosis Canada - Men and Osteoporosis). Men are also more likely to require long-term care placement after a hip fracture.

What then are the risk factors that would suggest you need an early BMD starting age 50 to 64 years? 
  • current smokers
  • high alcohol intake
  • low body weight (less than 60kg/132 lbs or BMI of 18)
  • weight loss great than 10% since age 25 years
  • a fragility fracture after age 40 
  • a vertebral fracture
  • an X-ray that indicates low bone mass (osteopenia or osteoporosis)
  • taking high-risk medications: chronic glucocorticoid use, aromatase inhibitors for breast cancer, androgen deprivation therapy for prostate cancer, anticonvulsants, heparin
  • rheumatoid arthritis
  • other disorders or treatments that may contribute to bone loss (e.g. DM type 1, COPD, Crohn's, malabsorption syndromes, Cushing's disease etc)
  • one of your parents had a hip fracture

What are the risk factors that would suggest you need an early BMD starting before age 50 years?
  • fragility fracture
  • high risk medications (as above)
  • rheumatoid arthritis
  • chronic inflammatory conditions (e.g. Crohn's, colitis, celiac disease)
  • Cushing's disease
  • malabsorption syndrome
  • hyperthyroidism (uncontrolled)
  • primary hyperparathyroidism
  • hypogonadism
  • early menopause before age 45y
  • other disorders or treatments that may contribute to bone loss or fractures

Ideally we all want to prevent osteoporosis before it happens. This is possible through lifestyle and should begin early in life when we are building bone as well as later in life when we are trying to conserve it. Lifestyle? You guessed it….nutrition and exercise. 

Nutrition for Prevention:
The best source of calcium is food and it is always better to get your calcium from nutrition rather than supplements (Osteoporosis Canada - How do I know if I need a calcium supplement).  But you have to make a real effort to ensure that you are getting enough calcium in your food every day. That means eating a variety of calcium rich foods every day. There are non-dairy sources of calcium, such as molasses and almonds, that you can choose if you are allergic to dairy or choose not to eat it. 

To read about the amount of calcium in foods and your daily requirements - click here for calcium list.
To calculate your calcium intake check out the Osteoporosis Canada Calcium Calculator - click here for calculator.

Vitamin D helps your body to absorb the calcium you eat. You can get this from food - fish, milk, egg yolks - as well as fortified foods (vitamin D added). It can be challenging to get enough Vitamin D from food  so figure out how much you are getting and supplement if you need to. This is especially the case for Canadians who for many months of the year don't get enough strong sun exposure to trigger the body to make vitamin D (Dietitians of Canada). To read more about vitamin D read our blog article - click here to read Vitamin D article.

People are very focussed on calcium and vitamin D for the prevention of osteoporosis and although these are both important factors in bone health our bones need more than this.  Protein and other minerals and vitamins are all required for our bones and muscles to work properly and remain strong (Osteoporosis Canada - Nutrition). So what that means is eating a well balanced diet with appropriate amounts of protein, leafy greens and other vegetables, nuts and seeds, and healthy fats. The "toast and tea" approach doesn't give your body what it needs. If you need to some help getting started on healthy eating view our nutrition tool on this blog -  click here for Tool: Starting a Healthy Diet.

It's also important to limit intake of both caffeine and alcohol (I know - boo!). Caffeine decreases our body stores of calcium. If you are drinking lots of coffee every day you are increasing your risk of osteoporosis. And most soda and energy drinks are loaded with caffeine as well. Tea on the other hand has far less caffeine than coffee. And water is even better. Alcohol? Increases your risk of osteoporosis if you have more than 2 or 3 drinks per day. Remember a "drink" is 142 ml or 5 oz of wine, 341 ml or 12 oz of beer, or 43 mL or 1.5 oz of spirits (Dietitians of Canada).

Exercise for Prevention: 
Active people have stronger bones. It's not too late to start. Exercising increases your muscle strength (which tugs and stimulates the bones), improves balance and posture, and decreases pain as well as making you feel good. To prevent or manage osteoporosis it's recommended that we do strength training, weight-bearing aerobic activities, flexibility exercises, and stability/balance exercises (Mayo Clinic). 

  • Strength training is typically weight lifting but there are also classes that use resistance and interval training to enhance strength. Upper body particularly around the spine is a good place to focus on. If you have osteoporosis make sure class instructors are aware of this. 
  • Weight bearing aerobic activity is anything that you moves you on your feet. Walking, dancing, and stair-climbing. This type of activity develops the muscles around your lower spine, legs, and hips. 
  • Flexibility Exercises are activities that move you through the full range of motion of your joints. Yoga and some Pilates classes include a lot of flexibility work. 
  • Stability and Balance Exercises are essential to fall prevention. These are exercises where you practice balance and enhance your stability. Tai Chi and Yoga include a lot of stability and balance work. 

Thanks for reading Getting Healthy with NP Sam. Comments welcome - please click the pencil icon below. 

Resources & References:
What is Osteoporosis? (Osteoporosis Canada)
Osteoporosis Facts & Statistics (Osteoporosis Canada)
Men & Osteoporosis (Osteoporosis Canada)
Interactive Tool: Risk Checklist - am I at risk for Osteoporosis? (Osteoporosis Canada)
Testing for Osteoporosis (Osteoporosis Canada)
Nutrition: Healthy Eating for Healthy Bones (Osteoporosis Canada)
Calcium Requirements (Osteoporosis Canada)
Osteoporosis Canada - How do I know if I need a calcium supplement?
Interactive Tool: Calculate My Calcium intake (Osteoporosis Canada)
Which Osteoporosis drugs are covered in your province? (Osteoporosis Canada)
Seniors & Healthy Living: Osteoporosis (Health Canada)
Eating Guidelines to Prevent Osteoporosis (Dietitians of Canada)
Exercising & Osteoporosis (Mayo Clinic)
Clinical Practice Guidelines for the Diagnosis & Management of Osteoporosis in Canada (Osteoporosis Canada)


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James pickford said...

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