November was Osteoporosis Month in Canada, which is designed to bring awareness about a disease that is characterized by bone loss and a subsequent weakening of the skeleton. Often called “the silent thief,” there are no symptoms of osteoporosis until one experiences a fracture as a result of the loss of bone.
If you are hit by a truck and fracture a bone, that is traumatic, but not unexpected. But if you fall from your adult height or from a few steps, such as falling off the curb or missing the last step in a staircase, and fracture a bone, that is a fragility fracture and it’s a sign of osteoporosis. What it means is that your bones were not strong enough and therefore broke.
Eighty per cent of fractures in women over 50 are fragility fractures. That is scary, because the likelihood of a fracture leading to another fracture is high, particularly in the first year or two after the initial fracture. Those who have experienced such a fracture should talk to their doctors about bone health.
What are the components of bone health? Vitamin D intake is essential. Osteoporosis Canada (OC) generally recommends 1,000-2,000 international units a day for women over the age of 50. Calcium is also important, as it is a building block of bone. Generally aim for 1,200 mg per day.
Ideally, people should get their calcium from milk, cheese, yogurt and other dairy products. While other foods have some calcium, the amounts are not high. On the OC website, there is a calcium tracker. You can input your diet and find out how much calcium you had on a given day. If you’re not getting enough, increase your intake of calcium-rich foods or start taking a supplement. But more is not better, as higher amounts of calcium are associated with other risks.
Bone health also depends on exercise. Weight-bearing exercise is ideal, as it strengthens the muscles around joints and bones, improves balance and decreases the risk of falls.
Bone mass is measured using a bone mineral density test (BMD), a scan that’s done at various facilities. By age 65, both men and women should have a BMD.
If your BMD is acceptable, that is great and you have good bone quantity. A lower score means that bone quantity is too low and must be acknowledged. The goal is to do a risk assessment – looking at bone health, the issues faced by a given patient and the risk of fractures – and then make a decision on whether to treat the patient using medication. We have a number of choices of medications in Canada, so patients should discuss with their doctors about which treatment option is best for them.
When it comes to osteoporosis, aggressive prevention, preventing the next fracture, is perhaps the most important thing. Indeed, a hip fracture can be deadly. About 23 per cent of women and 37 per cent of men will die from complications in the year after a hip fracture. And about 40 per cent of patients will not be able to live independently, but will need care in a facility. Another 40 per cent will not walk properly for the rest of their lives.
So when we talk about healthy aging, independence and empowerment, let’s remember the huge importance of osteoporosis, not just in November, but all year long.