Your Bone Health
Sponsored by the Alliance for Better Bone Health, Warner Chilcott, sanofi-aventis
What is Osteoporosis?Are You at Risk?How Can You Monitor Your Osteoporosis Status?How Can You Take Charge of Your Bone Health?Treatment Options
What is Osteoporosis?Osteoporosis is a disease that causes bones to become thinner and weaker and some – such as the spine, hip and wrist – are more likely to break or “fracture”. The key treatment objective in osteoporosis is to prevent fracture.
Did you know…
- Osteoporosis Canada reports that approximately 1.4 million Canadians suffer from osteoporosis.
- Osteoporosis affects one in four women and at least one in eight men over the age of 50.
- A 50-year-old woman has a remaining lifetime risk of 40% for hip, vertebrae or wrist fracture.
- For women who sustain a hip fracture, mortality is 20% higher than expected within one year and 50% lose the ability to live independently.
- For women over 50, the 1-in-6 lifetime risk of hip fracture is greater than the 1-in-9 lifetime risk of developing breast cancer, and the death rate associated with the complications of hip fracture is higher.
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Are You at Risk?No single cause of osteoporosis has been identified, but certain “risk factors” seem to play a role in the development of the disease. If you are over 50 and have at least one of the major risk factors or two or more of the minor risk factors, talk to your doctor about being tested for osteoporosis.
| Factors that identify people who should be assessed for osteoporosis |
| Majoyr risk factors for osteoporosis |
Minor risk factors for osteoporosis |
65 years of age and older |
Rheumatoid arthritis |
Spinal compression fracture |
Past history of hyperthyroidism |
Fragility fracture after age 40 |
Chronic us of aniconvulsant therapy |
Family history of osteroporotic fracture
(especially maternal hip fracture) |
Low dietary calcium intake |
Prolonged use of glucocorticoides
(greater than three months) |
Smoking |
Malabsorption syndrome |
Excessive alcohol intake
(more than two alcoholic beverages a day) |
Primary hyperparathyroidism |
Excessive caffeine intake
(more than four cups of coffee a day) |
Propensity to fall |
Weight less than 57 kg (125 lb) |
Osteopenia confirmed by an x-ray |
Weight loss > 10% of weight at age 25 |
Hypogonadism |
Chronic heparin therapy |
Early menopause (before age 45) |
|
Adapted from: Brown JP, Josse, RG, et al. 2002 Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ Nov 12, 2002;167
Key Risk Factors for Fracture
Because osteoporotic fractures are an important cause of morbidity, disability and mortality, Osteoporosis Canada recommends that you also consider your risk factors for fracture which include:
- Prior fragility (low impact) fracture
- Low bone mineral density (BMD)
- Age
- Family history of osteoporotic fracture
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How Can You Monitor Your Osteoporosis Status?
Height Loss May Be a Sign of Osteoporosis
Height loss is an important tool in determining whether or not an individual has suffered a spinal fracture. Spinal fractures can lead to height loss. Depending on the number and type of spinal fractures, the individual can develop kyphosis (a humped or gradually rounded back).
If you have lost 2 cm of height within 1 year, there is a possibility you may have a spinal fracture. Two out of three spinal fractures due to osteoporosis occur without pain, so you may have already had a spinal fracture and not even know it. Make sure to tell your doctor if you have noticed any height loss.
Bone mineral density (BMD) test
A bone mineral density (BMD) test is a commonly used tool in the diagnosis of osteoporosis. The test is safe and painless, and involves lying on a table for several minutes while a small detector scans the spine or hip. The test is available upon referral by a physician.
Osteoporosis Canada recommends testing for individuals 65 yrs or older, those over 50 yrs old with one major or 2 minor risk factors for osteoporosis, and those with a history of fracture confirmed by an X-ray.
The bone mineral density test provides a measurement of mineral (e.g. calcium) in the bone, and is used to estimated bone mass. It does not measure the quality of the bone and is not commonly used to detect fractures.
Understanding your BMD test results
Your BMD test results will be reported as a “T-score”. Your T-score compares the thickness of bones [bone mass] in your spine and hip to what is considered normal for a young adult.
It is important to recognize that low BMD is only one of several risk factors for fracture. Some women who do not have BMD within the osteoporosis range may still experience a non-spinal fracture. Your doctor may assess for other risk factors for fracture including age, prior fragility (low impact) fracture, and family history of osteoporosis.
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How Can You Take Charge of Your Bone Health?
Calcium and Vitamin D
Calcium and vitamin D are both important for strong bones. Osteoporosis Canada recommends the following intake of calcium and vitamin D every day from all sources, to maintain strong bones:
| Calcium and vitamin D daily intake recommendations by Osteoporosis Canada |
| Age |
Elemental calcium |
Vitamin D |
19-50 |
1,000 mg |
400 IU |
50+ |
1,500 mg |
800 IU |
Calcium Counter Tool
| Calcium Counter Tool |
| Calcium Rich Foods |
Portion |
Calcium (mg) |
Calories (kcal) |
Milk (0% milk fat) |
250 ml (1 cup) |
319 |
90 |
Spinach (cooked) |
125 ml (1/2 cup) |
129 |
22 |
Cheddar cheese |
50 g (1 ¾ oz) |
363 |
202 |
Almonds |
125 ml (1/2 cup) |
206 |
428 |
Exercise
Helpful exercises are those that combine weight bearing and resistance (muscular strength) types of activities.
Weight bearing exercise is any exercise in which your feet are bearing your weight. This includes:
- Jogging
- Brisk Walking
- Stair climbing
- Dancing
Resistance training involves using muscular strength to improve muscle mass and strengthen bone. This includes weight lifting and free weights.
For older men and women at risk of falling or who have fallen, tailored programs should be made available. These programs should be multidisciplinary in nature, and contain exercises to improve strength and balance. Please ensure that you consult with your doctor before you begin any exercise program.
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Treatment OptionsThere are a variety of drug treatments available for people diagnosed with osteoporosis. The key treatment objective in osteoporosis is to prevent fracture. Not all therapies are appropriate for all patients and the choice depends on an individual assessment by a doctor.
The following drug treatments are only available by prescription. To obtain more detailed information on the properties and appropriate use of any treatment option, please consult your doctor.
| Bisphosphonates are the most commonly used drugs to prevent and treat osteoporosis. They work by binding to bone surfaces and slow down bone eroding activity. |
Actonel (R) (risedronate sodium tablets)
Didrocal (R) (etidronate disodium and calcium carbonate tablets)
Fosamax (R) (alendronate sodium tablets) |
| Selective estrogen receptor modulators (SERMs) act like the hormone estrogen in some parts of the body such as the bones. Estrogen helps to build and maintain bone density. |
Evista (R) (raloxifene hydrochloride tablets) |
| Hormone Replacement Therapy (HRT). Following menopause, the body produces much less of the sex hormones estrogen and progestin. HRT treatment is intenede to supplement these hormones to the lowest level required to prevent bone loss. |
HRT (tablets, patch, gel) |
| Parathyroid hormone (PTH) works by stimulating bone building cells. |
Forteo (R) (teriparatide injection) |
| Calacitonin is a hormone found naturally in our bodies. It controls the activity of bone-eroding cells. |
Miacalcin (R) (synthetic calcitonin-salmon nasal spray) |
No matter what treatment option is chosen, remember that an adequate intake of both calcium and vitamin D is required to maintain healthy bones. Talk to your doctor to find out if a treatment is appropriate for you.
Talk to your doctor about how to help fight fractures!
Actonel® is a registered trademark of Procter & Gamble Pharmaceuticals Inc. (USA), and is co-marketed with sanofi-aventis Inc.
Didrocal® is a registered trademark of Procter & Gamble Pharmaceuticals Inc. (USA).
Fosamax® is a registered trademark of Merck & Co., Inc.
Evista® is a registered trademark of Eli Lilly and Company.
Forteo ® is a registered trademark of Eli Lilly and Company.
Miacalcin® Nasal Spray is a registered trademark of Novartis Pharmaceuticals Inc.
© Copyright 2006. Procter & Gamble Pharmaceuticals Canada Inc.
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