Osteoporosis

• What is osteoporosis?
• What are the risk factors for osteoporosis?
• Is hormone therapy an option if I have a medical history that suggests that osteoporosis could be in my future?
• Is hormone therapy my first option if I know I have osteoporosis?
• What are some of the early signs of osteoporosis?
• Are there nutritional or other supplements that I can take to prevent or delay the onset of osteoporosis?
• How does exercise affect my chances of osteoporosis? What if I already have been diagnosed with osteoporosis?
• What are some of the best weight bearing exercises that help prevent osteoporosis, or slow its progress?

What is osteoporosis?

Osteoporosis is defined as an impairment in bone strength due to abnormal quantity and/or quality of bone. This deterioration of bone tissue increases the risk of fracture. The most common fractures associated with osteoporosis are the hip, spine, wrist, and shoulder. At least 1 in 3 women will suffer from an osteoporotic fracture during their lifetime. Nutrition and exercise both play important roles in keeping bones healthy.

What are the risk factors for osteoporosis?

The following factors put women at some risk of osteoporosis:

• Older age (>65 years)
• Fragility fracture after age 40
• Prolonged use of glucocorticoids
• Use of other high-risk medications (e.g., anti-epileptic drugs, high dose thyroid medication, opioids)
• Parental hip fracture
• Vertebral fracture or osteopenia
• Current smoking
• Alcohol (consistently more than three drinks a day)
• Low body weight (<60 kg)
• Major weight loss (>10% of body weight at age 25)
• Rheumatoid arthritis
• History of irregular periods, no periods or an eating disorder
• Malabsorption syndrome
• Primary hyperparathyroidism
• Infrequent exercise
• Life-long low calcium intake
• Low vitamin D intake

Is hormone therapy an option if I have a medical history that suggests that osteoporosis could be in my future?

Even short-term hormone therapy (HT) can improve a women’s bone structure, and then other medications can be used to sustain bone health over the longer-term. The Women’s Health Initiative in the United States, a randomized clinical trial involving menopausal women, found that HT was clearly effective in the prevention of hip fractures, vertebral breaks and other injuries. The response is dose-related and persists after stopping estrogen-alone therapy. The SOGC Consensus Report, however, does not recommend HT as a first line therapy for osteoporosis, but HT may be recommended for certain individuals with the disease.

Is hormone therapy my first option if I know I have osteoporosis?

Doctors may prescribe hormone therapy (HT) specifically for osteoporosis, particularly if one of the more typical treatments is not suitable. HT does deliver a secondary benefit for women who are using it to deal with other troublesome menopause symptoms.

What are some of the early signs of osteoporosis?

Usually osteoporosis does not cause any symptoms until a break occurs. One sign may be loss of height. By the time a bone fracture occurs, even after a small fall, osteoporosis may have already done its damage. Understanding the risk factors previously mentioned, is the best way to determine if you are at risk for osteoporosis.

Osteoporosis Canada recommends that all postmenopausal women, men over 50, and all individuals over the age of 65, be assessed to see if they are at risk for osteoporosis. Assessment involves measuring your height annually and assessing bone mineral density (BMD) which is safe and painless, much like an X-ray. A BMD test can tell you whether or not you have osteoporosis and how likely you are to develop it in the future, and can help you to make decisions now that may prevent fractures or further bone loss. You may also have a blood test to measure your calcium levels and other markers of bone health.

Are there nutritional or other supplements that I can take to prevent or delay the onset of osteoporosis?

To reduce the risk of osteoporosis you should consume 1000-1200 mg of calcium per day, and 800 IU of vitamin D per day. It is preferable to get your calcium from foods (3 servings of dairy or calcium-fortified products per day). To determine your calcium intake, you can use Osteoporosis Canada’s Calcium Calculator. If you are not able to get your calcium through your diet, a supplement can be taken instead. Choose a slow release formulation, or take smaller divided doses of calcium, rather than one large supplement. You should also engage in weight bearing or resistance training exercise to help maintain strength, balance and flexibility, and not smoke.

How does exercise affect my chances of osteoporosis? What if I already have been diagnosed with osteoporosis?

Exercise is important at every stage of life, and it is never too late to start.  Weight bearing exercise such as walking, or lifting a reasonable amount of weight has a positive impact on bone mass. Other types of exercise help keep you flexible and improve your balance, factors that could help you avoid a fall leading to a bone break.

What are some of the best weight bearing exercises that help prevent osteoporosis, or slow its progress?

The ideal exercise program for women just before, at, and after menopause should include some weight bearing, some strengthening and some stretching exercises.

Since your bone mass begins to diminish as menopause is reached, weight bearing exercise is especially recommended. As pressure on your bones is applied, the body’s natural defence system wants to spread the load and actually builds more bone. Activities such as brisk walking, low-impact aerobics, and dancing are considered “weight bearing” exercises.

Stretching exercises keep muscles flexible and toned, and tend to make us relaxed as well. Yoga is a good example of exercise with the stretch built in. Resistance exercises that require lifting or pulling, sometimes known as weight training, should also be part of your exercise program.