Tag: osteoporosis

Osteoporosis is a condition in which there is a gradual softening of the bones which makes them fragile. It is caused by the loss of calcium. Our current understanding has been that osteoporosis occurs most often in women after the age of menopause. Men can suffer from osteoporosis as well when they experience low levels of testosterone.

Bone fracture is a common complication of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. A person may lose height if the vertebra collapses due to osteoporosis. One may develop a hump if several vertebrae collapse.

Other causes of osteoporosis for men and women are: long-term use of corticosteroid medication, maternal osteoporosis, smoking, heavy drinking, sedentary lifestyle, low body weight and medical conditions that affect absorption, such as celiac disease. Diagnosis of osteoporosis is made by measuring bone mineral density.

A recent article in the CMAJ says that our understanding of and approach to osteoporosis is in the middle of a revolution. Research now shows the bone loss begins before menopause and involves other hormones in addition to estrogen, and that measuring bone mineral density alone is an inefficient way of addressing the clinical burden of osteoporosis.

The ongoing Canadian Multicentre Osteoporosis Study also shows that both men and women experienced an additional phase of accelerated bone loss from age 70 onward. Hormone replacement therapy with estrogen in women does protect against bone loss over time.

The finding that bone loss began before menopause indicates that estrogen loss alone cannot account for the changes. Therefore, interest has focused on other hormones whose levels change in early menopause such as follicle-stimulating hormone and the activins and inhibins. The role of steroid produced in the body and the size of the body composition is being determined.

The current national guidelines recommend that the test for osteoporosis (measuring bone mineral density) should be done every 2-3 years. In one of the CMAJ articles, Berger and colleagues suggest that densitometry for most women can be repeated every five years rather than every 2–3 years because the average changes in bone density over 2–3 years is small and comparable to the measurement error in the scanning technique.

There is also a question whether women who are already receiving treatment for osteoporosis should have follow-up assessments of bone density at all, since changes in density as a result of therapy account for only a small component of the effectiveness of these medications, says the CMAJ article.

There are four key points in the CMAJ articles: bone loss in women begins before menopause and is accelerated in old age, medications which reduce the loss of calcium from the bone helps preserve bone density, the interval between bone density assessments can safely be increased to 5 years for many untreated women and finally, decisions about when to test and treat will increasingly focus on estimates of absolute fracture risk as indicated by the bone density test.

Osteoporosis is treated with calcium and vitamin D supplements, a variety of hormone treatments (hormone replacement therapy like estrogen) and Bisphosphonates, a group of drugs that prevent bone breakdown and can be very effective in osteoporosis. But prevention is better than cure. So, increase calcium and vitamin D in your diet, increase the amount of weight-bearing exercise you do, reduce your alcohol intake and quit smoking.

So, have you had your glass of milk today?

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Soon to be 90, the former U.S. president, Ronald Reagan, falls at home and breaks a hip. A middle-aged physician falls in his back yard and breaks his arm. A young nurse falls in the hospital parking lot and breaks an ankle. A teenager falls on the ski hill and breaks a wrist. A child trips and falls down and cracks his skull.

All this happens within a few days. You wonder who is going to be next? Is anybody immune to falls and injuries? No! Falls account for 75 percent of all injury-related in-hospital deaths. And our seniors are at high risk.

One-third of Canadians admitted to hospital with an injury are aged 65 or older. Approximately, 60 percent of persons who die from falls are 65 years old or older, and falls account for 87 percent of all fractures in older adults.

You may say, “Enough of statistics, Doc! What’s your point?”

The point is that 90 percent of injuries are predictable and preventable. And we can do a lot to prevent our seniors getting hurt.

It is not unusual to see one of our local seniors walking on a wintry slippery road to catch a bus or go shopping. The next thing you hear is that grandpa fell on icy roads and broke a hip.

I know some businesses do provide delivery services to our seniors for a fee. Are all businesses doing the same? Are seniors aware of these services and taking advantage of it?

This is just one example of how seniors are at risk of hurting themselves. Studies have shown there are many reasons why seniors fall and break their bones. And it is not always on icy roads. And there is a lot we can do to prevent this happening.

Hip fracture is the most frequent serious consequence of falling among seniors. Osteoporosis is one of the main reasons. Can we prevent osteoporosis?

Prevention of osteoporosis should start in childhood with an adequate intake of calcium, says an article in the New England Journal of Medicine. Hormone replacement therapy (25 percent reduction in hip fractures), calcium and vitamin D supplements in later life (23 percent reduction in hip fractures), active weight-bearing exercises (40-50 percent reduction in hip fractures), and combining these programs with balance training reduces osteoporosis and the risk of hip fractures, says the article.

Multimodal programs and interventions have shown success in preventing fall among the seniors. Home visit by a nurse and a physical therapist can assess and treat postural drop in blood pressure, discontinue sedatives and other medications which impair balance and walking, eliminate or modify hazards in the home, encourage exercise programs and gait training, and plan behavioural modification. These actions can reduce the risk of falling by 31 percent.

One thing we cannot control is the weather and slippery road conditions. Here the prevention is to stay home and seek help from family, friends and neighbours.

Nobody is immune to falls and fractures. But our seniors are the most vulnerable. Let us help them stay healthy and well. And they have to learn to ask for help. If you don’t ask then you don’t get it!

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