Boning up on Bone Health Treatments

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Part 3

As I mentioned in an earlier post, Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine, wrist and shoulder.   A fragility fracture is a fracture resulting from a fall from a standing height and may be an indication of osteoporosis.  Most fractures in women past the age of 50 are fragility fractures. And yet, fewer than 20% of individuals with fragility fractures receive anti-osteoporosis treatment post fracture.  That is a gap in treatment as clearly a fracture is an event that is part of the diagnosis of osteoporosis, much like a heart attack being an event that helps diagnosis heart disease.   

Fortunately anti-osteoporosis treatments are used to both prevent and treat osteoporosis. Fortunately there are now a variety of medicines available today that can slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.

If you are diagnosed with osteoporosis, you may be prescribed an anti-resorptive drug.  There are a few medications in this category, either taken orally, by 6 month injection or once a year intravenously.  There are other medications on the market, but this is our common first choice.

These drugs can reduce bone loss and fracture risk and may actually help build some bone density. You and your physician need to review the drug treatment options, assessing the risks and benefits each offers and choose the best treatment for you, based on current scientific evidence. What is very reassuring is that physicians have excellent guidelines from Osteoporosis Canada as to what is a first choice option. We know each patient is different and the side effects or mode of administration may suit different circumstances in different patients. Some people respond better to one drug than another. Some people have side effects on one and not another.

         No matter what drug therapy you choose, remember that a diet rich in calcium and vitamin D is required to maintain healthy bones. Calcium is the cornerstone of strong bones. Adults up to age 50 need 1,000 milligrams per day. Beginning at age 51, women need 1,200 milligrams every day, and when men hit 71, they need to hit that mark, too. The pop star of calcium sources is undoubtedly milk. A single 8-ounce cup of milk, whether skim, low fat, or whole, has 300 milligrams of calcium.

Source: Source –www.OoteoporosisCanada.com)

Remember, healthy aging is all about how to take care of yourself today so that you can enjoy an active healthy life tomorrow and bone health is one part of the equation.

 

 

 

Boning up on Bone Health. Why diet & exercise are important in preventing Osteoporosis

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Part Two. *

Bone is a living tissue that is constantly renewed through a process in which old bone is removed and replaced by new bone. Cells called osteoclasts erode the bone, creating small cavities; bone-forming cells called osteoblasts then fill in the cavities with new bone. This is nature’s way of restoring bones and keeping them healthy.

In younger people with healthy bones, the osteoclasts and osteoblasts work together, maintaining healthy bones. However, after our mid-30s the process is not as efficient, and we begin to gradually lose bone. In someone with osteoporosis, bone loss occurs more rapidly, causing the bones to become thinner and weaker over time. If you have osteoporosis, you have already lost a significant amount of bone and may continue to do so unless you receive medication.  Over 80% of all fractures in people 50+ are caused by osteoporosis.

That’s why diet and exercise is recommended as part of an overall healthy approach to preventing osteoporosis.

 We need to emphasize the importance of regular weight-bearing exercise for bone health. Weight bearing exercise, where you use your body weight in activities such as walking, running and weight lifting will help your bones become denser. The result is that you develop more bone material, and your bones become denser. Brisk walking, dancing, tennis, and yoga have all been shown to help your bones.

It will also help your balance and strength, which could help to prevent falls

Diet

  • Calcium is the cornerstone of strong bones. Adults up to age 50 need 1,000 milligrams per day. Beginning at age 51, women need 1,200 milligrams every day, and when men hit 71, they need to hit that mark, too. The pop star of calcium sources is undoubtedly milk. A single, 8-ounce cup of milk, whether skim, low-fat, or whole, has 300 milligrams of calcium.
  • Not a milk drinker? A cup of yogurt has at least as much calcium as an 8-ounce cup of milk. And 1 ounce of Swiss cheese has nearly as much. Even if you’re lactose intolerant, yogurt and hard cheeses are low in lactose. Or try dairy products that are lactose-reduced or lactose-free. Removing lactose from milk and dairy foods does not affect the calcium content
  • You might be surprised to learn that calcium is plentiful in many vegetables. Go for dark leafy greens such as Bok Choy, Chinese cabbage, and kale. If dairy products, sardines, and leafy greens leave you cold, consider eating fortified foods. These are products that do not naturally contain calcium but have been enhanced with varying amounts of the essential mineral.
  • Breakfast foods are a great start — fortified orange juice has up to 240 milligrams of calcium, and fortified cereals deliver up to 1,000 milligrams per cup. Check the nutritional label for the exact amount.
  • Half a cup of calcium-enriched tofu has as much as 861 milligrams of calcium, but calcium is not the only mineral that gives bones a leg up. New research suggests plant-based chemicals called isoflavones strengthen bone density as well. Isoflavones are plentiful in soy foods, such as tofu, and seem to have an estrogen-like effect on the body. For some women, this is a positive side effect, while others may choose to limit their intake
  • Salmon and other types of fatty fish offer an array of bone-boosting nutrients. They contain calcium as well as vitamin D, which aid in calcium absorption. They’re also high in omega-3 fatty acids, important as antioxidants in the body

 Calcium Supplements

Supplements are an easy way to boost your calcium intake, but some reports suggest you may not need them. If you’re already getting enough calcium from food, taking more in pill form won’t contribute to bone health. Experts say there’s little benefit in getting more than 2,000 milligrams of calcium per day, and too much can lead to kidney stones. For the best absorption, take no more than 500 milligrams at one time. Some calcium supplements, such as calcium carbonate, are better absorbed if taken with meals; however, calcium citrate can be taken anytime

Vitamin D

 

 

Vitamin D helps the body absorb calcium and store calcium from the foods we eat. Our bodies can produce vitamin D when we are exposed to sunlight. However, during the winter months, most Canadians do not get enough sun exposure to produce adequate amounts of vitamin D, nor do we get enough vitamin D through our dietary intake. However, Vitamin D intake can be enhanced through dietary sources and supplements.  It is important to continue to take Vitamin D, even in the summer months, as we tend to wear sunblock that limits the absorption of vitamin D.

Osteoporosis Canada recommends the following intake of vitamin D (total intake through diet and supplementation) on a daily basis.  For people age 19-50; 400-1,000 IU, and for those of us over the age of fifty; 800-2,000 IU’s.

* Source – http://www.osteoporosiscanada.com

 

No Bones about it: Protect Yourself From Osteoporosis

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Part # 1

A ninety-four year old woman has had two major falls in the past twenty years. Upon falling down a flight of stairs, she fractured her arm. More recently, when this tiny woman was picked up by a gust of wind and then dropped on the parking lot pavement one icy winter day, she fractured her elbow.  In both situations she could have also easily broken her hip or spine yet she didn’t. She recovered fully, continues to drive, live independently and most importantly enjoys a healthy and active life.

At ninety-four she most certainly has lost bone mass which peaks at the age of 16-20 for girls and 20-25 in men.  As women approach menopause they lose bone mass at the rate of 2-3% a year. Yet it would seem that a healthy diet, regular weight-bearing exercise and preventative medication are able to decrease the risk of fractures and the advance of osteoporosis.  And in a healthy, fit, active person, even when there is a fracture, there is better healing and recovery.

What is osteoporosis? 

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue. This leads to increased bone fragility and risk of fracture (broken bones), particularly of the hip, spine, wrist and shoulder. Osteoporosis is often known as “the silent thief” because bone loss occurs without symptoms. Osteoporosis is sometimes confused with osteoarthritis, because the names are similar. Osteoporosis is a bone disorder, with loss of the normal strength and quality of the bone, as well as a decrease in the amount of bone. Osteoarthritis is a disease of the joints and surrounding tissue, often described as wear and tear of a previously normal, smooth joint.  *

Consider this:

Osteoporosis can strike at any age and affects both men and women.

The most common sites of fractures are the hips, wrist, spine and  shoulder.

At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime.

Twenty-eight per cent of women and 37% of men who suffer a hip fracture will die within the following year.

Over 80% of all fractures in people 50+ are caused by osteoporosis.

How can you protect yourself?

Fortunately, there are a variety of ways an individual can protect or improve their bone health.

Have your physician conduct a fracture risk assessment! This may include a bone mineral density test, (BMD) which determines the amount of healthy bone you maintain.  Risk assessment is also evaluating your personal risk, your family history, your age and other complicating factors.  The average age for a BMD is 65 according to Osteoporosis Canada, but a risk assessment begins at age 50!

The two main issues I try to look at with every patient over the age of 50 is significant height loss, yes that’s why we measure your height, and if you have had a fracture since I last saw you–that way I quickly have an idea if there is an increased risk of osteoporosis in that patient.

Eat a healthy diet of calcium rich foods such as leafy greens and dairy products or soy-based products if you are averse to dairy.

Take Calcium & Vitamin D. If you are eating well, you may be getting enough calcium in your diet and supplements are not needed.  Generally speaking, we all need Vitamin D supplements as we get little direct sunlight in North America and that is the common source of Vitamin D.

For those over 50, Canada’s Food Guide recommends 3 servings of milk and alternatives – yogurt, cheese, calcium-fortified beverages, puddings, custards, etc.

This essentially means that, if you are over 50, you need the equivalent of one good serving of dairy at each meal or 1200 units a day of calcium supplements.

I have yogurt each day and at least one latte, so I often decide at night if I have had that 3rd serving of dairy that day.  If not, I take 500mg of Calcium.  If I have had 3 servings, then the third calcium is not needed and NOT advised. More is not better. So you can decide day by day, depending on your diet as it is normal for this to vary a bit every day.

Vitamin D a day –400-1000 IU’s for adults under 50 and 800-2000 IU for adults over 50.  That is a must!

Exercise.  Use weight-bearing exercises that uses your body weight such as walking, running, weight lifting to help to strengthen both bones and muscles, as well as improving your balance.

Consider taking medications that build bone density and prevent bone loss if your risk assessment is significant and you are at risk for fracture. We know that low risk individuals have less than a 10% risk of fracture in the next year and can do well with diet and exercise.  High-risk folks have a greater than 20% risk and should be on medications. And for those of us between 10 and 20%, the moderate risk patients, the decision is individualized, as there are more issues to consider this is the art of medicine and warrants a discussion with your physician.
*Osteoporosis Canada  WWW.osteoporosis.ca

March is Nutrition Month: Four simple ways to keep you and your family healthy

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This years’ Nutrition Month 2013 campaign by the Dietitians of Canada is focusing on healthy eating. Their campaign slogan is Best Food Forward: Plan, Shop, Cook, Enjoy!

And the best way to focus on healthy eating is to start at the grocery store. It’s where most consumers buy much of their food. Yet this is also where consumers face a multitude of choices.

Why is healthy eating more important than ever? According to Ashley Grachnik, RD, CDE, a Registered Dietitian and Certified Diabetes Educator,  obesity and Type 2 Diabetes are on the rise.   And it’s not just a US issue, it’s happening in Canada too. It is estimated that almost three million Canadians have Type 2 Diabetes and the numbers are rising[1].

Type 2 Diabetes is a condition in which your pancreas does not produce enough insulin to move sugar out of the blood and into the cells for  Or your cells are resistant to the amount of insulin your pancreas does produce.  Sugar builds up in the blood and, if left uncontrolled, Type 2 Diabetes can lead to blindness, heart disease and kidney failure among other health issues impacting quality of life and longevity.  Type 2 Diabetes used to develop after the age of 40, but with the increase of our waistlines and decrease in our activity level we’re seeing diabetes at a younger age[2].  Unfortunately we’re seeing more children diagnosed with this disease.

Start today

However with healthy eating and a few simple tips to keep you and your family healthy, you can prevent Type 2 Diabetes. You don’t need a lot of time.  You don’t need a lot of money.  You can start to make these changes today.

Here are Ashley Grachnik’s Top Tips help you make these changes today.

1.     Make fibre your friend!

What is fibre, anyway? Fibre is part of plant-based foods that we can’t easily digest or absorb into our blood stream.  Fibre keeps us feeling full and satisfied and when you fill up on fibre it is easier to cut back on less healthy things like fat and sugar.

One easy way to boost your fibre is to cut out fruit juice, which has no fibre, and eat whole fruit instead to get a few grams of fibre per serving.  Have you ever squeezed your own orange juice? It takes about 3-4 oranges to get the amount of juice you’d drink in a medium-sized glass.  And after that medium-sized glass of juice when you’re still hungry, you’d probably eat a meal or snack to fill up.  When is the last time you sat down and ate 3-4 oranges in a sitting? You’d be full and satisfied long before you finished all 3-4 oranges because of the fibre.  And you’d stay feeling full for longer than if you drank that glass of juice.  Instead of packing a juice box with your child’s lunch, try a bottle of water and a piece of fruit instead.  Need some flavor with your water? Try adding some lemon or lime wedges instead.

Choose whole grains. Switch your breads and pastas to whole grain.  If your children are picky try mixing whole wheat and white until they get used to the flavor.

2.     Avoid portion distortion!

I’m sure you’ve heard about portion control before, but most of us find it difficult without the right tools.  It’s easy to do if you know how to balance your plate.

Here’s the trick, put your knife across the middle of your plate separating your plate into 2 equal halves.  Fill one half up with vegetables.  Veggies are loaded with fibre so they help fill you up, they don’t raise blood sugars because they are low in starch and they’re also low in fat.  Now take your fork and separate the other half of your plate into quarters.  One quarter is for your starch (1 cup of whole grain pasta or 1 small baked potato) and the other quarter is for your protein (4-5 oz meat, fish or poultry).

Still hungry?  Wait about 10 mins then go back for seconds of your veggies…you likely won’t still be hungry after that!

3.     Get Cooking!

Make healthier versions of your favourite take-out or restaurant choices at home.  Do you have the local pizza place on your speed dial?  Delivery pizza and even frozen pizzas are high in fat and sodium and often lack fibre.

A healthier and portion controlled version is pita pizza.  Take a 6-inch whole grain pita as your crust.  Use a low sodium pizza sauce.  Lightly sprinkle low-fat mozzarella and top it off with your favourite veggies.  Pop it in the oven or toaster until the cheese melts and you’re done!  You can control the portion by having 1 small pita and you can limit the fat by watching the amount of cheese.  Everyone in the family can help with the food prep and can personalize their pizza with their favourite veggies.  The best part about this meal is how quick it is to make – the cook time is fast since there is no dough to cook.  Save even more time by buying pre-cut and washed veggies.

4.     Get moving!

So exercise is not everyone’s idea of a good time but he reality is we need to get  active to stay healthy.

The next time you take your kids to soccer practice don’t just sit on the side lines until practice is over, walk the perimeter of the field as many times as you can until you work up a sweat.  When it’s time to take your kids to a play date, walk instead of drive and you both will benefit.  Or the next time your kids want to play video games, take out the Wii Fit or XBOX KINECT and challenge them to an active game that keeps you moving.  Being active can be a fun family activity all it takes is a bit of creativity!

These 4 simple tips will help you get your family on track to eating and living healthy!

Written by Ashley Grachnik, RD, CDE  -Registered Dietitian and Certified Diabetes Educator. I work with adults and families to prevent and manage diabetes t

[2] Children and Type 2 Diabetes, Canadian Diabetes Association http://www.diabetes.ca/diabetes-and-you/youth/type2/

Top Ways to Manage Stress & Lead a Healthier Most Positive Life

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A few more tips..Part 2

We all have stresses in our lives…but if those stresses are positive and stimulating, we are productive, interesting and ultimately satisfied.   It is also important to recognize that stress that can be overwhelming but if you adopt the appropriate strategies you will be able to cope and conquer stress.

Here are a few more tips to manage stress.

Change your behaviour

Get organized—poor organization is one of the most common causes of stress. Prioritize your objectives and your duties and activities to make them more manageable and achievable.  Good organization will help to avoid personal and professional chaos and protect against “out of the blue” problems.

Vent–A problem shared is a problem halved. Develop a support network through friends or colleagues to talk with. It’s not always events that are stressful but how we perceive them. Often friends add new perspectives that could lessen your stress.

Use humor—cliche as it might seem, laughter is the best medicine. It is a good stress reducer at home and at work and it relieves muscular tension, improves breathing, pumps those good endorphins into the bloodstream.

Take time out—Get away from things that bother you and give yourself time to reduce your stress level and calm down to think logically.

Be assertive

Assertiveness helps to manage stressful situations, and will, in time, help to reduce their frequency.  Lack of assertiveness often shows low self – esteem and low self – confidence.

Time Management  

Make a list.  What MUST be done vs. What SHOULD be done vs. What would you LIKE to do? Cut out time-wasting and unimportant activities. Learn to drop unimportant activities

And JUST SAY NO.  Plan your day. Set achievable goals. Don’t waste time making excuses for not doing something

Change your lifestyle

Diet.  Nutritional stress is actually a major type of physical stress in today’s 2.0 world.  Are you eating chemically and toxin loaded food and expecting your body to cope? Are you smoking and drinking too much caffeine and alcohol?

Exercise.  Exercise.  Exercise.

Exercise uses up excess energy released by the “Fight or Flight” reaction. It helps improve blood circulation and pumps those feel good endorphins into your bloodstream. We are less stressed, less fragile, when we feel strong and healthy.

Sleep

Sleep is essential for adequate brain function. Often when people are stressed they lose sleep. One great way to purge your body of stress so your mind can relax is to learn progressive muscle relaxation and deep muscle relaxation techniques. Meditation is also a valuable tool to relax your body and quiet your mind — it can easily transition you into sleep.

It’s not too late to get the flu shot!!!

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The flu is hitting Toronto and other parts of the country hard, with an earlier than usual start to the season! And there has been a big spike in the number of cases according to Flu Watch, the national surveillance system that monitors its spread.  Flu Watch reports that as of December 15th, there were 3,557 cases reported in Canada, compared to the same period last year of only 188.

In Ontario, Toronto Public Health reports there have been 238 hospitalizations and 15 deaths.

What this means is that if you haven’t gotten a flu shot, it’s not too late, you should get it.  With so many people getting ill this season, it only makes sense to make the effort and help reduce both your chance of illness, as well as reducing the chance of spreading the disease

In Ontario, flu shots are available at pharmacies as well as your family physician’s office. And in Ontario, the Ontario Health Plan covers the shot for all ages.

The Flu is not the same as a cold although some of the symptoms may be the similar.With the flu, you usually develop a fever of 38 C (100F) or higher.  While you feel feverish, and you can also get the chills, body aches and you may experience headaches. Generally you are tired and may have a cough and a sore throat. You may feel nauseous.

The best care is to stay home until your fever has been gone for 24 hrs. You need to drink plenty of fluids, eat healthy foods, and gargle with salt water. Avoid contact with others and wash your hands often. And get plenty of rest.  There are antiviral medications that are sometimes advised, particularly in the elderly and high-risk patients.  The medications may help to shorten the course of the infection

If you’ve had a flu shot this year, but still get the flu, chances are it will be much less severe than if you were unprotected.  So you are less likely to need the emergency room and in hospital treatment.  And that’s what it’s all about.  We can’t avoid every case of influenza, but we can decrease our chance of a serious episode!

 

Your Comments and Topics Welcome

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As the Toronto Branch President of the Federation of Medical Women of Canada, I am very active in efforts to raise awareness for women’s health. I  am also a family physician in Toronto and Vice-President of Medisys Corporate Health.

My blog is about highlighting  important issues in women’s health, health promotion, and disease prevention, as well as keep you up to date with new research and changes in recommendations and guidelines related to these topics and as a resource for both patients and physicians looking for a credible source of information.

Most importantly this blog is for you.  Thanks to a comment by a reader who wanted to know how to suggest topics- I want to remind you to post your suggestions on topics by submitting them in the comment part of my blog posts. I will do my best to follow up.

I also want to say hello to readers at http://www.menopauseandu.ca- a website of The Society of Obstetricians and Gynecologists of Canada where this blog is also featured. I look forward to your comments and feedback as well.