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. *
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