November is Osteoporosis Month

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 disease; osteoarthritis is a disease of the joints and surrounding tissue.

Prevalence

Fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined.

Checklist for Risk of Broken Bones and Osteoporosis


Part A:  

□ Am I 65 or older?

□ Have I broken a bone from a simple fall or bump since age 40?

□ Has either my mother or father had a hip fracture?

□ Do I smoke?

□ Do I regularly drink three or more alcoholic drinks per day?

□ Do I have a condition that requires me to use a glucocorticoid medication such as prednisone?

□ Do I take any other medication that can cause osteoporosis such as an aromatase inhibitor for breast cancer or hormonal treatment (androgen deprivation therapy) for prostate cancer?

□ Do I have a medical condition that can cause bone loss or fractures? Examples include rheumatoid arthritis, celiac disease, gastric bypass surgery, COPD (chronic obstructive pulmonary disease) or chronic liver disease.

□ Did I have an early menopause, i.e. before age 45?

□ Have my periods ever stopped for several months or more (other than for pregnancy or menopause)?

□ Have I ever suffered from impotence, lack of sexual desire or other symptoms related to low levels of testosterone (male sex hormone)?

□ Do I currently weigh less than 60 kg or 132 lbs?

□ Have I lost more than 10% of my body weight since age 25?

□ Have I recently had an X-ray that showed a spinal fracture?

□ Have I had an X-ray that showed low bone mineral density?

If you are over 50 and have checked one or more of the above, Osteoporosis Canada recommends that you talk to your doctor to see if you need a bone mineral density test and about doing a comprehensive fracture risk assessment with FRAX or CAROC. 

If you are under 50, it is very unlikely that you need a bone mineral density test unless you have a chronic medical condition or medication that puts you at high risk for fractures. If you are unsure, speak to your doctor.

Part B:  

□ Have I lost 2 cm (3/4″) in height as measured by my healthcare provider, or 6 cm (2 1/2″) overall from when I was younger?

□ Do I have kyphosis (a forward curvature of the back)?

If you are over 50 and have checked one or more of the above, Osteoporosis Canada recommends that you talk to your doctor about getting checked for the possibility of a spine fracture. This is done with a regular back X-ray. 

Part C:  

Frequent falls can lead to broken bones.

□ Have I fallen two or more times in the past year?

□ Do I have an unsteady walk and poor balance?

□ Do I need to push with my arms to get up from a chair?

□ Do I need an assistive device such as a cane, walker or wheelchair?

If you have checked one or more of the above, you are at risk of falling and you need to take steps to prevent falls.


Exercises

  1. Strength training

Strength training refers to exercise where free weights (e.g., dumbbells), weight machines or exercise bands are used to make the bones and muscles work by lifting, pushing or pulling a “load.”

Strength training is a type of exercise with the goal of improving muscular strength. It involves performing movements against resistance; it is sometimes referred to as resistance training. Exercise bands, weights, machines or even your own body weight can be used for resistance. Strength training may increase spine and hip bone mineral density.

  1. Posture training

Posture training involves paying attention to how the parts of our body are aligned with each other. The alignment of the vertebrae of the spine can become a concern among individuals with osteoporosis. Some kyphosis, or curvature of the upper back, is normal, but fractures or weak back extensor muscles can cause the spine to curve more than usual, resulting in an exaggerated kyphosis or excessively curved upper back.

Poor alignment, especially during activities that involve bending and twisting, can cause increased loads on the spine and result in fractures. Attention to alignment during activity and at rest, along with exercises targeting the back extensor muscles, can improve the alignment of the spine.

  1. Balance training

Balance training exercises are those that challenge your balance. Examples include:

  1. Reducing your base of support (e.g., standing on one leg instead of two, walking on your toes or your heels),

  2. Walking in an unusual pattern (e.g., heel to toe walking in a line, figure eights),

  3. Shifting weight to the limits of support (e.g., moving your weight more to one foot than another).

Physical activities like dancing, or Tai Chi, that involve balance and coordination may also reduce falls and fractures.

Tai Chi is a very safe and effective low impact form of exercise that improves balance and reduces the risk of falls.

  1. Weight bearing aerobic physical activity

An activity can be considered aerobic physical activity if:

  1. It is a rhythmic activity that you do for at least 10 minutes at a time continuously, and

  2. It increases your heart rate and makes you breathe harder than you usually do during your daily activities.

Canada’s Physical Activity Guide suggest that ALL adults (including those over 65 years of age) participate in at least 30 minutes of moderate to vigorous intensity physical activity on most days of the week (5 days a week or more). Moderate intensity exercise is exercise that makes you work and breathe harder; you could probably still have a conversation, but you couldn’t sing while doing it. With vigorous exercise, you are working and breathing harder, and it would be difficult to talk or sing.


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