osteoporosis
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Osteoporosis is a skeletal disease characterized by the thinning of bones and low bone quality that predispose an individual to bone weakening, making the bone brittle, weak, and susceptible to breakage6.  Since bone is a living tissue, it requires constant repair. A hall marker characteristic of osteoporosis is when the bone breaks down faster than the bone is capable of repairing and strengthening itself6,1.

Although osteoporosis can strike at any age, it is more prevalent among the older population5. Specifically, older women are more susceptible to osteoporosis than men4. Individuals that are white and Asian or those whom are menopausal are more susceptible to developing osteoporosis1 (Mayo Clinic, 2018). The majority of older adults are unaware they have osteoporosis until they experience an event or accident that causes their bones to break, for example, a fall or a daily task in their homes6.

Reports show that patients living with osteoporosis are 33% more likely to experience a fracture reoccurrence at the previously fractured site, illustrating that osteoporosis is a growing healthcare concern that the community should be knowledgeable about3.

Symptoms of Osteoporosis

With an early onset of osteoporosis, individuals are typically asymptomatic – they do not exhibit any symptoms. The individual diagnosed with osteoporosis will only realize they have it after they have broken a bone or have experienced an injury that compromises the bone’s integrity6. At that point, the disease is typically advanced and difficult to treat, illustrating the need for the public to become knowledgeable of the signs and symptoms of osteoporosis4.

While there are individual variations with osteoporosis, commonly reported symptoms tend to congregate in areas around the hips, wrist, and spine, as they are more prone to movement1,5:

  • Stooped posture or kyphosis – characterized by a forward arch in the cervical or neck region of the spinal vertebrae
  • Spinal vertebrae shrinkage – the fluid in the vertebrae loses its cushion-like characteristics, compressing the vertebrae
  • Back pain
  • Reoccurring bone fractures

Causes of Osteoporosis

One’s likelihood of developing osteoporosis is dependent on the bone’s integrity throughout life. The body during younger years goes through many cycles of bone creation and bone degradation. By the age of 20, most individuals reach their peak bone mass, that rescinds as we age1. Due to individual variation, one’s peak bone mass will differ from another individual. However, the amount of bone mass you have in your 20s will determine how susceptible you will be to osteoporosis in later years.

Risk Factors for Osteoporosis

Non-controllable Risk Factors

Risk factors that are out of your control:

  • Gender – women are more likely to develop osteoporosis than men as they experience a faster deterioration of their peak bone mass as they age6
  • Age – older adults are more susceptible to develop osteoporosis because of sarcopenia, frailty, and gradual bone loss1 (
  • Caucasian or Asian descent – individuals that are white or Asian are more likely to develop osteoporosis than other ethnicities due to lack of dietary nutrition6 (
  • Family history of osteoporosis – a relative that has previously experienced a hip fracture makes you more susceptible to osteoporosis
  • Small body frame – individuals with smaller body frames have a greater risk of developing osteoporosis because they have a lower initial peak bone mass than the average population; thus they are more likely to break a bone during their youth6.

Controllable Risk Factors

  • Diet – low calcium intake5
  • Medical conditions – Celiac’s Disease, inflammatory bowel disease, kidney or liver disease, cancer, lupus, rheumatoid arthritis1
  • Lifestyle – being sedentary, smoking, and consuming an excessive amount of alcohol have been associated with increasing one’s risk of developing osteoporosis1
  • Medications – corticosteroids, cancer treatment, and antidepressants2)

Tests and Diagnosis of Osteoporosis

Bone mineral density tests (DXA) can estimate one’s susceptibility to bone fractures and osteoporosis. Examples of these measurements could be the central dual-energy X-ray scan that compares normal bone density to those that may have increased susceptibility to osteoporosis. This scan typically takes 10 to 15 minutes and requires the patient to lie on a table with a mechanical arm scanning your entire body2.

Your general practitioner will typically advise you to have a bone mineral density scan if you are over the age of 50 with some of the aforementioned risk factors. If you have low bone mineral density score, you are more likely to develop osteoporosis or encounter bone fractures. Thus, it is important that older adults or those that are approaching 50 years old consult their doctor on their risk factors for developing osteoporosis in their later years2. Bone mineral density scans will typically divide patients into three categories: normal, osteopenia or osteoporosis2. Osteopenia has been defined as a bone density score that is low but not low enough to be classified with osteoporosis5. These individuals are more likely to develop osteoporosis in the future but can manage their increased risk factors with resistance-based exercise and dietary supplementation. Your general practitioner will follow up with another bone density scan within one to two years of osteopenia diagnoses. Individuals diagnosed with osteoporosis will begin treatment arrangements to ensure optimal levels of Calcium and Vitamin D absorption.

Treatment: Preventative Strategies, Lifestyle Changes, and Management

Although there is no cure for osteoporosis, there are many strategies to manage the negative adverse effects associated with it.

Calcium

Men and women require 1,000 mg of Calcium per day and this requirement increases for women over the age of 50 to 1,200 mg of Calcium per day. To reach your daily Calcium requirements, one should engage in the consumption of leafy greens (i.e. kale, spinach, arugula), soy products (i.e. tofu), calcium-fortified cereals, and low-fat dairy products (i.e. milk, cottage cheese, yogurt)1.

If some of these dietary requirements are difficult to meet, calcium supplementation is also another alternative. However, it is important to be aware of the over-consumption of calcium. One should not exceed 2,000mg of Calcium per day as it increases the risk for kidney stones and heart disease1.

Vitamin D

Vitamin D is also another mineral to consume to reduce osteoporosis as it increases Calcium’s absorption5. Adults over 50 years are encouraged to consume 800 to 1,000 IU of vitamin D5. This is achieved by being under the sun or through supplementation for those living in higher latitudes, those living farther from the Earth’s equator1.

Exercise

Exercise, specifically, resistance training, weight-bearing activities, and balance exercises have reported to slow bone loss and strengthen existing bones and muscles5. Specifically, resistance-based exercises that target the muscles and bones in the upper body and lower body together have strengthened and stabilized postural muscles that keep the body upright whilst reducing the risk of an older adult becoming frail in the future5. These exercises include a chest press, lat pull down, seated row, leg extensions, and leg press. Balance and stretching exercises can also reduce falls risk in older adults living with osteoporosis.  All of these movements and exercise suggestions are compound exercises that recruit many large muscle groups to ensure a strong body foundation.

Weight-bearing exercises coupled with resistance training have improved bone health and have reduced the rate of sarcopenia, also known as muscle loss, into old age5. Weight-bearing exercises include walking, jogging, stair climbing to all activate the stabilizer muscles in the lower body. These muscles include the hamstrings, quadriceps, gluteals, and erector spinae muscles of the lower back. Individuals can participate in sports or recreational activities that work on sustaining these lower muscles to prevent fall frequencies linked to osteoporosis.

Written by Jennifer Kaitlyn Chiu, BA (Hons)

References:

(1) (2018). Osteoporosis. Retrieved from https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-causes/syc-20351968.
(2) Osteoporosis Australia Medical & Scientific Advisory Committee (2014). Diagnosis. Retrieved from https://www.osteoporosis.org.au/diagnosis.
(3) Ontario Osteoporosis Strategy. (2016). About Us. Retrieved from http://www.osteostrategy.on.ca/aboutus/.
(4) (2018). What is osteoporosis? Retrieved from https://osteoporosis.ca/about-the-disease/what-is-osteoporosis/.
(5) Randolph, S. A. (2016). Osteoporosis. Workplace Health & Safety, 64(11), http://dx.doi.org/10.1177/2165079916674484.
(6) Simmons, S. (2011). Osteoporosis. Nursing, 41(1), 35-70.

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