Did you know over two million Canadians are affected by osteoporosis, with at least one in three women and one in five men experiencing an osteoporotic fracture throughout their lifetime? In this piece, learn about the symptoms, diagnosis, treatment, and support systems available to those individuals with osteopenia or osteoporosis.

What is Osteoporosis?

Osteoporosis is a disease where bones deteriorate, which causes them to become less dense, more porous, and brittle. The decrease in bone mass and strength leads to increased fragility and risk of fracture. As Osteoporosis Canada states, the most common fracture sites are the wrist, spine, shoulder, and hip.

What is Osteopenia?

Osteopenia is when your bones have started to deteriorate and are weaker than normal, but not so weak that they break easily (like with osteoporosis). Osteopenia is not inevitable, as healthy lifestyle choices such as diet, exercise, and medication, can help you maintain bone density throughout your life.

What Are Symptoms of Osteoporosis?

Anyone can get osteoporosis and may not present with symptoms for several years. Often people don’t know they have low bone mass until they suffer a fracture. If left untreated, the deterioration will progress, and you may notice some of the following signs:

• Receding gums and bone loss in the jaw
  While receding gums are quite common over time, one main symptom of osteoporosis is bone loss in the jaw. There is a strong correlation between receding gums, bone loss in the jaw, and decreased bone density in other important signal areas, such as the lumbar spine. If you are concerned about bone loss and the health of your jaw, talk to your dentist during a scheduled check-up.
• Decreased grip strength
  A clinical article on grip strength as a risk factor of osteoporosis written by Li et. Al (2018) from the Department of Orthopaedics and Radiology confirmed that low grip-strength is strongly correlated with low bone mineral densitometry (BMD). More specifically, patients with low BMD are more likely to suffer a fragility fracture, which usually stems from a fall. These falls occur because patients don’t have the muscle strength to maintain balance and grip-supporting structures. Therefore, decreased hand-grip strength is a reliable indicator of osteoporosis and bone deterioration.
• Weak and brittle fingernails
  Brittle nails can be a sign of hormonal changes and nutritional deficiency. Many studies have been conducted assessing the reliability of fingernails as a means of staging bone health, fracture risk, and osteoporosis. While a correlation between bone health and fingernail health exists, it is not significant enough to be used alone to assess osteoporosis.
• Height loss
  Losing height over time is normal and typically caused by muscle imbalances leading to poor posture and slouching. However, loss of height can also be associated with damage to the spine, usually indicating vertebral fractures. DEXA scans look for vertebral fracture assessments (VFAs) while examining the bone mineral content in the spine, which is useful in the diagnosis of osteoporosis.
• Fracture from standing height or less
  The most common symptom of osteoporosis is when a bone breaks too easily. Unfortunately, fragility is usually not noticed until an individual suffers a fracture from a low-impact incident that should normally result in a bump or bruise. Common low-impact incidents include falling out of bed, off a toilet, out of a wheelchair, or simply from a standing height.

Osteoporosis Diagnosis and Bone Density Scanning

Consult your physician if you notice any of the signs or symptoms above. If you are concerned about the fragility of your bones, your physician may send you for a bone mineral densitometry (BMD) scan. We offer this scan at 11 Insight Medical Imaging locations, including Leduc, Sherwood Park, Spruce Grove, and Fort McMurray.

This exam will detect calcium levels, assess bone loss and structural fragility, and provide a fracture assessment risk (FRAX). Once your physician has this information, they can determine if you are suffering from bone loss and, if so, the best course of action.

Who is at Risk for Osteoporosis?

Individuals with fluctuating estrogen levels are more likely to get osteoporosis because of two factors:

• Anatomy
  There is a high correlation between elevated estrogen levels and thinner, smaller bones that fracture easier.
• Menopause
  This leads to a significant decrease in estrogen. The sharp change in estrogen levels accelerates bone loss, increasing the chances that postmenopausal individuals develop osteoporosis.

Osteoporosis and Osteopenia Treatment

Educating yourself about osteoporosis and osteopenia is the first step, allowing you to recognize the signs and symptoms that you or a loved one might be showing. If you do notice these signs, evaluate your lifestyle habits, such as exercise, diet, vitamins, supplements, and medication. If you are considering bone loss medication, talk to your physician first to learn about potential risks and benefits. It is never too late to adjust your lifestyle and make positive changes such as:

Exercise
Exercise helps build muscle and strengthen bones. Building muscle helps you maintain your balance and reduces the chance that you will fall and hurt yourself. Strength training with weights or resistance bands can help your arms and upper spine and improve your grip strength. Also, consider weight-bearing activities like walking or jogging to help your lower body. If you are looking for specific exercise suggestions, read “Eight Exercises to Strengthen Your Bones.”

Diet
If you are suffering from low bone mass or fragility, there is a good chance you are not eating the right combination of food. For the bones in your body to absorb calcium, they need vitamin D. Therefore, your diet should include foods high in calcium and vitamin D.

Foods high in calcium include:
-Dark, leafy greens such as spinach, kale, and collard greens
-Dairy products such as milk, yogurt, cheese
-Almonds
-Whey protein
-Broccoli
-Edamame
-Tofu

Foods high in vitamin D include:
-Fish (salmon, trout, mackerel, swordfish, tuna)
-Mushrooms (maitake, shiitake, portobello, white)
-Cod liver oil
-Oysters
-Shrimp
-Egg yolks
-Pork

Vitamins and Supplements
The National Institute of Arthritis, Musculoskeletal, and Skin Diseases (NIAMS) recommends that men from 19 to 70 years old take 1,000 mg of calcium per day (1,200 for females). The institute also recommends a vitamin D intake of 600 international units (IU) per day for anyone under 70. The older you get, the higher the suggested intake (800 IU for 70+). These numbers can be hard to achieve from diet alone. Therefore, supplements and vitamins provide a quick and easy solution.

Calcium supplements should be taken in smaller doses (500 mg), multiple times throughout the day. The best time to take a calcium supplement is with a meal, as they are better absorbed when taken with food. It is also easy to get in a habit when you take your supplement at a consistent time every day.

The most common vitamin D sources include sunlight, diet, and supplements. Since your diet and time in the sun can easily vary, supplements provide an excellent alternative. The institute recommends no higher than 4,000 IU per day for adults unless otherwise instructed by your physician. If you are planning on taking calcium and vitamin D supplements, the best habit to get into is to consume them together at the same meal, every day.

Medication
Medication can have a positive and negative impact on bone mass development. Sometimes people take medicines for other conditions, such as hyperthyroidism, breast cancer, heartburn, and blood pressure. While medication may help with a disease such as cancer, you must be mindful of potential side effects like bone loss.

Conventional medication with bone loss side-effects includes synthetic glucocorticoids such as Prednisone, most commonly used for severe allergies, aromatase inhibitors such as Arimidex, widely used by breast cancer patients, proton pump inhibitors such as Pantoloc, typically prescribed for ulcers, and more.

To this day, one of the most common ways to prevent bone loss is to take prescription medications; however, only patients with severe bone loss conditions should consider medication treatments. Typically, making healthy lifestyle changes is a more sustainable and natural way to improve your bone mass.

Conventional osteoporosis drug treatments include bisphosphonates such as alendronate (Fosamax), antibodies such as denosumab (Prolia), and hormone-medication such as selective estrogen receptor modulators (SERMs).

If these options do not have a positive impact, your physician may suggest hormone therapy. Hormone therapy is usually used on women in menopause to help them maintain estrogen levels. Hormone medication is most often administered in the form of a pill or patch and used once or twice a week.

Be that as it may, hormone therapy has also been shown to increase the risk of blood clots, stroke, and heart attack. Your doctor will likely try other methods with less serious side-effects first.

Living with Osteoporosis

Any time a patient is diagnosed with a medical condition, they may feel alone, afraid, or helpless. If a patient does not address these feelings, they can spiral into depression. The most important thing to focus on is that you are not alone. There are many resources available to educate yourself, help address your emotions, and manage any physical pain.

Educational Resources and Support Programs

• Bilingual toll-free Information line
  English: 1-800-463-6842
  French: 1-800-977-1778

• Multilingual resources
  Osteoporosis Canada provides two different pdf brochures in 17 different languages on how to manage osteoporosis through exercise, nutrition, and medication. These languages include Arabic, Cree, French, Gujarati, Hindi, Italian, Korean, Ojibway, Oji-Cree, Polish, Portuguese, Punjabi, Russian, simplified Chinese, Spanish, Tamil, and traditional Chinese.

• Brochures and fact sheets by Osteoporosis Canada
  Drug Treatments: Their role in fracture reduction and treatment of osteoporosis.
  Men and Osteoporosis: It is not just a disease for women.
  Osteoporosis and Osteoarthritis: General information, including definitions, symptoms, diagnosis, risk factors, and treatment.
  Nutrition: Healthy eating leads to healthy bones.
  Diagnosis: The importance of comprehensive fracture risk assessment.
  Your Guide to Strong Bones: Nutrition guide, exercise, and medication.
  Secondary Osteoporosis: Drugs and diseases that can cause bone loss, falls, and fracture.
  Too Fit to Fracture: Managing osteoporosis through exercise.

• Support groups
  Telephone: 1-877-303-2642
  Alberta Health Services provides a toll-free, 24/7 telephone service, which offers confidential, anonymous advice, including crisis intervention and referrals to other agencies if needed.
  Online chat: Live Crisis Chat
  If you don’t feel like talking to someone over the phone, the Canadian Mental Health Association offers an online crisis chat for Edmontonians as well. The chat is available seven days a week. Monday to Friday from 6 p.m. to 10 p.m. (MST) and Saturday to Sunday from 12 p.m. to 4 p.m. (MST).

Pain Management Suggestions

Pain associated with bone loss or fractures can impact many aspects of your life. Managing this pain is essential for your physical and mental well-being. Standard pain management techniques include:

• Apply hot or cold packs
  Varying between hot and cold stimulation through bags, packs, or buckets can help relieve pain and encourage healing.
• Acupuncture
  Inserting special needles into precise locations in your body to stimulate nerves can help reduce pain and discomfort.
• Massage
  Fractures and bone loss can cause pain and tension in muscles surrounding the tissue. One of the best ways to relieve this muscle pain is through deep-tissue massage from a specialist. Talk to your doctor before seeing a massage specialist to ensure it is the best pain management technique for your condition.
• Physical therapy and activity
  Exercise and conditioning are one of the best ways to release natural endorphins in your body. These endorphins help relieve pain and improve your state of mind. These techniques also help build muscles, which will enhance agility. Talk to your doctor about the best form of physical activity based on your health and mobility.
• Relaxation techniques
  Several relaxation techniques, such as deep breathing, progressive muscle relaxation, and meditation, can help relieve muscle tension and reduce pain.

Take Action

Understanding osteoporosis and its risk factors, symptoms, treatment, and pain management techniques are the first steps. While a diagnosis can seem overwhelming, there are plenty of actionable therapies, resources, and support groups available so you can maintain a healthy and happy lifestyle. Low bone mass is preventable through active choices and responsible decisions. It is never too late to make positive changes to your routine.

References

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