What is it and who gets it?

Osteoporosis, which means “porous bones,” causes bones to become weak and brittle, so brittle that even mild stresses like bending over, lifting a vacuum cleaner or coughing can cause a fracture. In most cases, bones weaken when you have low levels of calcium, phosphorus and other minerals in your bones. Osteoporosis can also accompany endocrine disorders or result from excessive use of drugs such as corticosteroids. Osteoporosis is often known as the “silent thief” because bone loss occurs without symptoms.

1.4 million Canadians suffer from osteoporosis, 1 in 4 being women over 50. One in eight men over 50 also have the disease. However, osteoporosis is found in all age groups. In Canada alone, the annual cost of treating osteoporosis and the fractures it causes is estimated to be $1.3 billion. With an increasingly aging population it is estimated that by 2018 Canada will spend at least $32.5 billion treating osteoporotic fractures. This type of financial forecast emphasizes the importance of effective osteoporosis prevention and treatment strategies.

How do I know if I have Osteoporosis?

Osteoporosis is a disease that can develop undetected for decades, until a fracture occurs, and this is why early diagnosis is important. The first step is to identify what risk factors apply to you. There are major and minor risk factors associated with the development of osteoporosis and the more risk factors that apply to you the greater your chance of developing the disease.

Major risk factors

• Fracture with minimal trauma after age 40
• Family history of osteoporotic fracture (especially if your mother had a hip fracture)
• Long-term (more than 3 months) use of glucocorticoid therapy such as prednisone
• Medical conditions (such as celiac disease, Crohn’s disease) that inhibit absorption of nutrients
• Primary hyperparathyroidism
• Tendency to fall
• Osteopenia apparent on x-ray
• Hypogonadism (low testosterone in men, loss of menstrual periods in younger women)
• Early menopause (before age 45)

Minor risk factors

• Rheumatoid arthritis
• Hyperthyroidism
• Medications such as : isoniazid, furosemide, heparin, tetracycline, anticonvulsants, cortisone, prednisone
• Nulliparous (never had full-term pregnancy), therefore no extended periods of high estrogen
• History of amenorrhea, infrequent menses, late menstrual onset, anovulation
• History of anorexia nervosa, diabetes mellitus, Cushing’s disease, hyperthyroidism, hyperparathyroidism
• Age/being female
• Body weight less than 57 kg (125 lbs.)
• If your present weight is more than 10% below your weight at age 25
• Low calcium intake
• Excess caffeine (consistently more than 4 cups a day of coffee, tea, cola)
• Excess alcohol (consistently more than 2 drinks a day)
• Smoker

Assessing your risk factors can help you identify those that you can change. Some of these factors are a result of heredity; others are lifestyle factors. By making changes in your lifestyle, you are doing something to improve your bone health and lower your risk of developing osteoporosis. Assessing the risk factors that apply to you does not scientifically determine whether you actually have osteoporosis but it may lead you to identify and change certain lifestyle habits or to consult with your physician to have further testing.

The only way to diagnose osteoporosis and determine your risk for future fracture is through Bone Mineral Density (BMD) testing. A BMD test measures the density of your bones (bone mass) and is necessary to determine whether you need medication to help maintain your bone mass, prevent further bone loss and reduce fracture risk. The machines required to perform this type of testing are not readily available in Canada and therefore priority for testing is typically reserved for those in the highest risk category. A bone mineral density (BMD) test is a special type of test that is accurate, painless and noninvasive. Referral to a diagnostic facility is provided by a physician after consultation and risk factor identification deem it necessary.

Prevention and Conservative Management

Osteoporosis is largely preventable for most people. Prevention of this disease is very important because, while there are treatments for osteoporosis, there is currently no cure. Building strong bones, especially before the age of 30, can be the best defense against developing osteoporosis, and a healthy lifestyle can be critically important for keeping bones strong. This does not mean, however, that if you are past this stage in your life that there is nothing you can do to improve your bone health. Listed below are five steps to aid in the prevention of osteoporosis. No one step alone is enough to prevent osteoporosis but all five may.

It is never too late – or too early – to do something about osteoporosis. Everyone can take steps to keep bones strong and healthy throughout life.

1. Maintain a Calcium-Rich Diet

Calcium is essential in maintaining strong, healthy bones and preventing bone loss. Young people rely on calcium to help build bone while studies have shown that calcium can help reduce bone loss and the risk of fractures in post-menopausal women. Milk, cheese, yogurt, citrus fruits, and shellfish are good sources of calcium. Vegetables that are rich in calcium include broccoli, spinach, kale, and collard greens. Calcium supplements are also available.

The recommended daily intake of calcium for women between 25 and 50 years of age is 1,000 milligrams (mg). For post-menopausal women who are not taking estrogen replacement therapy, the recommended daily intake of calcium is 1,500 mg.

2. Get Plenty of Vitamin D

Vitamin D helps the body absorb calcium and deposit it into bones. The recommended daily intake of vitamin D is 400 international units (IU). Vitamin D may be obtained from vitamin-D fortified milk and foods such as liver, fish, and egg yolks. Vitamin D supplements or a multiple vitamin that contains 400 IU of vitamin D are also good sources.

Sunshine on the skin also helps the body make Vitamin D. Generally, 15 minutes of sun exposure per day is enough to maintain sufficient Vitamin D levels. However, factors such as weather, latitude, time of year, etc. may influence absorption. It is important to use sunscreen and take other preventive measures when outside to help prevent skin diseases (such as skin cancer).

3. Engage in Weight-Bearing Exercise

Weight-bearing exercises help build strong, dense bones and guard against bone loss. Weight-bearing exercises are those that require the muscles to work against gravity to move the body. Exercises that can help prevent osteoporosis include walking, jogging, running, stair climbing, rope jumping, skiing, aerobic dancing, and impact-producing sports such as tennis or volleyball. Those who have not been active for a while or have other medical problems (such as heart disease) should talk to their health care providers before beginning an exercise program.

4. Don’t Smoke and Limit Alcohol/Coffee/Carbonated Beverage Intake

Smoking interferes with the absorption of calcium, causing smokers to experience vertebral fractures more frequently than non-smokers. Women who smoke usually reach menopause one to one and a half years earlier than non-smokers. Consequently, their bodies stop producing estrogen earlier than non-smoking women. Smoking can also lead to other serious health problems, such as lung cancer.

Consuming more than two alcoholic beverages a day may decrease bone formation and reduce the bone’s ability to absorb calcium. Moderate alcohol consumption (one drink per day or less) has not been shown to contribute to osteoporosis.

Coffee and carbonated beverage drinkers should be aware that the caffeine in these products actually depletes the bones of their calcium stores by increasing it’s excretion in the urine, contributing to the process leading to osteoporosis. Those who consume greater than 4-5 cups of coffee or carbonated beverages may be placing themselves at greater risk for developing osteoporosis if their daily intake of calcium is not sufficient to replace these lost stores. It is recommended that one cup of milk should be consumed for every cup of coffee, or what about a café latte?

5. Naturopathic options for preventing osteoporosis

Nutrition is a key component of a complete osteoporosis plan. Excessive animal protein (ie non-vegetarian diet) promotes an increase in urinary excretion of calcium. In addition, many animal proteins are high in phosphorus, which also promote excretion of calcium. A vegetarian diet is associated with higher bone density later in life. A diet high in refined sugar, salt and refined grains also promote bone loss. A diet high in soy products may assist with preventing bone loss in some women. People who eat a diet high in acidic foods may also promote their bone loss. Interestingly, dairy products such as milk, which are commonly touted as an ideal source of calcium, are highly acidic foods.

Nutritional supplements may be necessary to maintain bone density. Calcium supplementation may be one component of an osteoporosis treatment and prevention plan. Another component is Vitamin D, which increases the intestinal absorption of calcium. Magnesium is yet another part of the plan. Magnesium is required to produce parathyroid hormone and parathyroid hormone is involved with activation of Vitamin D. Other minerals which may be indicated for some women include manganese, boron and zinc. Botanical medicines such as the isoflavones derived from soy based foods may be one alternative for lower-risk individuals. Your own individual situation will determine what treatment is ideal for you.

There is controversy about the negative impacts of hormone replacement therapy (HRT) and its role in prevention/treatment of osteoporosis. It is essential that you speak with you primary health practitioner about these risks, alternatives and most importantly what your individual health status and circumstances require. Naturopathic doctors and other licensed healthcare practitioners can help you to understand alternatives and what your level of risk may indicate for treatment options.

Non-conservative Management

Hormone Replacement Therapy and Other Medications

Women who are menopausal or post-menopausal and are at risk for osteoporosis should talk to their physician about other preventative options, such as hormone replacement therapy (HRT) or other prescription medications. HRT has been shown to significant reduce bone loss and reduce the rate of hip and spinal fractures. HRT also helps decrease menopausal symptoms (such as hot flashes and vaginal dryness) and may provide other benefits with heart disease , Alzheimer’s disease, diabetes, etc.

However, some studies have shown that HRT may increase the risk of breast cancer. The link between HRT and breast cancer is controversial. Although studies have been inconsistent, there appears to be an emerging consensus that HRT does not significantly increase the risk for breast cancer, at least for women who are on estrogen less than five years or who take less than 0.625 mg per day. Women considering HRT should discuss the benefits and risks with their physicians.

Gokavi Transverse Technique (GTT) is a dry needling acupuncture technique which utilizes high frequency electrical stimulation to aid in the treatment and management of chronic pain. The goal of the technique is to release trigger points in muscles and areas of adhesion and tightness in connective tissue (fascia) that is causing chronic pain.

In the first part of treatment, needles are inserted in a specific transverse direction to form a special circuit surrounding and enclosing the area of pain. The needles are electrically stimulated at two different high frequencies (200Hz and 500Hz), resulting in relaxation and relief of pain (analgesia) in the targeted muscles and related tissues. The pain relief effect causes an important and significant improvement in patient compliance and tolerance to the dry needling.

In the second part of treatment, dry needling is then performed transversely. The relaxed muscle (due to the prior high frequency stimulation) can then be lifted and treated through its entire thickness, releasing spasms and trigger points. The increase in muscle length increases mobility and reduces pain, and since the needling is conducted transversely the procedure is considered safer than similar procedures. Most muscle groups can be treated in the body. When the procedure is performed by qualified hands, dramatic and long term effects can be expected in neck and back pain, shoulder and elbow pain, hip and lower limb pain Including Achilles tendonitis and plantar fasciitis. For more information contact Dr. Todd Norton.

Adapted from Dr. Cynthia N. Gokavi, The Treatment and Management of Chronic Myofascial Pain Release. Copyright 2000.

“Most people don’t really know how to succeed when it comes to fitness. And the reason is simple. Physical fitness – and wellness – begin in the mind.”

Most of us are aware of the endless benefits of regular physical activity; decreased risk of heart disease, cancer, osteoporosis, and decreased physical symptoms associated with arthritis and diabetes to name a few. So if we all know what to do then why are only 14% of boomers exercising 4 to 5 times per week? It’s not a matter of knowing what to do it’s knowing how to do it!

Before anyone can achieve physical fitness he or she must become mentally fit. What does that mean? The mental component of any fitness routine is what keeps us motivated to continue exercising and is as equally important as the physical aspect. Without a balance between the mental and physical components we will be led into a state of yo-yo dieting and exercising that gives us no long term health benefits and often leads to an unhealthier state of body and mind.

The most difficult part of starting an exercise program is just that – STARTING! It is important to be prepared when you are planning to incorporate exercise into your life. Obtaining the long-term health benefits from an exercise program means making activity a part of your life. Committing to a lifetime of activity will provide you with the physical and mental health benefits that cannot be realized with fad dieting and sporadic exercise programs. It is important to find an exercise or exercise program that draws you to it. You should be saying to yourself “I want to go exercise”, not “I have to go exercise”.

Where do I begin?

First and foremost be realistic! If you have never had a consistent exercise routine in the past and running is not high on your list of favorite activities then don’t put the national capital marathon as your first fitness goal. If finding time to exercise is hard to come by then stay away from planning to exercise 1-2 hours a day if that goal is not achievable. Start by writing down how much time you can dedicate to physical activity each day and building more time into your schedule when you are ready.

Start by identifying activities that you enjoy and are convenient to do. Make a list of activities that you enjoy doing. This list can include non-physical activities as well, The active part can be getting to and from these activities. “Cross Training” involves including a variety of activities in your fitness program. There are several health benefits to this approach including avoiding the boredom of doing the same exercises every day and exercising various muscle groups. This may be the time to take up that sport or activity that you have been meaning to do for years. Ever heard the saying “you can’t teach an old dog new tricks”? Well guess what? That doesn’t apply here. Taking up a new activity (tennis, dancing, golf) avoids boredom and challenges us physically and mentally.

Take lessons and invest in good equipment. Taking on a new sport does not have to be expensive, however, taking a few lessons from an expert will ensure you are learning proper technique thus decreasing your chance of injury. Good equipment, new or used, will also prove to be a worthwhile investment if you are intending to stick with the sport or activity for some time, which hopefully you are.

Proper footwear is very important and is best purchased at a store that specializes in running shoes such as the Running Room.

Start slowly and gradually increase the duration and intensity of your exercises. Try to follow the “10 percent rule”: increase the frequency, duration, or intensity of an activity by no more than 10% each week. It is also easier to maintain regular activity if your previous experience was a pleasant one and not remembered as an overly exhaustive experience.

Bring a friend! Exercise can be a social affair. Joining a running or walking group or a local gym or community center is a great way to stay motivated and meet new people with similar interests.

Develop a balanced exercise program. A general fitness program has three important components.

• Aerobic exercises (walking, jogging, swimming, skating) to improve cardiovascular capabilities.
• Strength Training (weight lifting, push-ups) to help develop muscle mass and combat osteoporosis.
• Flexibility exercises (stretches, yoga) to help keep muscles limber and avoid injuries.

You should be doing at least 30 minutes of moderate activity most days of the week. You can break your exercise routine into shorter periods, as long as it adds up over the course of the day. Remember that physical activity isn’t only running and weight lifting. Dancing, gardening, and housework count too.

You may not see results overnight, but cross training will have a beneficial effect on your health and fitness level. Regular physical activity increases your chances for a longer, healthier, and more independent life. Keep at it!

Set Goals

Like all other areas of life, goal setting is the key to success. Short and long term fitness goals allow us to keep track of our progress and reward ourselves for hard work and commitment. Not everyone will have the same fitness goals. Goals vary as much as the individuals who set them. From climbing a mountain, to lowering blood cholesterol, to walking around the block, fitness goals encourage us to continue pursuing an active lifestyle in order to achieve success. Using the 10% rule mentioned above will allow you to set realistic goals in advance. Goals should also be realistic in time. The “lose 20 pounds in 20 days” approach will jut lead to yo-yo weight changes, frustration, and stress on your body. Focusing on how you feel and what your body can do will always be rewarding.

The following links can help you get started. If you are aware of any other useful links we are happy to add them to our list.

The mandate of  is to encourage, promote and develop active living in Canada, thereby improving the overall fitness, health, well-being and quality of life of Canadians.

Routes To Learning Canada – (formerly Elderhostel Canada) is a non-profit organization committed to providing learning travel adventures to people 55 years and older. Explore Canada and the world through hands-on learning, in-depth lectures and cultural excursions.

The Heart and Stroke Foundation (Canada) works to further the study, prevention and reduction of disability and death from heart disease and stroke through research, education and the promotion of healthy lifestyles.

The Running Room offers programs for all levels from walking clinics and learn to run programs, to marathon clinics. Whatever your goals, the running Room can help you achieve them safely.