Bone health is a cornerstone of good health. Yet it’s not something we give much thought to until it is too late and suffer a fracture. Myths endure around osteoporosis, preventing us from making good nutrition and smart lifestyle choices to keep the disease at bay.
Not being cognizant of the role bone health plays in being able to age well is ironic given a common concern that physicians hear. “If you ask older women and women in general as they age what they value more than anything, what they value is independent living,” says Dr. Marla Shapiro, professor, department of family and community medicine at the University of Toronto and a member of the Order of Canada (C.M.).
“Even something as simple as a wrist fracture that doesn’t allow you to get dressed or bath yourself or do your hair or that type of thing is a big change. If you have a hip fracture and we look at what happens, 25 per cent of these women will die within the next calendar year,” she explains, adding that what most patients “can relate to is the fact that they’ll lose their independence. They may end up in a long-term care facility. It will have an impact on anyone else that they’re offering care to. It has huge implications. In terms of aging well, bone health is critical.”
Though men can get osteoporosis too, usually later in life, women are far more likely to develop the disease. It affects one in three. It’s much more common than many people think and clearly, much more serious considering the loss of quality of life and mortality rate due to hip fractures.
“Women are concerned about breast cancer and ovarian cancer and cardiovascular disease, as well they should, but if you look at the number of fractures we see, it surpasses by the number of the other three diseases added together,” Dr. Shapiro notes. “It’s a very high incidence and the fact is that women are often unaware of osteoporosis because it usually doesn’t have any symptoms. Even if you have a spontaneous fracture in your back – a vertebral fracture – two-thirds of those are without symptoms.”
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She feels that many women don’t fully understand the significance of a broken bone: “One of the things that is really alarming is that most fractures that we see after age 40 are fragility fractures. In other words, a woman falls from a standing height, twists out of an unusual plane of motion or trips up a couple of stairs and breaks a bone. They don’t realize that this is the same as if you had a cardiac event and wanting to prevent another one. A fracture is like a sentinel, screaming: ‘You are at risk!’”
A fracture should set off alarm bells because it could lead to subsequent fractures. But patients are often dismissive, believing that there’s nothing unusual about falling and breaking a bone. Dr. Shapiro says that’s a myth. “It is not normal. Patients don’t realize that a fracture is telling you something about the quality of your bones,” she says. “It’s alarming how many fractures we see where women are not alerted to the fact that they need a more formal risk assessment that may include a bone density test. They need to follow up to find out why the fracture occurred and understand how to prevent future ones.”
She is concerned that fractures are often ignored and not taken seriously. There’s a gap in awareness and in the care protocol. “It’s those patients who have fractured after the age of 40 that really need to understand this is a big warning sign. You would not ignore chest pain; you wouldn’t ignore angina, and yet you will ignore a fracture. If we look at individuals across the country who have cardiac events, 85 per cent will leave the hospital with a blood thinner, something for their cholesterol or some sort of heart-related medication. But if you look at someone who’s had a fracture, what do they leave the hospital with? Only 15 per cent of them will leave the hospital with information or medication and the vast majority will leave without any assessment or intervention for osteoporosis.”
“you wouldn’t ignore angina, and yet you will ignore a fracture.”
There is a myriad of reasons behind the lack of awareness when it comes to osteoporosis and bone health. Dr. Shapiro feels that it can be easily overlooked with people at this age because they aren’t getting routine physicals. Most will see their physician only when they perceive a problem. Osteoporosis is a silent disease without symptoms. Bones weaken over time and there’s often no sign of disease until a fracture occurs. Even then, the cause may not be connected back to an underlying issue of bone loss.
“We don’t talk about bone health,” she says. “We don’t talk about vitamin D. We don’t talk about calcium intake. We don’t talk about bone hygiene. It’s just getting overlooked. Patients – men and women – have to advocate for themselves. Women do worry about their heart and breast health, but bone health is something that needs to be on the agenda, too. It’s certainly on my agenda when I see both men and women.”
A bone density test is something that all Canadians should get at age 65. You may need one earlier if you have particular risk factors. This could include a family history of fracture, smoking, habitual consumption of more than three alcoholic drinks a day and being on certain medications.
The 2009 Canadian Community Health Survey from the Public Health Agency of Canada noted that adults under the age of 50 are at risk if they’ve had a fragility fracture, used glucocorticoid medications like prednisone long-term, experienced premature menopause or had a disorder associated with rapid bone loss and/or fracture, such as rheumatoid arthritis and malabsorption syndrome. Over age 50, another prime consideration is low body weight (less than 60 kg or 132 pounds) or significant weight loss.
Dr. Shapiro suggests patients talk to their healthcare providers. “I think asking, ‘What do I need to know about my bones?’ and ‘Do I need a bone density test?’ are critical. We all need to understand our osteoporosis risk.”
That’s something to keep in mind as we head into Osteoporosis Awareness Month in November.
Produced with support through a sponsorship from Amgen Canada Inc.