Wednesday, August 5, 2020

6 Most Dangerous And Enduring Myths About Osteoporosis That Need to End Now

Myths can be dangerous and life-threatening. Some people believe that osteoporosis is not serious like cancer or heart disease. That thinking puts us at greater risk of failing to do all we can to ensure bone health for living fully and independently as we age.

With that in mind, let’s shine a bright light on enduring myths and tackle them with facts from leading experts: 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.); Dr. Aliya Khan, director of McMaster University’s Calcium Disorders Clinic in Oakville, Ont. and director of the fellowship in metabolic bone disease; and Dr. David Kendler, a professor of medicine with the University of British Columbia.

  1. Weakened bones are a normal part of aging and there’s little you can do about it.

This is a common myth that needs to be debunked head-on. “Weakened bones are not normal at all,” says Dr. Khan. Osteoporosis is commonly seen with aging, but it’s not inevitable. “I see many people who do not develop osteoporosis and are able to maintain bone strength until late in life without fractures. We need to break down these stereotypes and advise Canadians that a healthy lifestyle with strenuous daily physical activity and adequate calcium and vitamin D intake can contribute to maintaining bone strength and preventing osteoporosis.”

Taking calcium supplements is not enough to prevent osteoporosis.

  1. Osteoporosis can be prevented by consuming enough calcium. 

Calcium is very important for bone health, there’s no doubt about that. But while it’s a major building-block and star player for bones, having adequate calcium intake is not enough on its own. The body also needs vitamin D to help with absorption.

“I think there’s a lot of confusion about calcium,” says Dr. Shapiro. “I’ve had patients wondering, ‘Do I need a calcium supplement? Do I not need a calcium supplement? Is it going to give me an increase in cardiovascular disease?’ So that’s part of it. But there’s just a general lack of awareness of the fact that we need to do things that are bone-friendly inclusive of calcium, vitamin D and exercise to name a few.” Maintaining calcium intake is critical for overall bone health throughout our life with varying requirements by age. It is best to consume calcium from your diet; but if the target is not reached, then a supplement may be taken to make up the difference.

She often tells her patients that bone health is a geriatric disease that starts in the pediatric years. Meaning if you lacked a good foundation of calcium and vitamin D as you were growing up and did not acquire your peak bone mass, you are likely to pay for it in your later years.

Dr. Shapiro also says people often don’t take vitamin D properly. Vitamin D is fat soluble and so supplements need to be accompanied by a meal that’s got a little bit of fat in it. “Newborns get a vitamin D supplement. But why, as adults, do we forget about the fact that we need one, too?” she asks. If you prefer taking vitamin D orally in the form of drops (as opposed to sublingually), the advice is the same as supplements: Take with a meal containing fat to increase absorption.

Getting enough calcium and vitamin D is just part of the battle in preventing osteoporosis, but it’s not enough. You can also lower your risk of a fall by making sure you’ve got good core strength from doing weight-bearing exercises. Behaviours that can also contribute to the disease like smoking, regular alcohol consumption (two to three ounces a day) and high salt intake are also within our control.”

  1. A bone fracture is treatable and can be repaired so is nothing serious.

Falling from a standing height or tripping up a couple of stairs and breaking a bone is serious. Healthy bones should be strong enough to withstand the impact. Yet many people dismiss a fracture to something they did, like slipping on ice.

Unfortunately, only about 20 percent of people are investigated and treated for an underlying cause after a fragility fracture. The remaining 80 per cent are left to have subsequent fractures. This happens not just in Canada, but around the world. Most common fractures affect the wrist, spine, shoulder and hip.

“People often don’t realize the impact of a fracture,” says Dr. Kendler. “Say ‘heart attack’ or ‘stroke’ or ‘cancer,’ and people put those pretty high on the list of importance … The perception for many is that if you have a fracture, you go to hospital, the orthopaedic surgeon fixes the break, then you think you’re as good as gold and go back to live life as you did before. And that’s far, far from the truth.”

Fragility fractures represent 80 percent of all fractures in post-menopausal women.

  1. Post-menopausal women are the ones who should worry about osteoporosis.

Osteoporosis is more than a women’s disease or exclusive to post-menopausal women. Men also develop osteoporosis and for both sexes it can happen at any age. An estimated two million Canadians are affected by it. At least one in three women and one in five men will break a bone in their lifetime due to osteoporosis.

But it’s true that women who are post-menopausal (on average around age 51 in Canada) are most affected by the bone disease. Fragility fractures represent 80 percent of all fractures in this demographic. After the onset of menopause, in the presence of estrogen deficiency, there’s more bone loss removed than formed. This imbalance can lead to osteoporosis.

Men are less likely to develop osteoporosis, Dr. Khan notes. “But when they do, there is a 40 to 50 per cent chance it was caused by something specific like steroid use, alcohol abuse, smoking, or a number of other diseases and medications, and should be evaluated to find out why they have osteoporosis.”

  1. There are no symptoms associated with this bone disease.

Early stages of bone loss typically have no symptoms. “It’s a quiet disorder,” says Dr. Kendler. “It’s like hypertension or high cholesterol. You don’t feel it. And so, things that people don’t feel, often they have little awareness of, and unless it’s brought to their attention, they have little consideration of it.”

But there can be symptoms as the disease progresses. Once bones start to weaken and become brittle, watch for loss of height, back pain caused by fractured or collapsed vertebra, or a stooped appearance. The gradual development of a Dowager’s hump (a rounded or hunched upper back) is also cause for speaking to a physician and asking for spinal X-rays.

The most tell-tale sign of osteoporosis is a fracture, especially if it was experienced from a standing height. Experts agree that further investigation, including a bone density test, is needed to determine the reason for the bone break.

  1. A fracture from a fall is normal.

Sometimes people view their first fracture as a single event never to reoccur, Dr. Kendler points out. “That’s not true. It’s quite likely to happen again,” he says. Research published by Osteoporosis Canada shows 14 per cent of persons with a wrist fracture suffered another within three years. And over one in two hip fracture patients will suffer another fracture within five years.

Dr. Shapiro has a clear message for women: “If, after age 40, you’ve fallen or tripped up the stairs and broken a bone, you need to follow up on that and ask the question, ‘Why did that happen?’ These are called fragility fractures and can say something about bone quality. It’s something that we need to look into. It’s a red flag for bone health.”

Presented through a sponsorship from Amgen Canada Inc.

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