It's November and time for all the bone vivants to stand up and be counted. Note, that's "bone" vivants and the key word is "stand" – something that's difficult when bones are brittle and hips and spine vertebrae are breaking.
November is osteoporosis month, focusing attention on the degenerative condition characterized by low bone mass and deterioration of bone tissue, leading to increased fragility and risk of fracture, particularly of the hip, spine and wrist. It's a condition that affects 1.4-million Canadians and one in four women over age 50.
What's happening?
This month public forums entitled "Healthy Bones: The Inside Story," sponsored by the Osteoporosis Society of Canada and the Dairy Farmers of Canada, will be held across the country to educate the population about this disease. Dates include Nov. 5 in Coquitlam, B.C., Nov. 6 in Winnipeg, Nov. 13 in Burlington, Ont., Nov. 15 in Montreal, Nov. 19 in Halifax, and Nov. 23 in Calgary.
It's also the beginning of the annual "bone china teas," held across the country each year from November to April. Ranging from intimate gatherings in private homes to formal affairs in public venues, these events raise awareness about the debilitating disease as well as funds for education, patient support, advocacy and research. To find out about teas in a particular area or to receive a how-to hosting kit – complete with invitations, recipes and information about osteoporosis – call 800-463-6842.
Health professionals concerned with this disease will be meeting in Toronto from Nov. 30 to Dec. 2 for a conference – "Osteoporosis in Canada: Canadian Guidelines Symposium and ISCD Certification Course" – hosted by the Osteoporosis Society of Canada and the International Society for Clinical Densitometry.
The Canadian society's scientific advisory council is now completing new clinical guidelines, expected to be published early next year, that will provide physicians with practical guidelines for diagnosis, treatment and prevention. This first-ever set of evidence-based guidelines comes out of the study of more than 90,000 research studies on the disease.
Who's at risk?
Although it affects both sexes, women are at higher risk than men for osteoporosis. A recent article in the Women's HealthSource newsletter from the Mayo Clinic breaks risk factors into those that can be changed and those that can't.
Factors that can't be changed include:
o Age. Risk increases with advancing years.
o Body size. Small, thin-boned women are at greater risk.
o Ethnic origin. Caucasian and Asian women are at highest risk. Black and Hispanic women typically achieve a higher peak bone mass and face lower risk.
o Sex-hormone levels. The greater the lifetime exposure to estrogen, the lower is the risk. Thus, early menopause or late onset of puberty may increase the risk.
o Family history. Having a mother or sister with osteoporosis increases risk.
Factors that may be controlled include:
o Sex-hormone levels. Hormone-replacement therapy may counteract the risk caused by depletion of estrogen after menopause.
o A diet low in calcium and vitamin D. These are crucial to building strong bones, so a calcium-rich diet and supplementation may help.
o An inactive lifestyle. "Use it or lose it" applies to bone strength, so regular exercise is a valuable tool for prevention.
o Cigarette smoking. Women who smoke have lower levels of the protective estrogen and frequently go through menopause at a younger age. Also, smokers may absorb less calcium from their diets.
o Excessive alcohol use. More than one ounce a day from women and two for men reduces bone formation and interferes with the body's ability to absorb calcium.
The calcium connection
Calcium is one of the most important keys to prevention of osteoporosis. In childhood, it's important to grow a healthy skeleton to carry the body through life.
As well, bone is living tissue that constantly regenerates or remodels itself, getting rid of weakened areas and growing new tissue at those sites. Calcium is important to this process.
But its absorption slows down with age, making a focus on good calcium supplementation an essential part of the prevention process.
The Osteoporosis Society of Canada website includes a "calcium calculator" that evaluates a day's intake. The site also features a calcium-enhanced "recipe of the month."
Other treatments
When calcium intake, exercise and other preventative measures aren't enough and bones become weakened, there are medications that can help.
o Bisphosphonates, a class of non-hormonal drugs, are often prescribed for post-menopausal women unable or unwilling to take hormone therapy. They bind to the bone, slowing down the bone-erosion process and allowing bone-building or remodelling to continue more effectively. Three bisphosphonates are currently approved for use in Canada: alendronate (sold as Fosamax), etidronate (Didrocal) and risedronate (Actonel).
o SERMS (selective estrogen receptor modulators) are a new class of estrogen-like drugs that have a positive effect on bones and the heart. One of these – raloxifene, sold as Evista – has been approved in Canada for the treatment of postmenopausal women with osteoporosis.
o Calcitonin is a naturally occurring hormone produced by the thyroid gland that controls the activity of the cells that break down old and weakened bone. A synthetic form that works by slowing down the cells that break down bone and allows the bone-building cells to work more effectively has been produced as a nasal spray called Miacalcin, for use by women with osteoporosis who are five years postmenopausal.