Osteoporosis

DEFINITION

Osteoporosis is a disease that gradually weakens the bones. They become porous and fragile, and the risk of fractures is increased.

It is estimated that one out of every four women over age 50 will suffer from osteoporosis. This means approximately 450,000 women in Quebec and, with the aging of the population, these numbers will continue to rise if no action is taken.

It is important to differentiate osteoporosis from arthritis and arthrosis. Osteoporosis affects the bones and makes them more fragile, whereas arthrosis is the early wearing of joints. Rheumatoid arthritis is an inflammatory disease of the joints, causing pain, swelling, stiffness and deformation.

Osteoporosis is known as a silent disease because there are no symptoms. It is therefore important to assess one's risk factors and take a diagnostic test if necessary.

As this disease mainly affects women (women lose bone mass faster at menopause because of the rapid fall in estrogens), your gynecologist is one of the physicians best able to prevent, detect and treat osteoporosis.

CONSEQUENCES OF OSTEOPOROSIS

Osteoporosis is not a trivial matter; it can have serious consequences. In addition to frequent fractures (wrist, hips, vertebrae), the spine can become deformed (fractures of the vertebrae can cause the body to hunch forward [dowager's hump], with a loss in height), acute or chronic pain related to the fractures, disability or a loss of autonomy (fractures restrict mobility), a loss of self-esteem (inability to carry out the same tasks as before and a change in body image), as well as breathing and digestive problems (compression of internal organs because of collapsed vertebrae). It should be noted that fracture-related deaths are estimated at 10 to 40%, and that one-third of people who have a hip fracture die within a year.

RISK FACTORS AND PREVENTION

It is important to identify your own risk factors to find out whether you have a predisposition to osteoporosis.

Factors that cannot be changed: (* = major risk)

• White or Asian women
• Over 65 years of age
• Weight under 57 kg (125 lb.)
• *Early menopause (before age 45)
• Personal history of fractures
• Family history of osteoporosis/fractures
• Certain specific health problems (Cushing's syndrome, chronic kidney disease, organ transplant, hyperthyroidism, rheumatoid arthritis)
• Digestive disorders related to the absorption of calcium (Crohn's disease, celiac disease, gastric or intestinal surgery)
• Hyperparathyroidism (parathormone imbalance interferes with calcium metabolism)
• Prolonged hormone imbalance (no menstruation for more than 6 months because of eating disorders [anorexia, bulimia] or excessive physical activity, etc.)
• Use of glucocorticoids (cortisone): 7.5 mg prednisone per day for more than 3 months
• Prolonged use or high doses of certain medications: anticonvulsants, heparin, methotrexate

Risk factors that can be changed (lifestyle)

Knowing the risk factors associated with lifestyle is important, as these are the only ones you can change and so prevent the onset of osteoporosis. They are:

• Insufficient calcium and/or vitamin D intake: Calcium requirements after menopause correspond to 4-5 portions of dairy products per day or the equivalent in supplements (1200 to 1500 mg)
• Consumption of large amounts of caffeine: Not more than 4 portions per day (coffee, tea, cola, dark chocolate)
• High consumption of alcohol: Not more than 2 alcoholic drinks per day
• Insufficient physical activity: Increase if less than three 30-minute periods each per week, during which the body supports its own weight (walking, dancing), or resistance exercises (elastic bands, weights)
• Smoking
• Menopause with no preventive therapy: Being menopausal with no hormone therapy or medications that are effective in preventing osteoporosis predisposes you to bone loss.

The presence of a major risk factor (*) or three other risk factors means that you are probably at risk of developing osteoporosis or already have it. It is important to talk to your doctor about having the diagnostic test.

DIAGNOSIS

Osteoporosis can be diagnosed in three ways:

Identification of risks (see above)
Ultrasonometry: The use of ultrasound equipment that gives bone mass at the heel. This equipment does not provide a diagnosis; instead, it makes it easier to identify people at risk.
Osteodensimetry (bone density measurement): This examination is used to diagnose and follow up osteoporosis and it requires a prescription. It takes around 15 minutes and uses low-dose x-rays.

TREATMENT

In addition to correcting various poor lifestyle habits and ensuring an adequate intake of calcium and vitamin D, a number of medications can halt the progress of the disease and even increase bone mass. These include hormone therapy, biphosphonates (Fosamax, Actonel, Didrocal), selective estrogen receptor modulators (Evista) and calcitonin (Miacalcin NS). Other medications are also being studied.

Your doctor will discuss with you the best medicine for your particular case.