What is osteoporosis?
Osteoporosis is a medical condition in which the bones become brittle and fragile, leading to an increased risk of fractures. It is often called a "silent disease" because it can progress without noticeable symptoms until a fracture occurs. Osteoporosis is more common in older adults but can affect people of any age. It is more common in women than in men.
Several risk factors can increase your chances of developing osteoporosis. These include:
Age: The risk of osteoporosis increases, especially in postmenopausal women.
Sex: Females are more likely to develop osteoporosis than males. Part of the reason is that females rapidly lose bone density during and after menopause. See below for more details.
Family history: If someone in your family has had osteoporosis, you may be at an increased risk for the condition.
Being thin or having a small frame: People who are thin or have a small frame have less bone mass to begin with, which puts them at a higher risk for osteoporosis.
Lack of exercise: Lack of weight-bearing exercise can lead to a loss of bone density.
Certain medications: Some steroids and anticonvulsants can increase the risk of osteoporosis.
Smoking: Smoking can increase the risk of osteoporosis by decreasing the amount of estrogen in the body and reducing the amount of calcium absorbed from the diet.
Poor nutrition: Not getting enough calcium and vitamin D in the diet can increase the risk of osteoporosis.
How does osteoporosis occur?
The body's bones are constantly broken down and replaced with new bone tissue. Osteoblasts are cells that secrete substances that promote the formation of new bone and play a role in bone repair and healing. On the other hand, osteoclasts are our cells responsible for breaking down bone tissue. They secrete enzymes that dissolve the minerals and bone, which allows them to reshape and remodel bone tissue in conjunction with osteoblasts. Osteoblasts and osteoclasts work together to maintain the balance of bones in our bodies. In people with osteoporosis, the rate of bone breakdown, performed by osteoclasts, is greater than the rate of new bone production, leading to a loss of bone density and strength. The bones become more fragile and prone to fractures, especially in the spine, hip, and wrist.
Did you know that over 2.3 million Canadians are living with osteoporosis? And that over 80% of all fractures in people 50+ are caused by osteoporosis. - Osteoporosis Canada
How are Vitamin D and Calcium involved in bone strength?
Calcium and vitamin D are essential nutrients for maintaining strong bones. Calcium is the main component of bone tissue and is necessary for bone growth and repair. Vitamin D helps the body absorb calcium from the diet and is necessary for bone growth and remodelling.
When the body doesn't get enough calcium and vitamin D, it can lead to a loss of bone density and an increased risk of osteoporosis. Adequate intake of these nutrients is significant during childhood when the bones are still growing and during the menopausal years when bone loss tends to increase.
There are several ways to ensure you get enough calcium and vitamin D in your diet. Good sources of calcium include dairy products, such as milk, cheese, and yogurt, leafy green vegetables, nuts and fortified foods, such as orange juice and cereals. Vitamin D can be found in foods such as fatty fish, egg yolks, fortified foods, and supplements. The body can also produce it when the skin is exposed to sunlight.
Why are females more at risk for osteoporosis than males?
Females are more at risk for osteoporosis than males for several reasons. One of the main reasons is that females typically have smaller, thinner bones than males. This means they have less bone mass to draw from as they age, which can increase their risk of osteoporosis. Another reason is that females experience a rapid decline in estrogen levels during and after menopause. Estrogen helps to keep bones strong and plays a role in bone density. When estrogen levels decline, it can lead to bone loss.
Additionally, on average, females have a longer lifespan than males, meaning they have a longer time during which they are at risk for developing osteoporosis. While females are more at risk for osteoporosis, it is essential to note that males can also develop the condition. Both males and females need to take steps to maintain strong bones, such as getting enough calcium and vitamin D in the diet, engaging in weight-bearing exercise, and not smoking.
Osteoporosis affects both men and women. At least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime. - Osteoporosis Canada
But how exactly does estrogen play a role in bone health?
Estrogen is a hormone that plays a role in many bodily functions, including bone health. In women, estrogen helps to maintain bone density and strength. It does this by inhibiting the activity of cells called osteoclasts, as mentioned above, which are responsible for breaking down bone tissue. During menopause, estrogen levels decline, leading to rapid bone density loss. This is why women are at a higher risk for osteoporosis after menopause. In fact, women can lose up to 20% of their bone mass in the first five to seven years after menopause.
Estrogen replacement therapy is effective at preventing bone loss in postmenopausal women. However, estrogen therapy is not without risks and should be used cautiously. It is important to speak with a healthcare provider about the potential benefits and risks of estrogen therapy.
What are some things everyone can do to prevent osteoporosis?
There are several things you can do to help prevent osteoporosis and maintain strong bones:
Get enough calcium and vitamin D: Adequate intake of these nutrients is essential for maintaining strong bones.
Engage in weight-bearing exercise: Exercise that puts stress on the bones, such as walking, jogging, dancing, and lifting weights, can help to stimulate the production of new bone tissue and prevent bone loss.
Don't smoke: Smoking can increase the risk of osteoporosis by decreasing the amount of estrogen in the body and reducing the amount of calcium absorbed from the diet.
Limit alcohol consumption: Drinking excessive amounts of alcohol can interfere with calcium absorption and increase the risk of osteoporosis.
Consider medications: If you are at high risk for osteoporosis, your healthcare provider may recommend medications to help slow bone loss or increase bone density.
Get your bone density checked: If you are at high risk for osteoporosis, your healthcare provider may recommend a bone density test to check the strength of your bones. This test can help to identify osteoporosis before a fracture occurs.
How does exercise improve bone strength?
Exercise can improve bone strength in several ways. When you perform weight-bearing and resistance exercises, the bones in your body have to work against gravity or external resistance. This stresses the bones, which stimulates the osteoblast cells to form more bone, allowing them to adapt and become denser and stronger.
It's important to note that bone density peaks in the mid-20s and gradually declines with age. However, regular exercise can help to slow this decline and maintain bone density at a healthy level. It's always possible to start exercising and taking care of your bones!
In 2016–2017, there were 150 hip fractures per 100,000 Canadians aged 40+. Women were 2x more likely to fracture their hip compared to men whereas men are 1.3x more likely to die from any cause following a hip fracture. - Osteoporosis Canada
How common is osteoporosis?
Osteoporosis is a common condition that affects millions of people around the world. According to the World Health Organization (WHO), osteoporosis is estimated to affect 200 million women worldwide and is responsible for more than 8.9 million fractures annually.
In the United States, the National Osteoporosis Foundation (NOF) estimates that approximately 54 million Americans have osteoporosis or low bone mass, which puts them at risk for the condition. Of these, approximately 10 million are men, and 44 million are women. The NOF also estimates that one in two women and one in four men over 50 will break a bone due to osteoporosis.
What is a bone density scan, and how does it work?
A bone density scan, also known as a bone densitometry test, is a diagnostic test that measures the density of the bones. The test is often used to diagnose and monitor osteoporosis. During a bone density scan, you will lie on a table while a particular machine passes over your body. The machine uses a low-dose x-ray to create detailed images of the bones. The images are then used to measure the density of the bones. There are two types of bone density scans. Central DXA scans measure the density of the bones in the spine, hip, and sometimes the wrist, while peripheral DXA scans measure the density of the bones in the wrist, finger, heel, or forearm.
Bone density scans are painless, noninvasive, and typically performed in a doctor's office or outpatient facility. The test takes only a few minutes to complete, and it can provide valuable information about the health of your bones. Your doctor may recommend a bone density scan if you have risk factors for osteoporosis, such as being over the age of 50 or being female. The test can also be used to monitor the effectiveness of treatment for osteoporosis.
What are some treatments for osteoporosis?
There are several treatments available for osteoporosis, including medications and lifestyle changes. The treatment recommended for a person with osteoporosis will depend on the severity of the condition, the person's age, and other factors.
Medications: Several medications can help to increase bone density and reduce the risk of fractures in people with osteoporosis. These medications include:
Bisphosphonates: These drugs help slow the bone loss rate and increase bone density. They are taken by mouth or injection. Denosumab: This drug is given as an injection and helps slow the bone loss rate and increase bone density. Calcitonin: This hormone is produced by the thyroid gland and can help to reduce bone loss. It is available as a nasal spray or injection.
In addition to taking medications, making specific lifestyle changes can help improve bone health and reduce the risk of fractures. These changes include:
Calcium and Vitamin D
Getting enough calcium and vitamin D is essential for maintaining strong bones. Calcium can be found in dairy products, leafy green vegetables, and fortified foods, while vitamin D is found in fatty fish, eggs, and fortified foods.
Weight-bearing and resistance exercises can help to strengthen the bones and improve muscle strength.
Avoiding smoking and excessive alcohol consumption
These habits can increase the risk of osteoporosis.
Taking steps to prevent falls, such as removing tripping hazards from home and wearing shoes with good support, can help to reduce the risk of fractures.
It's important to work with a healthcare provider to determine the best treatment plan for managing osteoporosis. With proper treatment and lifestyle changes, it is possible to slow the condition's progression and reduce the risk of fractures.
A study recently reported that only 44% of people discharged from hospital for a hip fracture return home; of the rest, 10% go to another hospital, 27% go to rehabilitation care, and 17% go to long-term care facilities.
What is the role of occupational therapy and osteoporosis?
Occupational therapy can be an essential part of treatment for people with osteoporosis. Occupational therapists are healthcare professionals who help people perform daily activities and participate in meaningful occupations, despite physical, mental, or social challenges.
In the case of osteoporosis, an occupational therapist may work with a person to:
Develop strategies to reduce the risk of falls: This may include recommending assistive devices, such as grab bars or a cane, and teaching balance and mobility exercises.
Recommend modifications to the home environment: An occupational therapist may recommend changes to the home to make it safer and easier to navigate, such as removing tripping hazards and installing grab bars in the bathroom.
Teach energy conservation techniques: Osteoporosis can cause fatigue, and an occupational therapist may teach the person with osteoporosis strategies to conserve energy and reduce the risk of overexertion.
Recommend assistive devices: Depending on the person's needs, an occupational therapist may recommend assistive devices, such as a reacher or long-handled shoe horn, to help with ADLs.
Help with activities of daily living: An occupational therapist may work with the person with osteoporosis to develop strategies for completing ADLs, such as bathing and dressing, to minimize the risk of falls and fractures.
In addition to these specific interventions, an occupational therapist may work with the person with osteoporosis to develop a comprehensive treatment plan that addresses the person's overall health and well-being. This may include recommendations for medication, physical therapy, and other interventions, as needed.
Overall, the role of occupational therapy in the treatment of osteoporosis is to help the person with the condition maintain their independence and participate in meaningful occupations, despite the challenges posed by the condition.
Compston, Juliet E., et al. “Osteoporosis.” Lancet (London, England), vol. 393, no. 10169, Jan. 2019, pp. 364–76. PubMed, https://doi.org/10.1016/S0140-6736(18)32112-3.
International Osteoporosis Foundation: IOF https://www.osteoporosis.foundation/
Osteoporosis Canada https://osteoporosis.ca/
Sözen, Tümay, et al. “An Overview and Management of Osteoporosis.” European Journal of Rheumatology, vol. 4, no. 1, Mar. 2017, pp. 46–56. PubMed Central, https://doi.org/10.5152/eurjrheum.2016.048.