Osteoporosis guide to help treat brittle bones
New Canadian guidelines aim to identify fractures caused by weakened bones in people over the age of 50.
Osteoporosis Canada released the guidelines Tuesday in the Canadian Medical Association Journal, with the aim of improving the diagnosis and treatment of fragility fractures caused by osteoporosis.
Fragility fractures are responsible for excess death and disease, chronic pain and economic costs, said guideline author Dr. Alexandra Papaioannou, a professor of medicine in the geriatrics division at McMaster University and Hamilton Health Sciences.
Osteoporosis at 25
Salima Ladak-Kachra of Toronto was just 25 when she discovered the ongoing back pain she'd been experiencing was the result of osteoporosis.
After she took a fall on a ceramic floor, X-rays showed she had broken her vertebrae in four places — but they also revealed the telltale signs of previous fractures that were still healing.
"I was actually having fractures and not knowing it," said Ladak-Kachra, adding that because of her young age, doctors hadn't considered osteoporosis as a cause of her earlier back pain.
But Ladak-Kachra had several risk factors: she was underweight for her height, didn't eat calcium-rich dairy products, got no weight-bearing exercise and both her parents had the bone-thinning disease.
Now 40, the married mother of two has put on weight, eats a healthy diet and exercises. But she has lost more than an inch in height due to a compressed spine and still suffers chronic back pain that makes tasks such as doing the laundry or making beds difficult.
"Osteoporosis is not just an elder person's disease," said Ladak-Kachra, who has run an osteoporosis clinic for the last 12 years. "It's a multifactorial disease that can happen to anyone."
Source: The Canadian Press
Less than 20 per cent of women and less than 10 per cent of men are appropriately tested and treated after a fragility fracture, according to the guidelines.
"We're really focused on closing that care gap," Papaioannou said in an interview. "The reason being is that when you have a hip fracture and/or a spine fracture, there's an increased risk of death."
Among women over age 50, 80 per cent of fractures are because of osteoporosis, Papaioannou noted. When such a fracture occurs, the patient has a 20 per cent risk of another fracture within the year.
Since the guidelines were last published in 2002, the focus has shifted from treating low bone mineral density to identifying fragility fractures, the group said.
The guidelines recommend that people at risk for fracture:
- Get regular physical exercise that includes weight-bearing activities for strength and balance training.
- Take 400 to 1,000 IUs of vitamin D per day for those aged less than 50, and 800 to 2,000 IUs daily for those 50 and older.
- Get 1,200 milligrams per day of calcium from both diet and supplements.
While osteoporosis often goes unnoticed and without symptoms, in severe cases hip or spinal fractures can occur without significant trauma to the bone, such as breaking a rib by coughing or sneezing.
For many Canadians over the age of 50, a hip fracture due to osteoporosis usually occurs after a fall or bump. A major risk factor for osteoporosis is family history of fragility fractures. A hunched upper back or loss of height as the spine compresses commonly point to the possibility of spinal fractures.
"A lot of women think that loss of height and a curved back is normal aging and it's not," Papaioannou said.
The guidelines introduce tools for doctors and patients, including a new 10-year fracture risk assessment tool to guide physicians in managing those at high risk of fracture.
The new guidelines focus on preventing fractures.
The costs of fragility fractures for the health-care system are enormous since hip fracture patients are hospitalized for surgery and often end up being institutionalized prematurely, Papaioannou said.
About half of hip fracture patients never regain the ability to walk independently, she added.
Smoking, lack of weight-bearing exercise, taking certain medications and being underweight are among the causes of osteoporosis.
At least two million Canadians are affected by osteoporosis, the group said.
With files from The Canadian Press