Osteoporosis FAQ Section Regarding Information on this Bone Disease

Osteoporosis FAQ

1. What causes osteoporosis?

There is no one single factor that causes osteoporosis, but several different factors have been found to play a role in its development. These are known as "risk factors." Gender is one of these important risk factors. Women are at greater risk for osteoporosis than men because of the hormone estrogen. As a woman approaches menopause, her body's ovarian function gradually declines and estrogen production slows. As estrogen levels decrease, a loss of bone tissue and osteoporosis can begin. For the first several years following menopause, rapid loss of bone density occurs in women.

Age is another important risk factor for osteoporosis. Anyone over the age of 50 should have bone density testing completed if they have any of these additional risk factors for osteoporosis or low bone mineral density and are at risk for fractures and falls:

• a parent who suffered a hip fracture at any time in their life
• a prior broken bone resulting from minor trauma
• use of corticosteroids for longer than 3 months increases the risk for osteoporosis
• a current smoker
• rheumatoid arthritis increases the risk of osteoporosis
• alcohol intake of 3 or more drinks per day
• vertebral fracture confirmed by x-ray
• weight loss of more than 10% since age 25 increases the risk of osteoporosis
• history of falls in the past year

2. Do men develop osteoporosis?

Osteoporosis occurs most often in women, but men also can have the disease. One out of every eight men has osteoporosis, and in Canada, up to 30% of fractures due to bone density loss occur in men. Just like declining levels of estrogen lead to the disease in women, testosterone levels decline in men, leading to an increase in bone loss and increase the risk for osteoporosis. This decline is not universal in men as it is in women, and it is more gradual. A study was done in Canada (CaMOS) found that the rate of vertebral fractures in men was similar to rates found in women.

3. How is osteoporosis different from osteoarthritis?

Even though their names start with the same "osteo" prefix, these are two conditions are very different. Osteoporosis is a disease of the bone. Osteoarthritis is a disease that affects the joints and the tissues that surround them. There are several different forms of arthritis. One type is rheumatoid arthritis, a disease that causes inflammation in the lining of the joints and is a risk factor for osteoporosis.

Osteoarthritis is caused by degeneration, or destruction and thinning of the joint cartilage. It is a degenerative joint disease that often causes painful irritation and inflammation. Extra pieces of bone may form due to injuries and trauma caused by rubbing together or degeneration of the bones. Osteoporosis does not cause pain unless injury or trauma occurs to the bone or other structures.

Osteoarthritis:

• Joints most often affected are the vertebral joints, knees, hips, feet, and fingers
• Often causes pain and swelling
• Risk factors for development include obesity, heredity, and injury or overuse of joints
  

If you suffer from both osteoporosis and osteoarthritis, a healthcare professional can help you develop a plan to manage both conditions. It is especially important to plan an exercise routine. Exercise can help strengthen weak bones and muscles, help prevent falls and injuries, and it can also be used to help control pain. Weight-bearing exercise can help prevent osteoporosis.

4. Why is calcium so important?

Calcium helps build new bone tissue in children, helps maintain strong bones in adulthood, preventing osteoporosis, and helps decrease the risk of bone fractures. Every cell in the body depends on calcium in order to function properly. Our bodies carefully regulate calcium to keep it within the normal range in the bloodstream. If calcium is too low, it is taken out of the bones, leading to osteoporosis. If it is too high, the body stores it in the bones. The body uses bones as its calcium "bank," making withdrawals and deposits as needed.

Everyone needs the recommended amount of calcium every day, from food sources if possible. Vitamin D is needed in order for the body to absorb calcium, so this vitamin is also essential. People who are 19 to 50 years old need 1000 mg of calcium and 400 to 1000 IU of Vitamin D daily; people over the age of 50 need 1200 mg of calcium and 800 to 2000 IU of vitamin D daily. Since there are so few food sources of vitamin D, supplementation of vitamin D is recommended to help decrease the risk of osteoporosis.   

5. How do I choose a calcium supplement?

If you're not able to get enough calcium in your diet and are unable to make changes in your diet, your doctor may advise supplements if you are at risk for osteoporosis. One of the most popular supplements is calcium carbonate. Calcium carbonate is absorbed more slowly than other types of calcium supplements making it a better choice if you are at risk for osteoporosis. Its rate of absorption matters, because in order for the calcium to be absorbed, it must be completely disintegrated. If you choose a chewable supplement, chewing helps to disintegrate the tablet. Read the labels on products to make sure the product you purchase meets the national standard for safety. In the United States, approved products have a USP (United States Pharmacopoeia) number and in Canada, they have a DIN (Drug Identification Number). When taking calcium supplements to prevent osteoporosis, also keep these suggestions in mind:

• Calcium carbonate should be taken with food
• Take calcium carbonate with plenty of water
• Take no more than 500 mg of elemental calcium for osteoporosis prevention at one time

6. What is "bioavailability"?

Bioavailability refers to whether or not the body is able to use the calcium it takes in. For example, spinach contains calcium but it also contains other components that "bind" the calcium, so the body cannot absorb and use it to protect the bones from osteoporosis. The calcium found in beet greens and rhubarb is also bound by oxalates. These foods have other vitamins and minerals that are healthy and can be absorbed by the body, but they cannot be counted as good sources of calcium to prevent osteoporosis.  Some foods interfere with the body's ability to "hold onto" calcium. Excess salt and caffeine both cause calcium to be excreted in urine, which makes less calcium available for the body to use. Decreasing your intake of salt and adding milk to your coffee can help prevent this and may help prevent osteoporosis.

7. Why is physical activity so important in managing osteoporosis?

Exercise and activity help prevent loss of bone mass and reduces the risk of falls and fractures. Exercise to prevent osteoporosis includes both strength-training and weight-bearing activities.

"Weight-bearing" activity occurs any time the weight of the body is supported by the legs. Examples include dancing, walking, low-impact aerobics and racquet sports. People at risk for osteoporosis or who currently have the disease should set goals aimed at increasing their strength and improving their coordination, flexibility, and balance.

If you are just starting an exercise program for osteoporosis, seeking help from an instructor or a physical therapist can be beneficial. Before signing up for a class or group activity, find out if the instructor has knowledge or training in helping people with osteoporosis. If you have recent fractures, see a physical therapist for help with your rehabilitation exercise program.

8. What should I do before I start my exercise program?

• Before you start an osteoporosis exercise program, check with your physician.
• Never do exercises that cause pain
• Always stretch before and after exercising for osteoporosis
• Make sure your instructor is knowledgeable about osteoporosis
• Choose an activity or program you enjoy

9. Is the test for bone density in the heel bone an acceptable screening tool for osteoporosis?

In Canada, new methods for diagnosing are always of interest, especially since osteoporosis remains a major and growing health issue. A new technology using ultrasound measures the bone mineral density (BMD) in the heel and other bones. This is called quantitative ultrasound (QUS). This test is now being offered to test for osteoporosis by several companies in Canada, outside the provincial Medicare system, for payment by the patient or a sponsor, for example, a pharmacy. Some recognize QUS as having several benefits: it is portable, easy to use and is inexpensive. It is also available in areas where dual x-ray absorptiometry scans (DXA scans) may not be available and it does not require the use of ionizing radiation to test for osteoporosis. 

Questions remain, however, about the role of QUS in assessing for the presence of osteoporosis. There are concerns in the scientific community regarding the technological diversity, the precision of the standards and instruments used with these devices, and quality assurance concerns have been raised. Heel ultrasound does not detect as many cases of osteoporosis as DXA, and experts are unsure how to deal with this discrepancy.

Often, individuals who undergo heel ultrasound require DXA scan later to test for osteoporosis, which leads to further expense and inconvenience. QUS also does not detect changes in bone structure that can be used in follow-up as part of ongoing therapy for osteoporosis. As of now, DXA continues to be the diagnostic tool of choice for identifying people with osteoporosis