Osteoporosis

Dec 22, 2015

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

Im a hairy guy. That leads to more issues than you might imagine. For example, when I get my flu shot, or have a blood test, I never get the spot bandaged. I'd rather get a few spots of blood on my white shirt than have to rip out hairs when I take the band-aid off. The worst medical procedure for hairy guys are heart tests. EKG's or electrocardiograms, involve people from the lab, nurses or doctors putting stickers on my chest to see how my heart is doing. Removing those stickers hurts. A lot. I have found different EKG's hurt different amounts. The 24 hour holter monitor in Dauphin is the worst. The glue is so sticky, I took someones advice and shaved my own chest before my last test. The portable EKG at St. Boniface had the best stickers/glue. They were small and came off without removing any hair. That was fantastic.

Recently my dog Sheldon needed an EKG. His breed is prone to heart problems and Dr. Sonia thought she heard something funny during a check up. I was excited. Not because Sheldon might have a heart problem, but because dogs are hairier than me don't like having stickers pulled out of their fur. Maybe the Vets had a better hairy guy EKG.

Osteoporosis can be a sticky problem whether you are hairy or not. Osteoporosis affects about 1 in 4 women and about 1 in 8 men over the age of 50 in Canada. In severe cases it causes hunching over or kyphosis of the spine. Kyphosis can cause shortness of breath and problems with your stomach. Even in less severe cases, osteoporosis makes you more likely to break a bone.

Osteoporosis is when your bones get thinner and more brittle. If you look at a bone under a microscope, it looks like a honey comb. It isnt solid. When a person has osteoporosis, the microscopic structure changes, and the holes in the honey comb get bigger. The bone also gets weaker. Osteoporosis is called a silent disease. Sometimes the first sign of the disease is when a person breaks a bone unexpectedly. For example, someone with osteoporosis can break a rib by coughing. Other bones that can break in osteoporosis are the vertebrae in the spine, the upper thigh bone, the wrist, and the hip. Hip fractures are the most serious osteoporotic fracture. People with osteoporosis begin to break their hips at about age 60 and the average age of a hip fracture patient is 80. Up to 28% of women and 37% of men die within a year of breaking their hip.

What causes osteoporosis? Bones are a living tissue. Bones are built up by a type of cell called osteoblasts. Bones are broken down by cells called osteoclasts. Up until the age of 30 the osteoblasts are more active. They build a scaffolding of protein and then fill up the spaces with calcium, phosphorous and other minerals. The osteoclasts are still breaking down old bone, but up to the age of 30 you are building more bone than you are breaking down. The osteoclasts and osteoblasts are pretty much in balance between the ages of 30 and 50. Then after the age of 50, the amount of estrogen drops in women and the amount of testosterone drops in men. We think that is the trigger that causes less bone to be built than is broken down. After the age of 50 our bones start to get less dense. For many people this gradual decline in bone mass is no big deal. For some people the bone density decreases rapidly and the bones get so fragile and porous they break easily. This is osteoporosis.

What factors put someone at risk of developing osteoporosis? The one of the biggest risk factors is being female. Women are 4 times more likely to get osteoporosis than men. Besides being female, other risk factors include being Caucasian or Asian, being over 65, having a small frame, having relatives with osteoporosis, being inactive, low calcium intake, smoking and high alcohol intake.

What can you do to help reduce the risk of breaking a bone? Depending on your age, you should be getting 1000 to 1500 mg of calcium per day either from your diet or supplements. You should be getting 800-2000 IU of Vitamin D per day. Calcium helps build and maintain bone. Vitamin D helps your body absorb calcium from the gut. Regular weight-bearing exercise will also help build bone. Regular walks with the dog 4-5 times a week for about 20 minutes each will help strengthen your bones. Also, quit smoking and reduce your alcohol intake.

If your doctor has determined your bones are already thinning and you are at risk for breaking them, they may put you on a prescription medication. There are a lot of choices but the most common class of medications are called the bisphosphonates. The have names like alendronate, fosamax, risedronate and actonel. They are a little complicated to take. You have to take them first thing in the morning at least 30 minutes before food and you cant go lie back down during that 30 minutes. On the plus side, there are bisphosphonates that you can just take once a week, which reduces their inconvenience.

I am still hoping for an EKG test that is both more convenient and less painful. My dog Sheldon grudgingly went to try out the vet EKG for me. The good new is Dr. Sonia says his heart is fine. The bad new is the canine EKG doesn't sound that comfortable. Doris went with Sheldon, so I told her to see what kind of leads they use on dogs. Doris said they looked like metal clothes pins. Even though they go through fur, that doesnt sound very comfortable. Oh well, I guess I'll have to keep looking for a hairy guy approved EKG.

As always if you have any questions or concerns about these or other products, ask your pharmacist.

For more information on Osteoporosis please see: www.osteoporosis.ca

FRAX algorithm for 10 year fracture risk: www.shef.ac.uk/FRAX/tool.jsp

The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.

We now have this and most other articles published in the Parkland Shopper on our Website. Please visit us at www.dcp.ca

 


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