Osteoporosis

Nov 17, 2014

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

I can't even get at the keyboard with your stuff here! I can't find my friend on my iPod anymore! You deleted him! I don't know where my lunch is! Look I have a vegetable! Are you happy? Good morning Trevor. It's your mother. Does your morning sound like this? Eric got a second hand iPod touch from his grandparents last year. Yesterday he figured out how to send a text message to his friend. Then he sent one to my phone this morning. I responded. Unfortunately my response went to both Eric and my Mom as we didn't reset Eric's iPod properly. So my Mom and Eric responded. Then we tried to reset the iPod. And we deleted Eric's friend. Best of all we realized it was now 8 am and no one was ready for school or work. So all h,e, double hockey sticks broke loose. Life is what sneaks up on you when you were making other plans.

Osteoporosis can sneak up on you when you were making other plans too. 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.

How do you know for certain that your bones are thinning and you are at risk of an osteoporotic fracture? Sometimes the doctors can tell you have osteoporosis by the way you break a bone. Before you actually break a bone it can be difficult to tell that your bones are thinning with a regular exam and regular X-rays. The gold standard to see if your bones are thinning is a special X-ray called a DEXA or dual-energy x-ray absorptiometry. This special DEXA x-ray can only be done in Winnipeg and often there is a long wait to get in and have one done. The Dauphin Clinic Pharmacy has brought in another tool to assess your fracture risk.

Dauphin Clinic Pharmacy is doing a bone health clinic November 17 -21. We will scan your wrist with an ultrasound machine. That information will give you an idea how likely you are to break a bone. The ultrasound will cost $25. If you are interested, call us at 204-638-4602 to book an appointment.

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.

How about we all take a deep breath. Let's take a short rest from the craziness around us. Yes, we may have deleted our son's friend, but we can put him back on the iPod. Let's take a moment to think about our health. Dont let weak bones sneak up on you while you were making other plans. If you are over 50, have a talk about bone strength with your doctor. And consider if DCP's bone health clinic might give you some useful information.

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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