What puts you at risk of developing Osteoporosis?

Jul 7, 2020

By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy

The ground crew has finished loading up your plane. You take off and get into formation. Your mission is to protect these slow, lumbering bombers from the Luftwaffe. Over Leipzig, you feel the tension rise. As Dresden appears on the horizon, a group of unfriendly dots rapidly approaches. Your squadron breaks off from the bomber. Roll right. Pull up. Dive. You have the Messerschmitt in your sights. And you... and you what? You give 'em the whole nine yards. Apparently, the length of the 50 caliber ammunition loaded for each machine gun in a US fighter plane in WW2 was nine yards. This is my favorite, if probably not the oldest, origin story of the idiom "the whole nine yards".

If you are talking about the whole nine yards of health, having a functioning skeleton is high on the list. However, about 1 in 3 women will have an osteoporotic fracture during their lifetime. Over 80% of all fractures in patients over 50 are due to osteoporosis. 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 isn't 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. In older people with osteoporotic hip fractures, 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. However, in 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. For example, 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 can't 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.

There are some newer, but more expensive osteoporosis treatments available. Zoledronic acid is an injectable bisphosphonate that only has to be injected once a year. It will cost about $400, and is only for people who are unable to take oral bisphosphonates. Parathyroid hormone analogs are now available for those who fail on bisphosphonates. These often are people whose bones are thinned by long term treatment with steroids. Teriparatide is a parathyroid hormone analog that requires daily injections and will probably cost more than $13,000 per year.

When sailing ships had three masts and square sails, each sail was hung from a horizontal piece of wood call a yard. Often each mast would have three sails. So "the whole nine yards" was all the sails deployed. Still relatively exciting. Sailing. High Seas. Maybe pirates? But not machine guns on fighter planes. And the most boring, oldest and probably the origin of the idiom? Cloth has been sold in a unit called a bolt for a long time. A bolt is nine yards of cloth. If you wanted the entire bolt, you bought the whole nine yards. That idiom origin story is like hoping for the Baking Powder Submarine as a prize in your Frosted Flakes and instead getting the Animal Stamps book. It's fine, but what are you going to do with it in the bathtub?

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.


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