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Toolbox 206: Helping to Prevent Fractures in Your Patients

Osteoporosis - Tips for Patients

Osteoporosis is a chronic condition, best thought of as poor bone quality.  This condition is NOT the same as osteoarthritis.  

Osteoporosis is notoriously underdiagnosed and undertreated in Canada, despite the fact that two million Canadians suffer from osteoporosis.   According to Osteoporosis of Canada, one in three women and one in five males with suffer from an osteoporosis related fracture in their lifetime.  

The major risk of osteoporosis is a potential fracture that not only may affect your ability to function in the short-term, but may have severe outcomes to your long-term health.  Following a hip fracture, twenty-eight percent of women and thirty-seven percent of men will die within a year.

Nevertheless, it is not all doom and gloom!  We have several tools that can be shared with patients to help prevent and treat osteoporosis.

Dr. Christine Palmay

MD, CPSO

Family Physician,
Toronto, ON

  • PREVENTION

    Bone density loss naturally occurs following menopause and can be accelerated by several risk factors including medical conditions (thyroid disorders, gastrointestinal disorders), medication use, low body weight, smoking/alcohol use. Family history also plays a role. Part of prevention is ensuring that your primary care provided has a detailed health and family history.

    1. Calcium
      • Adequate intake of calcium is important for bone building. Healthy adults between 19-50 years old, require 1,000 mg of calcium daily. Adults over 50 years old require 1,200 mg calcium daily.
      • Given our reduced consumption of dairy products, I strongly suggest you evaluate your calcium intake and ensure that you are meeting standards. An excellent calcium calculator can be found here.
      • Calcium Rich Foods 1 - View Download
      • Calcium Rich Foods 2 - View Download
    2. Vitamin D
      • Guidelines recommend that all Canadian adults take a vitamin D supplement vitamin D3 or cholecalciferol) YEAR-ROUND (no time off during the summer!). Healthy adults between 19-50 years old, require 400-1,000 IU daily. Adults over 50 years old or younger adults at high risk should receive 800-2000IU daily
      • Vitamin D is at fat soluble and overdosing can cause toxicity. Please speak to your health care provider regarding optimal dosing
    3. Physical Activity
      • Physical activity to address bone health includes strength training, balance, postural awareness and aerobic physical exercises. Given the reduced access to gyms, I recommend that everybody invest in a set of home weights if possible
    4. General Health
      • Avoid Smoking. Minimize alcohol intake. Maintain a healthy body weight.
    5. Screening
      • Speak to your primary care provider about Bone Mineral Density Testing. In general, screening officially starts for all women and men over sixty-five years old, but I start the discussion process earlier at fifty and with those who have risk factors.
      • Safety
        • Be safe during our winter weather. When conditions are hazardous, ensure that you don’t put yourself at risk by venturing outside. Invest in proper winter footwear. Rely on assisted transportation if needed.
        • Identify risk factors in your home: stairs, rugs, objects that may cause you to trip
        • Check your vision and ensure that you have proper eyewear prescriptions
        • Have nightlights available should you need to wake up at night. Several of my patients have fallen en route to the bathroom during the wee hours of the night
        • Invest in solid footwear

  • TREATMENT

    In the case of a diagnosis of osteoporosis, our main goal is to prevent fractures.  This is to avoid the catastrophic consequences of a major fracture with a complex set of related health outcomes and loss of independence.  Remind yourself and your doctor “It wasn’t  just a fall” - fewer than 20% of fracture patients in Canada currently undergo diagnosis or adequate treatment for osteoporosis.

    The treatment of osteoporosis has changed over the past few years. We now approach osteoporosis as a spectrum and treatment is catered to individual risk factors based on the risk of fracture.   We have several treatment options for osteoporosis that range in type (pills, injections, infusions), frequency (daily, weekly, monthly, every 6 months etc) and duration.  

    Please see below for some comprehensive resources that provide guidelines for nutrition, physical activity, medication summaries and risk tool analysis. You can empower yourself to protect and treat your bone health.

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