June 15, 2019

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The slipping season

A nasty fall is often the first time patients learn they have osteoporosis

KEN GIGLIOTTI / WINNIPEG FREE PRESS FILES</p><p>Unshovelled sidewalks add to the risk of falling for pedestrians of all ages.</p>

KEN GIGLIOTTI / WINNIPEG FREE PRESS FILES

Unshovelled sidewalks add to the risk of falling for pedestrians of all ages.

Hey there, time traveller!
This article was published 26/11/2018 (201 days ago), so information in it may no longer be current.

Joan Bartley has had plenty of Christmas memories in her 73 years.

Not the least of which is one more than 20 years ago. Friends from Australia were visiting, but that’s hardly the most notable part. Rather it was that she spend much of the day in hospital after slipping on the ice and shattering her wrist.

“My bones were mush,” says the Winnipeg grandmother and retired educator. “I will not forget it, and our Australian friends, whenever we connect, that’s the first thing we often talk about.”

Not that Bartley minds. As a vocal advocate for awareness of a disease in Canada that affects millions of Canadians, including herself, she will discuss that fateful day with just about anyone.

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Hey there, time traveller!
This article was published 26/11/2018 (201 days ago), so information in it may no longer be current.

Joan Bartley has had plenty of Christmas memories in her 73 years.

Not the least of which is one more than 20 years ago. Friends from Australia were visiting, but that’s hardly the most notable part. Rather it was that she spend much of the day in hospital after slipping on the ice and shattering her wrist.

SUPPLIED</p><p>Dr. Farmida Jiwa, president and CEO of Osteoporosis Canada.</p>

SUPPLIED

Dr. Farmida Jiwa, president and CEO of Osteoporosis Canada.

"My bones were mush," says the Winnipeg grandmother and retired educator. "I will not forget it, and our Australian friends, whenever we connect, that’s the first thing we often talk about."

Not that Bartley minds. As a vocal advocate for awareness of a disease in Canada that affects millions of Canadians, including herself, she will discuss that fateful day with just about anyone.

Bartley has osteoporosis, but it wasn’t until she fractured a wrist that she eventually ended up being diagnosed.

Her story is not unusual, says Dr. Famida Jiwa, a chiropractor, health administrator, president and CEO of Osteoporosis Canada.

"You often don’t realize your bones have become that weak until your fall and break a bone," she says. "That’s why osteoporosis is called ‘a silent disease.’"

The fact that osteoporosis creeps up on people is somewhat ironic considering it has become so common. About two million Canadians are affected by the disease, Jiwa says. That’s why the non-profit organization recently launched the Know Your Risk campaign for Osteoporosis Awareness Month this November.

"It’s a simple quiz Canadians can take to identify their individual risk associated with getting osteoporosis along with lifestyle recommendations to make bone health a priority," Jiwa says about the initiative that can be found online at osteoporosis.ca.

While most people recognize the disease is related to aging — the result of our bones losing mass and becoming more porous — few realize that it can become problematic as early as age 50.

Dr. Heather Frame, a family physician at the Assiniboine Clinic in Winnipeg and the chair of Osteoporosis Canada, says our bones are strongest in our 20s, and we generally maintain good bone health into our 30s.

"Then it’s a slow, downhill progression from then on in," says Frame, who had worked at a clinic in the city specializing in osteoporosis prevention and treatment for women before it closed in the last year.

"The bone loss tends to accelerate for women right at the time of menopause for about five years."

That said, osteoporosis is not a women’s disease. While women tend to have a higher risk — one in three will break a bone as a result from the disease — it is common among men, too. About one in five men also will suffer a broken bone caused by osteoporosis.

A number of factors cause the brittle effects of bone-density loss including falling levels of estrogen in women (hence why menopause is a risk factor) and testosterone in men.

Hormones play a role in building bone density, Frame adds, yet treating people with hormone-replacement therapy is not considered a safe and effective way to build up bone mass in people with the osteoporosis.

But plenty of effective drug therapies do exist, which help maintain and can even increase bone density. These include alendronate (Fosamax), zoledronic acid (Aclasta) and denosumab (Prolia).

"These medications reduce the risk of future fracture by between 40 and 60 per cent."

Frame adds that some medications have been in the news recently because they can, on very rare occasions, cause fractures themselves. And the headlines can be misleading.

"These medications prevent in the range of 100 hip fractures, but maybe cause one atypical fracture," she says. "On balance there is way more benefit than risk, but the risks have been written a lot about in the last while so people are afraid to take them."

Fragility fractures, breaks caused by osteoporosis, are serious business—especially those involving your hip. According to the Centers for Disease Control and Prevention in the U.S, one in five hip fractures results in death within a year — often the result of falls. The fracture renders them bed-ridden, which can cause a "cascade of negative health events... including pneumonia," Jiwa says.

A test for osteoporosis is available, but bone density scans — an X-ray of your lower back and your hip — are generally done after you break a bone from falling after age 50.

Besides the scan, individuals undergo a risk evaluation, which includes looking at family history, Frame says.

"We consider high risk to be 20 per cent or more over 10 years, and that’s when someone is offered treatment."

Until that point the focus is on prevention. While bone-density loss inevitably occurs with age, fractures resulting from osteoporosis are avoidable. Part of everyone’s prevention plan should be a diet rich in calcium, supplemented by vitamin D. Both are critical to bone health. Calcium builds and maintains bones, while vitamin D helps the body absorb the mineral.

Exercise can maintain bone health, particularly weight-bearing activities like walking. Putting a little stress on your bones can stimulate bodily processes that increase their strength. Frame says strength training is also important because stronger muscles, in your legs particularly, can prevent falls.

More than 20 years after being diagnosed, Bartley is living proof this formula works. She hasn’t since broken a bone. And while she takes medication, she makes sure she eats plenty of calcium-rich foods, supplements her diet with vitamin D, and keeps active — including doing Pilates.

And she encourages others to do the same, for the good of their bones.

What she doesn’t recommend, though, is letting a diagnosis fill you with dread.

"Often people think worry they can’t lift this or do that, so it’s easy to become depressed because you think ‘What can I do?’" Bartley says. "But there are ways to live well with osteoporosis."

joelschles@gmail.com

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