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Osteoporosis in Canadian Women: Building Strong Bones for a Healthy Life

Author: Shali Tayebi, MSc Global Health, University of Copenhagen

Osteoporosis is a metabolic bone disease that is a major public health issue. It also places a tremendous physical, emotional and mental burden on those who it afflicts. Over 200 million people worldwide are affected by osteoporosis. There are 2.2 million people with osteoporosis in Canada; a country with a growing and ageing population [3,7]. 

The disease is characterized by weakening bones, which increases the risk of fractures. Most often, people live with bone loss for many years without knowledge of their condition until their first fracture -- most commonly in their hip, wrist, or spine. Physical consequences can include reduced mobility, disability, chronic pain, loss of height, and premature death [7]. 

Subsequent psychological effects can follow. This includes depression in reaction to living with a chronic condition and anxiety stemming from a fear of future injuries and falling. People may experience a social decline through the loss of social duties and social isolation [7]. 

Causes

The causes of osteoporosis are grouped into primary and secondary classifications. The primary group mainly consists of older individuals experiencing changes in hormone levels after reaching menopause and from chronic low dietary calcium. In the secondary group, low bone mass is a side effect of other health conditions [3]. 

Risk Factors

More than 80% of cases in Canada are women. This increased risk is due to several factors. First, women tend to have thinner, smaller, and less dense bones than men. Women often also have longer life spans than men and are more likely to make up a bigger portion of those with osteoporosis in older demographics. Lastly, a bone mass loss can be attributed to the sex-exclusive biological event of reaching menopause due to dramatic hormonal changes.

Other notable co-risk factors include small body size (weighing less than 127 pounds), eating disorders, missing menstruation for at least three consecutive months (amenorrhea), and genetics. Ethnicity affects the prevalence of osteoporosis through the correlation of bone mineral density (BMD) [3]. In one study conducted by Keen and Reddivari (2020) in the United States, the highest prevalence rates were noted in Indigenous Americans with 11.9%, Asians 10%, Hispanics 9.8%, Caucasians 7.2%, and Black Americans 4% [3].

Prevention

Building strong bones and using preventative strategies is essential in maintaining good health later in life. New bone generation slows down with age compared to bone loss, so early prevention is critical. By 18 years of age, women have already developed 90% of their bone mass. Thus, it is crucial to minimize health problems that impede building bone mass early in life, such as eating disorders, poor diets, and lack of physical activity. Once reaching adulthood, it is important to adopt healthy habits and activities so that the natural degradation of the bones is reduced. Exercise, especially weight-bearing activities that work the body against gravity, such as dancing, tai chi, yoga, running, and walking, help build strong bones and prevent bone loss.

Mitigation strategies include lifestyle changes, such as cessation of smoking, reducing alcohol consumption, and adequate calcium and vitamin D intake. The amount of calcium one needs depends on the person’s age. Since the body does not produce calcium, it needs to be consumed through foods such as milk, cheese, tofu, soy-milk, breakfast cereals, and leafy green vegetables. If the daily calcium intake is insufficient, the body uses calcium found in the bones which weakens them over time. 

Vitamin D assists the body to absorb calcium from the consumed foods and supports bone growth and reformation. The skin can naturally make vitamin D through sun exposure. But the amount needed varies depending on one’s skin tone, use of sunscreen, the season, and age. Foods such as salmon, tuna, and egg yolks can also be a good source of vitamin D. Notably, Health Canada recommends that people over 50 years of age take daily vitamin D supplements, since obtaining sufficient vitamin D exclusively through diet and sunlight can be difficult [7]. 

Burden in Canada  

In a report by the Canadian Institute of Health Research (2016), the national costs attributed to osteoporosis fractures in 2011 cumulated to $4.6 billion. This is an 83% increase since the previous 2008 report [2]. The increase in expenditures are explained by the rise in admissions for acute care, rehabilitation, and complex continuing care [2]. Such findings also underlie the necessity of using more healthcare resources and preventative care for this disease [2]. 

In assessing Canada’s different elements of osteoporosis care, the health care system performs generally quite well - there are short wait times for hip fracture surgery and integration of various risk assessment algorithms [1]. However, further initiatives could be taken, such as a nation-wide fracture database to track incidence rates and monitor the delivery of healthcare. Osteoporosis is also not officially recognized as a health priority in many provinces [1]. 

Most importantly, there is a salient gap in best-known practices of care and the actual services that are provided [7]. Of those with an osteoporosis-related injury, less than 20% received a BMD diagnosis test or any medication within one year of the fracture [7]. 

Factors contributing to this inadequacy are multidimensional. In the context of the patient, there is compromised access to proper testing and treatment, lack of recognition of risk, and lack of healthcare provider awareness.  At a health system level, there is an insufficient alliance between hospitals and community health systems, and poor communication between clinicians over secondary prevention of fracture responsibilities [7]. 

Osteoporosis disease is a heavy burden on public health and women’s health in particular. It is important to raise awareness around the risk factors and encourage women to make long-term lifestyle changes to prevent osteoporosis. Exercising and reducing harmful behaviours such as smoking and drinking alcohol are essential steps in maintaining strong bones. Osteoporosis prevention and treatment need to be a strategic priority within the public health system throughout the country. 

 
References

1. Amgen Canada. (2020, October 20). New Scorecard Reveals Critical Need to Make Osteoporosis a National Health Priority. Cision. https://www.newswire.ca/news-releases/new-scorecard-reveals-critical-nee...

2. Hopkins, R. B., Burke, N., Von Keyserlingk, C., Leslie, W. D., Morin, S. N., Adachi, J. D., ... & Tarride, J. (2016). The current economic burden of illness of osteoporosis in Canada. Osteoporosis International, 27(10), 3023-3032.

3. Keen, M. U., & Reddivari, A. K. R. (2020). Osteoporosis In Females. StatPearls [Internet].

4. National Osteoporosis Foundation. (2020, December 21). What Women Need to Know. https://www.nof.org/preventing-fractures/general-facts/what-women-need-t...

5. “Osteoporosis Canada.” Osteoporosis Canada |, 4 Jan. 2021, osteoporosis.ca/. 

6. Osteoporosis | Womenshealth.gov. (2019, May 20). Womenshealth.Gov. https://www.womenshealth.gov/a-z-topics/osteoporosis

7. Public Health Agency of Canada. (2020, November 27). Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System 2020 - Canada.ca. Government of Canada. https://www.canada.ca/en/public-health/services/publications/diseases-co...

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