Our bones are constantly renewed through a natural process in which new bone cells replace old bone cells. As we age, however, this process becomes less efficient and we begin to gradually lose bone tissue.
Osteoporosis is a bone disease where bone loss occurs more rapidly than normal causing bones to become very thin and weak over time. While osteoporosis is more common among older individuals, it can affect people of all ages.
When bones become severely weakened by osteoporosis, a simple movement such as bending over to pick up a bag of groceries, or a minor trauma, such as a fall from standing height or less, can lead to fracture (breaks or cracks in the bone). The most common places for these fractures to occur include the wrist, shoulder, spine and hip. Such fractures, particularly fractures of the hip, are a significant cause of disability, health care costs, and premature death in Canada.
According to the 2009 Canadian Community Health Survey, the Public Health Agency of Canada estimated that approximately 1.5 million Canadians aged 40 years and over (10%) have osteoporosis. Of these people, women were four times more likely to report having osteoporosis than men. Women are more at risk of developing osteoporosis than men because they start with lower bone density and they lose bone mass more quickly as they age. For more facts on the impact of osteoporosis on Canadians refer to: Fast Facts from the 2009 Canadian Community Health Survey - Osteoporosis Rapid Response.
Risk factors for osteoporosis
Several factors play a role in the development of osteoporosis and the more risk factors you have, the greater your risk. Since bone loss occurs without symptoms, determining if you have osteoporosis requires a bone mineral density test. Your doctor may want you to have a bone mineral density test if you have the following risk factors:
Younger adults (age < 50 years):
- Fragility fracture (breaking a bone as a result of a minor accident)
- Long term use of glucocorticoids such as prednisone
- Hypogonadism or premature menopause (age < 45 years)
- Having other disorders strongly associated with rapid bone loss and/or fracture such as rheumatoid arthritis, malabsorption syndrome, and primary hyperparathyroidism.
Older adults (age > 50 years):
- Being 65 years or older
- Clinical risk factors for fracture (menopausal women, men age 50 to 64 years):
- Fragility fracture (breaking a bone as a result of a minor accident)
- Long term use of glucocorticoids such as prednisone
- Having a parent who had a hip fracture
- Having a spine fracture or low bone mass identified on x-ray
- Being a smoker
- High alcohol intake (greater than or equal to 3 units per day on a consistent basis)
- Low body weight (less than 60 kg or 132 lbs) or major weight loss (present weight is more than 10% below your weight at age 25)
- Having other disorders strongly associated with rapid bone loss and/or fracture as mentioned above.
For more information on risk factors and bone mineral density testing visit Osteoporosis Canada
Assess your risk of fracture
To assess your fracture risk there are currently two fracture prediction tools available that have been tested in the Canadian population:
- WHO Fracture Risk Calculation Tool (FRAX®) for Canada
- Canadian Association of Radiologist and Osteoporosis Canada (CAROC) 2010 Risk Assessment Tool
Both of these tools can estimate your risk of having a major fracture (i.e., fracture of the wrist, upper arm, spine and hip) associated with osteoporosis within the next 10 years. The FRAX® tool uses several risk factors (e.g., sex, age, height, weight, previous fracture, parent fractured hip) and (optionally) the bone mineral density score of your hip to calculate your risk of fracture. The CAROC tool uses your age, sex and bone mineral density score of your hip to estimate your risk of fracture.
For more information on these fracture prediction tools consult the 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: Summary
Reduce your risk of developing osteoporosis
It's possible to prevent, delay or reduce bone loss through a healthy lifestyle. Assessing your risk for osteoporosis and related fractures can help you identify lifestyle factors that you can change.
Basic bone health for all individuals includes regular weight bearing and resistance type exercise as well as adequate vitamin and mineral intake.
Regular exercise that involves weight-bearing aerobic exercise and resistance training is beneficial to bone development and maintenance.
Exercises that focus on balance (e.g., Tai Chi, yoga and/or exercises in standing) are beneficial for people who are at risk of falling.
For tips to help you get active and information on how much physical activity is recommended, consult Canada's Physical Activity guides and Osteoporosis Canada.
Vitamins and minerals
A diet rich in calcium is essential for healthy bone development. Good sources of calcium include milk products (such as milk, cheese and yogurt), fish products containing bones (such as canned salmon and sardines) and calcium-fortified beverages such as soy beverage or orange juice. Other food sources of calcium include calcium-set tofu, leafy greens and legumes such as soybeans or chickpeas. It is important to know how much calcium you need each day. For individuals who are unable to obtain enough calcium through their diet, calcium supplements are often recommended. For specific recommendations, speak to a health professional.
Vitamin D is also essential for bone development because it supports the body's ability to absorb calcium. Vitamin D can be made in the skin following exposure to the ultraviolet (UVB) rays in sunlight. However, many factors such as winter season, use of sunscreen, darker skin tone, older age and extensive clothing coverage can reduce the amount of vitamin D our skin makes. Since too much sunlight can be harmful and cause skin cancer and eye damage, recommendations for vitamin D are made assuming minimal exposure to sunlight.
In Canada, it is required that cow's milk and margarine be fortified with vitamin D. Vitamin D may also be found in fortified goat's milk, plant-based beverages (e.g., soy-based), calcium fortified orange juice and some cheeses and yogurts made with vitamin D fortified milk. Vitamin D is found naturally in fatty fish, fish liver oils and egg yolk. It is important to know how much vitamin D you need each day. To ensure you get enough vitamin D, a supplement is sometimes recommended. Health Canada has advised that everyone over the age of 50 take a daily supplement of 400 IU in addition to following Canada's Food Guide. For specific recommendations, speak to a health professional.
For more information on nutrition and healthy eating check out Canada's Food Guide and Osteoporosis Canada.
Living with osteoporosis
There are a number of things you can do if you have osteoporosis to help prevent further bone tissue loss:
Adopt a bone-healthy lifestyle
A bone-healthy lifestyle includes regular exercise/physical activity and ensuring that you get the necessary vitamins and minerals to prevent, delay and/or reduce bone loss.
For more information on ways to adopt a bone-healthy lifestyle visit Osteoporosis
Your doctor may recommend one of a variety of drugs to help you with osteoporosis. These include:
- antiresorptive agents, which slow down bone loss such as bisphosphonates, denosumab, raloxifene and estrogen
- bone formation therapies, which help to build up bone such as the medication teriparatide
The primary aim of these drugs is to reduce your risk of fractures. You and your doctor should review the options, assess the risks and benefits of each, and choose the most suitable one based on current scientific evidence.
You may also need to explore several treatment options as some people can have side effects while taking certain medications.
For more information on treatment options visit Osteoporosis Canada.
If you have osteoporosis, preventing falls and fractures is an important concern. Some tips on reducing your risk include:
- doing regular weight bearing, balance and strengthening exercises
- having your doctor review your medications to ensure none causes dizziness or sleepiness, which can lead to falls
- having your vision checked regularly
- making your home safe, for example by removing throw rugs, using non-slip mats in the shower and wearing shoes inside
- wearing hip protectors (pants or underwear that have padding in them) to protect your hips if you do fall
For more information on falls prevention:
- Seniors' Falls in Canada: A Second Report
- If you Fall or Witness a Fall, Do you Know What to Do?
- The Safe Living Guide - A Guide to Home Safety for Seniors
- You CAN Prevent Falls
- Prevention of Falls in Long-Term Care Facilities: Recommendations from the Canadian Task Force on Preventative Health Care
What we do
Addressing osteoporosis in Canada is done through a coordinated and collaborative effort among many individuals and organizations including:
- Government and public health agencies such as the Public Health Agency of Canada, Canadian Institutes of Health Research, Health Canada, Statistics Canada, Canadian Institute for Health Information
- Not for profit organizations such as Osteoporosis Canada
- Provincial and territorial partners
- Academic researchers
- Health care professionals
- People living with osteoporosis
These types of partnerships help to ensure a comprehensive approach to the prevention and management of osteoporosis.
The Public Health Agency of Canada's Osteoporosis Surveillance Program measures and monitors the impact of osteoporosis on Canadians through the:
- Systematic, regular collection of best available data
- Analysis, interpretation and integration of the data into surveillance products
- Dissemination of information to those who need to know
This section includes links to Public Health Agency of Canada publications, Clinical Practice Guidelines, and other links of interest on this subject.
Public Health Agency of Canada publications:
- Osteoporosis and related fractures in Canada, 2021
- Care gap following osteoporosis-related fractures in Canada, 2021
- Osteoporosis and related fractures in Canada: Report from the Canadian Chronic Disease Surveillance System 2020
- Leslie WD, O'Donnell S, Lagacé C, Walsh P, Bancej C, Jean S, Siminoski K, Kaiser S, Kendler DL, Jaglal S; Osteoporosis Surveillance Expert Working Group. Population-based Canadian Hip Fracture Rates with International Comparisons. Osteoporosis Int. 2010 Aug; 21(8):1317-22.
- Leslie WD, O'Donnell S, Jean S, Lagacé C, Walsh P, Bancej C, Morin S, Hanley DA, Papaioannou A; Osteoporosis Surveillance Expert Working Group. Trends in Hip Fracture Rates in Canada. JAMA-J Am Med Assoc. 2009 Aug 26; 302(8):883-9.
- LeMessurier J, O'Donnell S, Walsh P, McRae L, Bancej C; Osteoporosis Surveillance Expert Working Group. The Development of National Indicators for the Surveillance of Osteoporosis in Canada. Chronic Dis Inj Can. 2012;32(2):101-7.
- Jean S, O'Donnell S, Lagacé C, Walsh P, Bancej C, Brown JP, Morin S, Papaioannou A, Jaglal SB, Leslie WD; Osteoporosis Surveillance Expert Working Group. Trends in Hip Fracture Rates in Canada: An Age-period-cohort Analysis. J Bone Miner Res. 2013;28(6):1283-9.
- O'Donnell S; Canadian Chronic Disease Surveillance System (CCDSS) Osteoporosis Working Group. Use of Administrative Data for National Surveillance of Osteoporosis and Related Fractures in Canada: Results from a Feasibility Study. Arch Osteoporos. 2013;8(1-2):143.
Clinical Practice Guidelines:
- 2010 Clinical Practice Guidelines for the Diagnosis and Management of Osteoporosis in Canada: Summary
- Canadian Association of Radiologists Technical Standards for Bone Mineral Densitometry Reporting
- Canadian Association of Radiologists Clinical Practice Guidelines - Recommendations for Bone Mineral Density Reporting in Canada
- Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada
- A Best Practices Guide for the Prevention of Falls Among Seniors Living in the Community
Other useful links:
- Canadian Association of Radiologists
- Canadian Institute for Health Information
- Canadian Institutes of Health Research - Institute of Musculoskeletal Health and Arthritis
- Canadian Multicenter Osteoporosis Study (CaMos)
- Ontario Osteoporosis Strategy
- Osteoporosis Canada
- Statistics Canada
- Australian Institute for Health and Welfare
- Bone and Joint Decade
- U.S. Centers for Disease Prevention and Control
- International Osteoporosis Foundation
- International Society for Clinical Densitometry
- National Osteoporosis Foundation (U.S.)
- National Osteoporosis Society (UK)
- North American Menopause Society
- Osteoporosis Australia
- U.S. Department of Health and Human Services
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