Stop the Silent Thief

You have heard it called “the silent thief.” You remember a friend whose mother or grandmother was never the same after breaking her hip because of it. You may even have been told that you are at risk yourself.

It is osteoporosis, a bone disease that most of us know about, but it’s one that we may not fully understand. What is it exactly? Why does it happen? Who is at risk? And what can be done?

Here we provide an overview of what you need to know to better understand what osteoporosis is, if you are at risk, and what steps you can take to help support the health of your bones.

What is osteoporosis?

Osteoporosis is a condition in which bones become thin and filled with holes (hence the “porous”), making them weaker and more prone to fracture. Approximately one in four women and one in eight men are at risk of developing osteoporosis once they are over 50 years of age. More than 2 million Canadians are currently living with it.

What causes osteoporosis?

Bone is constantly undergoing a process known as remodelling. During remodelling, bone material is broken down and rebuilt in an ongoing cycle in which small damages to the bone are repaired and minerals are released and distributed to other cells in the body.

In healthy bone the cells that break down bone (osteoclasts) and the cells that build new bone (osteoblasts) work together to balance bone breakdown (resorption) and bone formation.

In osteoporosis something in this delicate balance goes awry and resorption occurs in excess of formation. There is no single cause of this imbalance, and it likely occurs in different people due to different sets of circumstances.

Most therapies aimed at preventing or treating osteoporosis are aimed at slowing down bone resorption and/or providing necessary nutrients to support bone formation.

What are the symptoms?

Many people who develop osteoporosis do not even know that they have it until they break a bone. Common fracture sites in people with osteoporosis include the spine or hip.
Wrists are another common site of osteoporotic fracture, likely because when most of us fall, we instinctively put our hands out to break the fall (unfortunately, if you have osteoporosis, you could be breaking a lot more).

Once someone with osteoporosis suffers a fracture, their overall health can decline significantly, particularly in the case of hip fractures. Osteoporosis Canada reports that osteoporosis-associated hip fractures result in death (due to complications) in up to 30 percent of cases. That’s an alarming statistic, and one that should cause us all to consider the health of our bones.

What to do?

Know your risk
The first step toward reducing your risk of osteoporosis is to learn what your risk factors are. In the world of osteoporosis risk, there are things that you can change and things that you can’t. Know the factors that increase your risk, address the things that you can change, don’t sweat the things that you can’t change, and pursue a lifestyle that supports bone health.

Risk factors for osteoporosis include:

• being female
• being over 60
• being sedentary
• being Asian or Caucasian
• being underweight (BMI of 19 or less)
• having a family history of osteoporosis
• having certain medical conditions including hyperthyroidism, Crohn’s disease, celiac disease, or other digestive problems that can significantly impair calcium absorption
• smoking
• low dietary calcium intake
• chronic intake of more than two alcohol-containing drinks per day
• chronic intake of more than three cups of coffee a day
• long-term use of certain medications including corticosteroids, methotrexate, anti-seizure medication, some antidepressants, aluminum-containing antacids, and proton pump inhibitors

Use it or lose it
Bone is a living tissue that remodels itself continually. As we go about our business, our bones are being gradually broken down and rebuilt by our bodies. How strong a bone is built depends, in part, on how strong it needs to be.

Bones that have to carry a load stay stronger, longer. If you do not subject your bones to the stress of weight-bearing activities, you will gradually lose bone mass. Just ask an astronaut. In the weightlessness of space, astronauts can lose as much bone density in one month as postmenopausal women lose in one year.

Rate of loss may be slower here on earth, but the same rule applies: if you don’t use your bones, they won’t stay strong.

So get out there and play. Seek activities that put stress on the bones; this encourages the body to lay down new bone during the remodelling process. Some of these activities include:

• hiking
• walking
• running
• weight training
• yoga
• dancing
• jumping rope
• stair climbing
• tennis

Get outside
The sun is our greatest source of vitamin D. But between work, family, and a variety of indoor commitments, we can’t all get outside as much as we need to. This can lead to an increased risk of inadequate vitamin D.

Vitamin D supports bone health by helping the body to absorb calcium. It also plays a role in maintaining muscle strength—and stronger muscles, particularly as we age, mean a decreased risk of falling, which reduces the risk of fracture.

Because many parts of Canada do not get adequate sunshine year round, and because many of us may not spend enough time in the sun even when it is shining bright, supplementing with vitamin D is a good idea. A safe dose for most people to take regularly is 1,000 IU per day.

Ask your health care practitioner to check your vitamin D levels, and have a discussion about where your levels are and where they should be to support bone health.

Bone-healthy diet
A nutritious diet is an important foundation for healthy bones. Several nutrients are required to build bone, and a diet rich in variety will help you to obtain as many of these nutrients
as possible.

Most of us are aware of the importance of calcium and calcium-rich foods, but the body needs other nutrients to build healthy bones.

Not-so-bone-healthy diet
While many foods support bone health, there are also several foods that may promote bone loss, and it is just as important to make sure that you do not get too much of these in the diet.

Foods and ingredients to use in moderation

Salt - High salt intake increases calcium output in the urine, calcium that your body has to replace. To do this, the body naturally turns to its largest calcium store, the bones. So be mindful of how much salt you are shaking over your food. You may also consider using natural artisanal salts containing minerals, particularly those which include potassium, a mineral that has been shown to reduce sodium-induced loss of calcium in the urine.

Caffeine - High intake of caffeine (more than 300 mg per day, equivalent to 18 oz/530 mL or more of coffee) has been shown to accelerate bone loss in post-menopausal women. Keep in mind that those ever-popular energy drinks are also loaded with caffeine, and therefore not a bone-friendly choice.

Alcohol - Although occasional and social intake of alcohol does not present any significant risk to bones, chronic intake of more than two alcoholic beverages per day may increase osteoporosis risk.

Refined, processed, canned foods - These foods contain very little of the nutritional value found in whole foods such as whole grains, legumes, nuts, and fresh fruits and veggies. As a result, they tend to be low in the minerals needed to build healthy bones.

Butt out!
These days it is well known that smoking is not good for health; smoking increases the risk of several cancers, cardiovascular disease, and respiratory diseases. But it may surprise you to know that smoking is also associated with an increased risk of osteoporosis.

Various researchers have shown that smoking leads to increased bone loss and that smoking cessation may even result in increased bone density in women. Not only does smoking weaken bones, but it can also delay bone healing (bad news if you are already at increased risk of osteoporotic fracture) and damage cartilage.

Now that you know a little bit more about what osteoporosis is, what the risk factors are, and some tips for prevention, consider sitting down with your health care practitioner to determine your own risk of osteoporosis.

Once you know your risk, take action through diet, lifestyle, and supplementation as required, to reduce your risk. It is never too early—or too late—to start taking positive steps toward better bone health.

Calcium Facts

Recommended intake
The recommended calcium intake for adults under 50 is 1,000 mg per day. For those over 50, the number jumps to 1,500 mg per day. That is a lot of calcium, and many people will have difficulty getting this much calcium from food alone.

Luckily, a variety of calcium supplements is available on the market.

Elemental calcium
This refers to the amount of calcium that is in a calcium compound. For example, calcium carbonate and calcium citrate are two types of calcium compounds and each one contains a different percentage of calcium.

When your doctor recommends 1,000 mg of calcium, he or she is referring to elemental calcium. In Canada the calcium content listed on your supplement bottle is referring to elemental calcium content.

Calcium carbonate
This form of calcium contains a high amount of elemental calcium compared to other forms of calcium, such as malate or citrate. In other words, gram for gram, calcium carbonate contains more elemental calcium than these other forms of calcium.

This is why you generally need to take fewer tablets or capsules of a product containing calcium carbonate in order to get the same dose of calcium found in several more capsules or tablets of citrate, malate, or some other forms of calcium.

Calcium citrate
Some people with reduced levels of stomach acid can absorb calcium citrate more easily than calcium carbonate. In addition, calcium citrate is absorbed by the body equally effectively taken with or without food.

Calcium citrate contains a lower amount of elemental calcium than does calcium carbonate.

Absorbability
Many factors affect the absorption of calcium. For example, calcium carbonate seems to be affected by stomach acidity, vitamin D levels, and estrogen status to a greater degree than calcium citrate.

In women under 30, there does not seem to be a significant difference in effect between calcium carbonate and calcium citrate in terms of absorption or effect on bone. In postmenopausal women, calcium citrate may be better absorbed.

Absorption is also affected by the total amount of elemental calcium consumed at one time; the higher the elemental calcium, the lower the percentage of absorption. Because absorption is highest in doses of less than 500 mg, a daily dose of 1,000 mg is better absorbed in two separate doses.

Side effects
Some people experience uncomfortable side effects when taking calcium supplements, such as gas, bloating, or constipation. This may be resolved by spreading out the dose of calcium over the course of the day, taking it with meals, or even changing the brand of supplement.