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www.osteoporosis.ca
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Overview of the Presentation
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Osteoporosis: An Overview
Bone Basics
Diagnosis of Osteoporosis
Drug Therapies
Risk Reduction
Living with Osteoporosis
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Osteoporosis: An Overview
What is Osteoporosis?
“A skeletal disorder characterized by
compromised bone strength predisposing a
person to an increased risk of fracture.
Bone strength reflects the integration of two
main features: bone density and bone
quality”
(US National Institutes of Health)
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Osteoporosis: An Overview
What is Osteoporosis?
Porous Bone
Normal Bone
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Osteoporosis: An Overview
Who Will Fracture from Osteoporosis?
1 in 3 women
1 in 5 men
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Osteoporosis: An Overview
Common Fracture Sites
wrist
spine
hip
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Osteoporosis: An Overview
Impact of Osteoporosis
4 cm
8 cm
12 cm
Height Loss
3 FB’s
2 FB’s
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Osteoporosis: An Overview
Projected Number of Hip Fractures
in Canada
Proportion of
population at age
65+
85+
Estimated # of
hip fractures
1993
2041
12%
1%
25%
4%
23,375
88,124
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Osteoporosis: An Overview
Impact of Osteoporosis
Approximately 30,000 hip fractures each year in
Canada (70% are osteoporosis related)
1 in 4 people with a hip fracture will die within a year,
1 will return to independent living and 2 will require
assisted living
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Osteoporosis: An Overview
Economic Burden of Osteoporosis
in Canada
• Healthcare costs are estimated at $2.3
billion as of 2010*
• Acute care costs $1.2 billion
• When outpatient care, prescription drugs
and indirect costs are added, the yearly
total comes to over $2.3 billion
*J.E. Tarride et al, The burden of illness of osteoporosis in
Canada, Osteoporosis International (2012)
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Bone Basics
What is Bone?
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Bone Basics
The Remodeling Process:
How Bone Repairs Itself
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Bone Basics
Normal Growth and Development
of Bone
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Bone Basics
Four Major Factors that
Contribute to Bone Health
• Genetics
• Hormones
• Nutrition
• Physical Activity
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Diagnosis of Osteoporosis
Assessment for Osteoporosis and
Fracture Risk
Who should be assessed?
• Women and men over 50 to identify
those at high risk
• Anyone over 50 who has experienced
a fragility fracture
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Diagnosis of Osteoporosis
Assessment for Osteoporosis and
Fracture Risk
How is the Assessment Done?
Detailed history to identify risk factors for low BMD,
future fractures and falls:
• Prior fragility fracture
• Parental hip fracture
• Glucocorticoid use
• Current smoking
• High alcohol intake (3 or more drinks per day)
• Rheumatoid arthritis
• Inquire about falls in past 12 months
• Inquire about gait and balance
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Assessment for Osteoporosis and
Fracture Risk cont.
Physical examination
• Measure weight
• Screening for vertebral fractures:
– Measure height annually
– Measure rib to pelvis distance
– Measure occiput-to-wall distance
– Spinal x-ray indicated if there is evidence of
vertebral fracture
• Assess fall risk by using Get-Up-and-Go Test
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Diagnosis of Osteoporosis
Who Should Get a BMD Test?
• All women and men 65 years or older
• Postmenopausal women and men
50 – 64 with risk factors for fracture
• Younger men or women (under 50) with a
disease or condition associated with low
bone mass or bone loss
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Diagnosis of Osteoporosis
Bone Densitometry
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Diagnosis of Osteoporosis
How is Osteoporosis Diagnosed?
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Diagnosis of Osteoporosis
10-year Absolute Fracture Risk
(CAROC)
• Other factors in addition to (hip) BMD results
are used to determine 10-year fracture risk
• These factors are age, sex, fracture history
and glucocorticoid use
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FRAX
• In 2008, the World Health Organization
(WHO) launched FRAX, a web-based fracture
risk assessment tool. In 2010 Canadian data
were added
• In addition to femoral neck (hip) BMD, age,
sex, fracture history and steroid use, FRAX
also takes into account other risk factors to
calculate the absolute 10-year risk of a hip
fracture or other major osteoporotic fracture
(spine, forearm, upper arm)
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Drug Therapies
How do Drug Therapies Work?
Slow bone erosion
Speed up bone building
• Bisphosphonates
• Denosumab
• Raloxifene
• HT
• Calcitonin
• Parathyroid hormone
(hPTH 1-34)
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Drug Therapies
Bisphosphonates
• Etidronate: Taken cyclically with
calcium supplements
• Alendronate: Taken in a continuous
daily or once weekly dose
• Risedronate: Taken in a continuous
daily, once weekly or monthly dose
• Zoledronic acid: Taken once yearly by
IV infusion
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Denosumab
• Denosumab (Prolia™) was approved in
Canada in 2010 for the treatment of
postmenopausal women with osteoporosis
• Administered twice yearly by a healthcare
professional
• Dosage 60mg/ml solution for injection under
the skin
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Drug Therapies
SERMs (Selective Estrogen
Receptor Modulators)
• Raloxifene (Evista®)
Taken in a continuous daily dose
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Drug Therapies
Hormone Therapy (HT) Estrogen and
Progesterone
• Prevention of menopausal
symptoms
• Prevention of vertebral, hip and
non-vertebral fractures in the
presence of menopausal
symptoms
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Drug Therapies
Hormone Therapy (HT)
Benefits and Risks
Benefits
Risks
• Menopausal
symptoms
• Bone loss and
fracture
• Colon cancer
• Cardiovascular
disease (heart attack
and stroke)
• Blood clots
• Breast cancer
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Drug Therapies
Calcitonin
• Salmon Calcitonin (Miacalcin® and
generic)
• Approved in Canada in 1999 for treatment of
osteoporosis in women five years postmenopause
• Taken one spray each day in one nostril,
alternating nostrils daily
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Drug Therapies
Parathyroid Hormone (PTH)
• Teriparatide (FORTEO®)
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Approved in Canada for treatment of
severe osteoporosis in postmenopausal
women and men at high risk of fracture or
who have failed to respond to or are
intolerant of bisphosphonates; also GIOP
Self-injected each day for a period of 24
months maximum
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Osteoporosis Risk Reduction
Choosing a Bone Healthy Lifestyle
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Osteoporosis Risk Reduction
Calcium Must Always be Available
to the Body
Meeting your daily
calcium
requirement
Not meeting your
daily calcium
requirements
Body does not
take calcium
from bones
Calcium taken from
bones to be
used in body
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Osteoporosis Risk Reduction
Calcium: OC’s Daily
Recommended Intake
Age
Daily Intake
Children (4 – 8)
Adolescents (9 – 18)
Men & women (19 – 50)
Men & women (50+)
Pregnant or lactating women (> 18 years)
1000 mg
1300 mg
1000 mg
1200 mg
1000 mg
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Osteoporosis Risk Reduction
Vitamin D: OC’s Daily
Recommended Intake (IU)
Age
Men & women (19 – 50)
Men & women (50+)
Pregnant or lactating women (> 18 years)
Daily Intake
400 - 1000
800 - 2000
400 - 1000
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Osteoporosis Risk Reduction
Good Nutrition for Healthy Bones
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Eat foods high in calcium
Ensure proper calcium absorption
Ensure adequate vitamin D
Eat a balanced diet with adequate
protein, and fruits and vegetables
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Osteoporosis Risk Reduction
Calcium Supplements:
Questions & Answers
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What are they made of?
How do I choose one?
What is the best way to take them?
Which types are recommended?
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Osteoporosis Risk Reduction
The Benefits of Being Physically Active
• Better coordination and balance, falls
prevention
• Improved muscle strength and flexibility
• Healthier bones - works with calcium and
vitamin D to build strong bones
• Increased endurance for daily activities
• Improved posture
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Osteoporosis Risk Reduction
What Type of Exercise Helps Bone?
Weight bearing
Resistance
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Living with Osteoporosis
The Physical Impact
of Osteoporosis
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Living with Osteoporosis
Some Movements Should be Avoided
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Living with Osteoporosis
The Psychological Impact of
Osteoporosis
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Living with Osteoporosis
Advice for People
Living with Osteoporosis
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Take charge of your health
Find ways to cope with pain
Learn how to manage difficult movements
Consider your daily needs
Get emotional support
Seek out professionals who can help
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Osteoporosis Canada
Our Vision
Canada without osteoporotic fractures
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Osteoporosis Canada’s mission is to
work towards a future where all
Canadians will
• Be knowledgeable about osteoporosis
• Be empowered to make informed choices about their
bone health
• Have access to the best osteoporosis care and
support
• Benefit from research into the prevention, diagnosis
and treatment of osteoporosis
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Get Involved
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Make a donation
Become a member
Add your name to COPN
Go to an event
Become a volunteer
Participate in a Break Through program