An introduction to osteoporosis 

Having previously worked as a dietitian at the Osteoporosis Program at British Columbia’s Women’s Hospital, I've learned just how manageable it is to minimize bone loss through small, daily action steps. We'll explore this in more detail below, but for now, let's explore some basics. 

What is osteoporosis?

Osteoporosis literally means ‘porous bones’. It’s a condition in which the bone strength is compromised due to reduced bone mass. This bone deterioration makes the bones more fragile and increases the risk of fracture.

What is osteopenia?

Osteopenia, now more commonly referred to as "reduced bone mass", differs from osteoporosis in the amount of bone loss observed. Basically, osteopenia refers to a reduced bone mass that isn't yet low enough to be labelled osteoporosis. Over time, and if not tended to, reduced bone mass can develop into osteoporosis. 

Startling statistics

• Osteoporosis can be diagnosed at any age. 1 in 3 women suffers from an osteoporotic fracture at some point in their life, while 1 in 5 men suffer from an osteoporotic fracture.
• Maximum bone density, or peak bone mass, is achieved at approximately 16 - 20 years of age for women, and 20 - 25 years of age for men. After peak bone mass is reached, bone density very gradually declines until approximately 40 years of age.
• In the several years before menopause, women experience an accelerated bone loss of ~2 - 3% per year (at the spine) due to a 90% decline in estrogen production by the ovaries. This rapid loss lasts roughly five years and is followed by a slower loss of approximately 0.5% per year.
• Although men experience a gradual rather than accelerated loss, they experience larger loss after 70 years of age compared to women.
• In those over 50 years of age, over 80% of fractures are caused by osteoporosis. In individuals that have fractured their hip, there's over a 1 in 2 chance they'll suffer another fracture within 5 years. 
• Nearly 30% of women and nearly 40% of men who suffer a hip fracture will die within the following year.
• Osteoporotic fractures are more common than a heart attack, stroke, and breast cancer combined.

Types of osteoporosis

Primary osteoporosis is believed to be a bone disorder of unknown origin, where genetics likely plays a role. Remember genetics are like a loaded gun: our environment and lifestyle choices are what pulls the trigger. In other words, even if we have a genetic predisposition to developing a disease, we do have some control over our diet, physical activity, and smoking cessation. 

Secondary osteoporosis is a result of other imbalances that cause reduced bone mass. This includes, but isn't limited to:

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No. 01	Hormone abnormalities, such as premature menopause; and primary hyperparathyroidism.
No. 02	Decreased nutrient intake, such as in the case of eating disorders, low intake of nutrient-rich foods, or excess alcohol consumption.
No. 03	Impaired nutrient absorption, such as in those with Celiac disease, or those suffering from inflammation of the gut.
No. 04	Medications that affect bone health, such as glucocorticoids (prednisone), some diabetes medications, or proton pump inhibitors used for acid reflux.

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Detecting osteoporosis

Can it be felt? 

Bone deterioration is not something that can be detected based on feeling alone. 

You can't always feel it in your bones.  

Many people believe that pain felt in their joints, neck, or back may be a sign of the development of osteoporosis. This could be true if a compression fracture has occurred, but otherwise, it's more likely that this is the development of osteoarthritis or some other condition. The reason it is unlikely to be osteoporosis is that osteoporosis cannot be felt unless a fracture has already occurred. This is why osteoporosis is often referred to as the "silent thief". 

I once saw a patient that was diagnosed with osteoporosis after having fractured two ribs simply by sneezing. Another patient fractured her ribs by bending over to pick up a pen off the floor. Bones can become extremely delicate and yet the individual sometimes doesn't even know they have this condition until a fracture has occurred. 

The only way to know if you have reduced bone mass or osteoporosis is by receiving a bone density scan - more on this below. This scan is often only offered to those who are believed to be at risk, or for those over the age of 65. With this in mind, we don't need to wait until the point of fracturing to take control of our bone health. 

Regardless of our bone mineral densities, it's never too late to make dietary and lifestyle changes that help minimize bone loss.

Bone fragility scans 

The diagnosis of poor bone health requires a DEXA scan. This is a tool that assesses bone density. Although a DEXA scan is similar to an X-ray, it’s important to note that X-rays are not intended to assess bone density. Rather, X-rays are used to see if a fracture has occurred.

The DEXA scan measures our bone mineral density and reports it as a ‘T-Score’. A T-score reveals our bone mineral density in comparison to a young, healthy adult free from osteoporosis. A positive (+) T-score means that bone mineral density is better than the average young, healthy adult. On the other hand, a negative (-) T-score means that the bone density is less than what's seen in a young, healthy adult. 

A reduced bone mass with a T-score of -1.0 to -2.0 is considered reduced bone mass (or osteopenia), whereas a T-score of -2.5 or lower is considered osteoporosis.

Keeping bones strong  

There are several small steps that can be taken daily to ensure our bones stay strong and healthy. These tips can be adopted by anyone, at any time, and the sooner you start, the better it will be for your bone health! 

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No. 01	Consume enough calcium from calcium-rich foods over supplements where possible.
No. 02	Consider taking a daily vitamin D supplement in fall and winter months to help increase the absorption of calcium.
No. 03	Avoid low-calorie diets as this can strip calcium away from the bones.
No. 04	Limit alcohol and avoid smoking.
No. 05	Exercise regularly, especially weight-bearing and resistance exercises which help significantly to improve bone health.

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Summary

1. Osteoporosis is known as a "silent thief," meaning that it cannot be felt unless a fracture has already occurred.

2. Osteoporosis is a mobility-limiting and life-altering condition. Although there are numerous non-modifiable risk factors (eg. heredity, gender, age), there's a large number of modifiable risk factors (eg. dietary choices, supplementation if needed, smoking cessation, and physical activity).

3. It's never too early to start preventing osteoporosis. Even if you don’t have osteoporosis and are not at high risk, the dietary interventions discussed in the following articles remain beneficial. 

Want to learn more?

Calcium and vitamin D are both important nutrients for good bone health. Read more on how to get enough of these nutrients on a plant-based lifestyle in our calcium and vitamin D articles.