Dr. Marla Shapiro speaks to the importance of bone health, and her approach to managing this issue among her patients. Since the condition presents itself without symptoms, timely and accurate diagnosis is difficult, and effective treatment is rarely prescribed or maintained. Proactive management is required. The incidence of fractures related to low bone mass is surprisingly high, but there are several options available to prevent bone deterioration. Workplaces can do their part through education and action related to on-site food choices. These health messages can be integrated with those for other conditions, because the risk factors are common.

Marla Shapiro, MHSc, MDCM, CCFP, FRCP, FCFP, NCMP.

Dr. Shapiro is family physician and Medical Consultant for CTV News and Canada AM. She is also a columnist for the Globe and Mail, and Editor of ParentsCanada

Though much more prevalent in women, osteoporosis doesn’t affect men and women differently. All men can develop the condition, and post-menopausal women are at increased risk. It does affect many over age 50 who are actively working. This is a double-edged sword: the women who are most often the caregivers for parents may also see their own health issues surface.

Dr. Shapiro noted the "silver tsunami" as aging Canadians use progressively more health care. "We know we are not going to keep up with the burden of care in either societal or financial costs. It makes no sense to wait for a fracture and a diagnosis [of osteoporosis]. Unfortunately, this is not a disease that gives you symptoms,so we must be proactive or we might not see the consequences until after the disease has advanced."

2. How does osteoporosis affect people’s mental and physical states and ability to work?

This disease is not only about morbidity and increased mortality. It seriously affects one’s ability to be independent, to walk around freely, to stay within the home and to care for someone else. One of two will suffer a fracture in their lifetime. Incidence of fractures is far higher than stroke or heart attack, breast cancer for women and prostate cancer for men.

3. Osteoporosis has been called ‘a pediatric disease with geriatric consequences’. What steps, literally and figuratively, can women and men take to prevent this condition?

Bone mass peaks during the third decade of life. After that, adequate calcium and vitamin D become even more critical because bone absorption accelerates relative to bone building. Milk and dairy products are an obvious choice for calcium, but vitamin D is needed to ensure it is absorbed. Look for vitamin D in fatty fish like Pacific salmon and sardines, as well as through careful sun exposure. Some foods are now supplemented with calcium and vitamin D, like orange juice. Weight-bearing activity and exercise is also recommended because it stimulates new bone construction – this is a ‘step’ everyone can take.

For adults in the later stages of their careers, low bone mass is risk factor for fracture. Broken bones lead to work absence and rehabilitation costs. The consequences of ignorance can be serious: broken hip bones lead to death in 20% of those patients, and disability in half the survivors. Osteoporosis accounts for 70% of hip fractures, and most of those are preventable.

4. What are some of the major risk factors for osteoporosis? What happens if you think you may have a problem?

Osteoporosis patients should be assessed regularly, and Dr. Shapiro tries to stratify them according to their relative risk. "I consider their sex, age (especially those over 60), their history of fractures in immediate family members, medication use (particularly steroids like prednisone), and whether they’ve had any fracture after age 40", she says. "I also speak to them about modifiable lifestyle habits, like smoking, and their intake of caffeine and alcohol."

If a bone health issue is suspected, then a bone density scan is ordered. Those tests predict the fracture risk (low, medium and high) over the next ten years, adjusted for the patient’s age and risk factors. "It amazes me how many patients who have low bone mass and osteoporosis remain undiagnosed and therefore untreated. Only 20% of people with an osteoporosis-related fracture end up on some kind of treatment", says Dr. Shapiro.

5. Osteoporosis is not on the radar screen for most employers. What role could they take?

The broad suggestion is to include bone health in any health-oriented communication going to employees. Dr. Shapiro suggests employees can be involved in promoting this issue, looking at cafeteria food choices and price incentives, and perhaps flagging foods that help prevention. Importantly, this information can be taken home to encourage better habits for the whole family.

"It’s important to keep employees healthy", Dr. Shapiro says. "And many of the things that will help prevent osteoporosis are good for your general health as well."