Osteoporosis

Osteoporosis is a condition in which bones lose mass, or density, and the bone tissue breaks down. As bones slowly become weaker, more brittle and less dense, they can fracture or break easily. The bones that have the highest risk of breaking because of osteoporosis include those in the hip, pelvis, spine, ribs, wrist and leg.

Our bones naturally lose density as we age (called bone loss). As a result, osteoporosis is most common in elderly people, particularly after menopause. But certain cancer types and treatments can also weaken bones, resulting in osteoporosis.

Osteoporosis can be caused by bone cancer or by certain types of cancer that spread to the bones, such as breast cancer, prostate cancer, lung cancer and multiple myeloma. It can also be a side effect of certain types of cancer treatments.

Our bodies naturally make certain hormones that help keep our bones strong over time. Lowered levels of hormones such as estrogen (a female sex hormone made by the ovaries) and testosterone (a male sex hormone made by the testicles) in the body can contribute to osteoporosis. Osteoporosis can be a side effect of hormone therapies used to treat breast, uterine, ovarian and prostate cancers because this treatment blocks or lowers the body's production of these hormones. Find out more about hormone therapies.

Some cancer treatments cause early menopause, or treatment-induced menopause. These treatments include chemotherapy, surgery to remove both ovaries and radiation therapy to the pelvis. If the ovaries are removed or damaged, they can’t make estrogen or progesterone. This results in less estrogen in the body, which can weaken bones.

Some people with brain tumours need to take antiseizure medicines (anticonvulsants) to prevent seizures. People with brain and spinal cord tumours may also need to take glucocorticoids, which are hormones that help reduce swelling and lower the body’s immune response. These drugs are a type of corticosteroids that can also weaken the bones. Find out more about corticosteroids and anticonvulsants.

People can have osteoporosis for years without noticing any symptoms. A broken bone may be the first symptom that can help diagnose osteoporosis. Other symptoms may develop more slowly over time, including:

• loss of height
• stooped posture
• rounding of the upper back, which is called kyphosis
• bone tenderness or pain

Report any symptoms to your doctor or someone on your healthcare team right away, especially if they get worse or don’t go away. It is important to find osteoporosis early to help prevent fractures.

Your doctor will try to find the cause of osteoporosis. It is usually diagnosed using the following:

• bone density scan
• x-rays
• blood tests
• urinalysis, or urine tests

Find out more about these tests and procedures.

Once your healthcare team knows the cause of osteoporosis, they can suggest ways to manage it. There is no cure for osteoporosis, but maintaining a healthy lifestyle and certain treatments can help prevent, control or even reverse bone loss.

Try to eat more foods that have calcium and vitamin D, especially oily fish and milk products. Your body needs these nutrients to keep bones strong. Talk with your healthcare team about Health Canada's suggested daily intake of calcium and vitamin D. Your healthcare team may suggest that you take calcium and vitamin D supplements if you aren’t getting enough through your diet.

Be physically active regularly to help keep your bones healthy. Physical activity includes weight-bearing exercises such as walking, jogging, dancing, playing tennis, climbing stairs and low-impact aerobics. You can do strengthening exercises using free weights, weight machines, rowing machines and stretch bands. You can also try stretching or balancing exercises such as tai chi. Talk to your doctor or physiotherapist about a specialized exercise program if you have been diagnosed with osteoporosis.

Stop smoking and limit how much alcohol you drink to maintain bone health. Get help to quit smoking and find out ways to drink less alcohol.

Your healthcare team may suggest certain treatments to help decrease bone loss and the risk of fractures.

Bisphosphonates are drugs that strengthen bones and stop the natural process in which the body breaks down bone. Examples of bisphosphonates that may be used to prevent and treat osteoporosis include:

• alendronate (Fosamax)
• risedronate (Actonel)
• zoledronic acid (Aclasta)
• pamidronate (Pamidronate Disodium for Injection)
• clodronate (Clasteon)

Find out more about bisphosphonates.

Other medicines or hormones that can be used to prevent or treat osteoporosis include:

• Raloxifene (Evista) is a drug that helps increase bone density and prevent vertebral (spine) fractures. You may be given it to prevent and treat osteoporosis if you are post-menopausal.

• Teriparatide (Forteo) is a drug that helps new bone to develop. It is used to treat severe osteoporosis or if you can't tolerate other osteoporosis treatments. Doctors may also try it when other treatments don't work. While teriparatide can increase bone density and prevent fractures better than bisphosphonates, it is often avoided if you have had radiation therapy.

Hormone replacement therapy (HRT) is a treatment that replaces female sex hormones (estrogen, progesterone or both) when the ovaries no longer make them. HRT may be used to relieve the symptoms of menopause. It may also be used to prevent and treat osteoporosis. HRT has both risks and benefits. Talk to your doctor about how it might be used to treat osteoporosis.

Details on specific osteoporosis drugs can change regularly. Find out more about sources of drug information and where to get details on specific drugs.

Osteoporosis Canada provides more information about osteoporosis and support for people living with this condition. Visit the Osteoporosis Canada website for further information and resources.