Unseen and Unheard: Osteoporosis Creeps up on the Unsuspecting

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Osteoporosis: a disease affecting over 800,000 Canadians… or is it 1.4 million? These two figures provide just an example of the differing reports of osteoporosis cases in Canada. Why this discrepancy?

“Osteoporosis is often underdiagnosed and therefore underreported,” says Dr. Margaret Grant, Medical Director of the geriatric assessment unit, Geriatrician and an Internal Medicine Specialist at The Credit Valley Hospital.

Osteoporosis, a disease characterized by a progressive decrease in bone mass that deteriorates and weakens bones, is a growing reality for many Canadians, especially as the population ages. This leads to increased bone fragility and risk of fracture, particularly of the hip, spine and wrist.

Why all the underdiagnosing? “There is an increased number of people with osteoporosis who have no idea that they are losing bone mass, and therefore they do not go to their doctors and cases go unreported,” says Dr. Grant.

A common example is when a person falls and breaks a bone, she may not follow up with a doctor because the fall is considered “minimal trauma”, that is, a light force, and she may think it is not serious enough to be assessed by a doctor.

“When a person breaks a bone even with minimal trauma, there is a good chance he or she will have osteoporosis,” says Dr. Grant. “If you’ve had a fracture with minimal trauma, you should be seeing a doctor.”

Since she began working at Credit Valley in August 2000, Dr. Grant has seen a number of patients who did not know they had osteoporosis. The main reason for this is because bone loss often occurs slowly and without any symptoms. Patients are often unaware of it until the bone is weakened to the point that a slight fall or strain could easily cause a fracture or a collapse, causing pain and soreness, and sometimes an abnormal curvature of the back. This is why you should see your doctor to get assessed.

FracturesA fracture is a break in a bone that is a result of a force impacting on a bone that is not strong enough to withstand the force. “I’m seeing a lot of people with osteoporosis who have had a fracture,” says Dr. Grant. “In my experience, I have seen how people are affected by it, such as patients who have had to go to nursing homes after they couldn’t regain daily function because of a broken hip. I’ve also seen people in lots of pain because of increased back fractures.”

Severe compression fractures in the spine can be painful, possibly leading to deformity (which has been referred to as a “hump”), and there’s a more serious risk of developing a hip fracture. When a person has a hip fracture, she may need to have an operation, which involves the risk of death, and she often become less mobile, which can result in being placed in a nursing home. “The real danger or concern with this disease is that you are more likely to have a fracture and all the ill effects that go with that – the pain, deformity and loss of function,” says Dr. Grant. “This is why we want to prevent osteoporosis in the first place.”

Risk factorsSome of the common risk factors that contribute to the likeliness of developing osteoporosis include:

  • Female
  • Age 50 or older
  • Women of Caucasian or Asian ancestry
  • Family members with osteoporosis
  • Thin, small-boned build
  • Underweight
  • Smoker
  • Regular intake of alcohol
  • Use of certain medications

These are only some of the risk factors for developing osteoporosis and are not exact indicators of who will develop the disease. For more information, see your doctor or contact the Osteoporosis Society of Canada at 1-800-463-6842 or on the web at www.osteoporosis.ca