Winter Fractures – How to Prevent them

I walk for 30 minutes almost every day. Will that keep my bones strong?

Walking is fundamental to good bone health. Walking also has a number of other health benefits. The impact on bone as you walk will help stimulate bone development. You may wish to include upper body strengthening as well. As you walk, your legs, and to some extent your spine, will feel the benefits, but your arms and upper body may need some attention. You might try swinging your arms or “pole walking” to increase your arm involvement, but be careful not to trip over the poles.

How much daily intake of calcium do I need?

It is important to know that calcium alone cannot prevent osteoporosis, but it will help slow the progress of bone loss. Generally, the combined total of dietary and supplemental calcium on a daily bases should be 1000mg for men and women under age 50 and 1200mg – 1500mg for men and women over the age of 50. 

What type of calcium should I buy?

 Calcium carbonate and calcium citrate are the forms of calcium that are best absorbed by the body. Calcium carbonate has the highest percentage of elemental calcium at 40%, but is one of the hardest forms for the stomach to break down. It should be taken with a glass of water and food. It tends to be less expensive than other forms. Calcium citrate has a low percentage of elemental calcium at 21%, but is a high ability to be absorbed. Unlike calcium carbonate, calcium citrate can be taken on an empty stomach.

How much vitamin D do I need? 

Few natural foods contain vitamin D, so supplementation is often needed. The recommendation from the national osteoporosis organizations is that people over 50 need 800IU – 2000IU of vitamin D per day. Some experts feel the tolerable upper limit may be a little higher. The research into vitamin D and all its benefits is ongoing. Various factors can influence the amount of vitamin D supplements you may need. One factor is where you live and how much sunshine you get at any one time of the year. In Northern Canada, for example, it may be sunny, but at 40 below you have all your skin covered and you are not getting the benefit of the sun’s rays. If you live near the equator, the sun is very hot and you are at increased risk of skin cancer, so you apply a strong sunscreen over your skin to reduce exposure to the sun’s rays and, therefore, to vitamin D. Other factors include skin color and age. People with darker skin or who are older do not process vitamin D as well as people with lighter skin or as well as they did when they were younger.

Fracture Risk and Treatment

One of the biggest changes in the field of osteoporosis has been the use of FRAX and other fracture risk assessment tools to evaluate fracture risk of patients. Clinical Assessment: can easily be completed with your doctor to assess your level of risk and need for a lifestyle change or prescribed treatment. It would include a discussion and assessment of Osteoporosis risk factors: age, diet, exercise, family and medical history and medications you are taking.

1. Fracture risk factors: risk of falling – sight, hearing, balance, muscle weakness, use of medications; previous low trauma fractures; family history of osteoporotic fractures.
2. Bone Mineral Density test (preferably DXA) if required you cannot show bone loss unless you do a DXA at least twice over a four years or once every two years to establish risk of osteoporosis and fracture.
3. FRAXtm test or CAROC test – assess your risk of fracture in the next ten years at www.FRAX.com

Treatments: in all cases ensure you are at the optimum for dietary calcium, vitamin D and strengthening and weight-bearing exercises. Sometimes this will mean taking a medication. There are several different options so work with your doctor and pharmacist to identify the one that best fits your needs. The Osteoporosis Book: Bone Health, Third Edition Authors: Gwen Ellert RN, Med; Alan Low Pharm D, CCD; John Wade MD, FRCPC