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Heather Eatson Peterborough & Area Manager Ontario Osteoporosis Strategy Osteoporosis Canada. Ontario Osteoporosis Strategy. GOAL: To reduce fractures, morbidity, mortality and costs from osteoporosis…

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heather eatson peterborough area manager ontario osteoporosis strategy osteoporosis canada
Heather Eatson

Peterborough & Area Manager

Ontario Osteoporosis Strategy

Osteoporosis Canada

ontario osteoporosis strategy
Ontario Osteoporosis Strategy


To reduce fractures, morbidity, mortality and costs from osteoporosis…

through an integrated and comprehensive approach aimed at health promotion and disease management.


October 2000:

  • “A Framework and Strategy for the Prevention and Management of Osteoporosis”

May 2002:

  • “Osteoporosis Action Plan: An Osteoporosis Strategy for Ontario”

February 22nd, 2005:

  • MOHLTC announced the launch of Ontario’s first Osteoporosis Strategy
identification of service gaps
Identification of service gaps
  • Low public awareness
  • Inappropriate diagnostic testing
  • Lack of adequate management
  • Lack of clinically useful information
  • Lack of integrated post-fracture care protocols
osteoporosis strategy 5 components
Osteoporosis Strategy: 5 Components

Health Promotion

1. Education programs for seniors and children:

  • Increase seniors knowledge of osteoporosis and improving bone health
  • Increase bone health education in schools
Disease Management

2.Improve the use, and accuracy of bone mineral diagnostic testing (BMD) to increase early diagnosis of osteoporosis

3. Integration of fracture care, rehabilitation and osteoporosis management

4. Improve evidence based practice by Health Professionals

5. Research and evaluation


What Is Osteoporosis?

“Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.”1

Osteoporosis- (Porous Bone)

Normal Bone

  • 1. Consensus Development Conference, JAMA 2001; 285: 785-95.
osteoporosis is a
Osteoporosis is a…

potentially crippling disease characterized by low bone

mass (density) and deterioration of bone tissue, a

condition that can lead to increased bone fragility and

risk of fracture- most often at the spine, wrist or hip.

Common Fracture Sites

overview on osteoporosis
Overview on Osteoporosis
  • Bone loss occurs without symptoms- The Silent Thief
  • Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence
  • 1.4 million Canadians live with Osteoporosis
  • Healthcare costs are estimated to be $1.9 billion each year in Canada
hip fractures
Hip fractures

Hip fractures related to osteoporosis are a serious problem in older people

Approx. 25,000

hip fractures each

year in Canada

(70% are



Hip fractures result in death in up to 20% and disability in up to 50% of those who survive

Osteoporosis is a major public health issue in Canada
  • Osteoporosis is diagnosed and treated by a variety of specialists and family physicians
  • Osteoporotic fracture cases are treated almost exclusively by orthopaedic surgeons
the evidence
The Evidence
  • The majority of individuals who sustain fragility fractures are not receiving adequate osteoporosis management
    • Less than 32% of fracture patients are investigated for osteoporosis.

Elliot-Gibson et al, 2004

fragility fractures
Fragility Fractures…

“ a fracture caused by injury that would be insufficient to fracture normal bone: the result of reduced compressive and/ or torsional strength of bone ”

  • Minimal trauma
  • From standing height, or less

WHO, 1998

post fracture care
Post- Fracture Care

Osteoporosis Screening Coordinators

  • Increase the rate of referral of fragility fracture patients for assessment and treatment of OP, in order to reduce the risk of re-fracture
what does op screening coordinator do
What does OP Screening Coordinator do?
  • Identify all men and women 50+ who have suffered a fragility fracture
  • Assess patient for OP risk factors
  • Encourage patient to see family physician for further OP assessment
  • Educate identified patient
  • Follow up evaluation- 3/6 month
long term outcome goals
Long-Term Outcome Goals
  • To increase preventive health behaviours in patients who have sustained a fragility fracture.
  • Lower rates of subsequent fracture in this high-risk patient population, particularly hip fractures.
  • Lower fragility fracture-related health care costs for the hospital and provincial government.
other initiatives
Other Initiatives
  • Low Volume Fracture Screening
  • Fracture Fighters – Rehab component
  • Break Through – Adult Education
  • Bone Fit – Osteoporosis Fitness Cert.

Osteoporosis: An Overview

Who Gets Osteoporosis?

1 in 4 women

1 in 8 men

how strong are your bones
How strong are your bones?
  • Healthy strong bones are critical in preventing fractures.
  • Bone is renewed through a process in which old bone is removed and replaced by new bone.

Four Major Factors that Contribute to Bone Health

  • Genetics
  • Hormones
  • Nutrition
  • Physical activity
risk factors
Risk Factors
  • Certain factors appear to play a role in the development of Osteoporosis
  • These are called “risk factors”
  • There are both minor and major risk factors
Age  65

Vertebral compression fracture

Fragility fracture after age 40

Family history of osteoporotic fracture

Systemic glucocorticoid use > 3 months

Malabsorption syndrome

Primary Hyperparathyroidism

Propensity to fall

Osteopenia apparent on x-ray


Early menopause (before age 45)

Diagnosis of Osteoporosis

Assessing Your Risk Factors: Major Risk Factors

Excess alcohol

Excess caffeine

Low body weight (<57 kg or 125 lbs)

Weight loss > 10% of weight at age 25

Chronic heparin therapy

Diagnosis of Osteoporosis

Assessing Your Risk Factors: Minor Risk Factors

  • Rheumatoid Arthritis
  • History of clinical hyperthyroidism
  • Chronic anticonvulsant therapy
  • Low dietary calcium intake
  • Smoker

Review Your Risk Factors with Your Physician

  • Everyone over the age of 50 should assess their risk factors with their physician.
  • Those individuals with at least one major or two minor risk factors should have a bone mineral density (BMD) test.
  • Everyone age 65 and over should have a bone mineral density (BMD) test.

Diagnosis of Osteoporosis

Bone Densitometry

determining your 10 year absolute fracture risk
Determining Your 10-year Absolute Fracture Risk
  • Factors that influence this are:
  • BMD results
  • Age
  • Gender
  • Fracture history
  • Family history
  • Glucocorticoid (steroid) use
goals of osteoporosis management
Goals of Osteoporosis Management
  • bone loss
  • Maintain and/or increase bone density
  • Reduce the risk of fracture(s)
Slow bone erosion

Bisphosphonates include:

Etidronate (Didrocal )

Alendronate (Fosamax, Fosavance )

Risedronate(Actonel )

Zoledronic Acid (Aclasta)

SERMs-Raloxifene( Evista)

Calcitonin (Miacalcin)

Speed up bone building

Parathyroid hormone (PTH )

Teriparatide (Forteo) a daily subcutaneous injection for 18 months

Drug Therapies

eat foods high in calcium
Dairy sources- whole and skim milk products, cheese, yogurt

Fortified beverages

Fish bones-salmon, sardines

Vegs- broccoli, bok choy, kale

Eat foods high in Calcium
calcium content of some foods
Calcium Content of Some Foods

Milk – all 1cup 300mg

Yogurt ¾ cup 295mg

Cheese-hard 245mg

Ice cream ½ cup 80mg

Salmon/bones ½ can 240mg

Beans,baked ½ cup 75mg

Broccoli,cooked ¾ cup 50mg

Orange 1 med 50mg


Osteoporosis Prevention

Calcium Supplements: Questions & Answers

  • What are they made of?
  • How do I choose one?
  • What is the best way to take them?
  • Which types are recommended?

Osteoporosis Prevention

Vitamin D: OSC’s Daily Recommended Intake

where to find vitamin d
Where to find Vitamin D?
  • Foods that are a natural source of Vit D – fish oils, eggs, chicken livers, salmon and sardines
  • Foods fortified with Vit D

- milk, margarine, some yogurts, some soy beverages (check labels)

  • Vit D supplement, Multi vitamin, calcium supplement with Vit D
physical activity
Physical Activity
  • Regular weight bearing activity
  • Resistance exercise
weight bearing exercise
Weight Bearing Exercise

Some examples of weight-bearing physical activities are…

  • Walking, running, stair climbing, dancing
  • Games and sports such as badminton, tennis, basketball, volleyball etc
resistance exercises
Resistance Exercises

These involve moving objects or your own weight to create resistance

  • Common forms of resistance exercise include:
  • Weight – training with barbells, dumbbells, household objects or wrist weights
  • Strength training with equipment in a gym or health club
exercise with caution
Exercise with Caution

Check with a physician before starting any exercise program

  • Don’t do exercise that causes pain
  • Warm up before exercise and stretch well after exercising
  • Choose a facility, leader or trainer who knows the exercise restrictions associated with osteoporosis
  • Choose an activity or program that is enjoyable

Living with Osteoporosis



Should be



Osteoporosis Prevention

The Benefits of Being Physically Active

  • Healthier bones - works with calcium & vitamin D to build strong bones
  • Better coordination and balance
  • Improved muscle strength and flexibility
  • Increased endurance for daily activities
  • Improved posture
balance falls prevention
Balance & Falls Prevention
  • 1 in 3 seniors 65+ falls each year
  • 1 in 2 seniors 80+ falls each year
  • The fall-related injury is 9x greater in seniors than among those under 65
  • Vitamin D has been shown to reduce falls
  • Exercise has been shown to decrease falls as well as the risk of falls if exercise includes activities aimed at improving balance.
personal costs after a fall
Personal costs after a Fall
  • Pain and suffering
  • Loss of independence
  • Increased risk of falling- fall cycle
  • Falls cause 90% of all hip fractures in seniors
  • Almost half of all falls occur in/around home

The Key Messages for Osteoporosis

  • Knowing/Assessing your risks
  • Bone Mineral Density Testing
  • Medication
  • Diet – Calcium and Vitamin D
  • Exercise – Wt Bearing and Resistance Training
  • Falls and Safety Prevention
osteoporosis canada
Osteoporosis Canada
  • 1-800-463-6842 (English)
  • 1-800-977-1778 (French)
  • www.osteoporosis.ca
  • COPN (Canadian Osteoporosis Patient Network)