UNBREAKABLE The OC Podcast from Osteoporosis Canada features evidence-based information from healthcare providers and subject matter experts, as well as personal stories from those affected by osteoporosis.
UNBREAKABLE The OC Podcast from Osteoporosis Canada features evidence-based information from healthcare providers and subject matter experts, as well as personal stories from those affected by osteoporosis.
Emily Richards, Professional Home Economist demonstrates how to make the featured recipe – Shrimp & Herb Stuffed Shells with 39 g of protein and 350 mg of calcium per serving.
Dr. Aliya Khan, Dr. Heather Frame, Dr. Claudia Gagnon, Dr. Rowena Ridout, Dr. Lianne Tile and Dr. Sandra Kim
Recommendations from Osteoporosis Canada Rapid Response Team
Osteoporosis is a chronic condition which requires consistent pharmacologic intervention. There is currently no evidence that osteoporosis therapy increases the risk or the severity of COVID-19 infections. With the exception of bisphosphonates, which have long-term skeletal retention, cessation of osteoporosis drug therapy is associated with bone loss and an increased risk of fracture (1, 2). Thus it is important to not stop osteoporosis therapy or delay the dose of medication without consulting your physician.
The COVID -19 vaccine is given intramuscularly and may result in a mild flu like reaction as well as a local injection site reaction. This has been documented with both the adenovirus vector-based vaccine as well as the mRNA-based vaccine (3, 4). Since intravenous zoledronate or injected denosumab or romosozumab medications may also result in a flu like reaction or local injection site reaction, it is advisable that these medications not be administered at the same time as the COVID-19 vaccine. An interval of one week between infusion of the intravenous bisphosphonate zoledronate and COVID-19 vaccination is recommended. An interval of 4-7 days between subcutaneous administration of denosumab or romosozumab and the COVID-19 vaccination is recommended. As teriparatide is administered daily subcutaneously, it can be continued if it is well tolerated and has not resulted in any local injection site reactions. Osteoporosis Canada recommends administration of teriparatide in the abdominal wall or the thigh and not in the same location as the COVID-19 vaccine. Oral bisphosphonates and raloxifene can be continued without any delay in their administration. These recommendations are consistent with the joint recommendations made by the ASMBR, AACE, Endocrine Society, ECTS, IOF and NOF.
Osteoporosis Canada emphasizes the importance of close adherence to the dosing regimens of all osteoporosis medications to ensure optimal skeletal health.
References:
Dr. Aliya Khan, Dr. Heather Frame, Dr. Claudia Gagnon, Dr. Rowena Ridout, Dr. Lianne Tile and Dr. Sandra Kim
Recommendations from Osteoporosis Canada Rapid Response Team
Osteoporosis is a chronic condition that, if you are at high risk of fracture, requires treatment with an osteoporosis medication. There is currently no evidence that osteoporosis medications increase the risk or the severity of COVID-19 infections. With the exception of bisphosphonates, which stay in your bones for a longer time after you stop taking them, stopping osteoporosis drug therapy is associated with bone loss and an increased risk of fracture. Thus it is important to not stop osteoporosis therapy or delay the dose of medication without consulting your physician.
The COVID-19 vaccine may result in a mild flu-like reaction as well as a reaction at the injection site. This is true of all the vaccines available at this time. Since intravenous zoledronate (Aclasta) or injected denosumab (Prolia) or romosozumab (Evenity) medications may also result in a flu-like reaction or local injection site reaction, it is advisable that these medications not be administered at the same time as the COVID-19 vaccine. Although the timing of denosumab (Prolia) can be adjusted to accommodate vaccine timing, it is important to make sure that the denosumab (Prolia) dose is not more than seven months after the previous dose. An interval of one week between infusion of the intravenous bisphosphonate zoledronate (Aclasta) and COVID-19 vaccination is recommended. An interval of 4-7 days between an injection of denosumab (Prolia) or romosozumab (Evenity) and the COVID-19 vaccination is recommended. As teriparatide (Forteo) is administered daily, it can be continued if it is well tolerated and has not resulted in any local injection site reactions. Osteoporosis Canada recommends administration of teriparatide (Forteo) in the abdominal wall or the thigh and not in the same location as the COVID-19 vaccine. Oral bisphosphonates (Actonel, Fosamax, Fosavance) and raloxifene (Evista) can be continued without any delay in their administration. These recommendations are consistent with the joint recommendations made by the American Society of Bone and Mineral Research, the International Osteoporosis Foundation, the National Osteoporosis Foundation and other international organizations.
Osteoporosis Canada emphasizes the importance of following the dosing regimens of all osteoporosis medications to keep your bones healthy. It is also important to keep up with good bone health habits: enough calcium ideally from food, vitamin D supplementation, a balanced diet and appropriate exercise, including weight-bearing and strength training.
Osteoporosis is a chronic condition that, if you are at high risk of fracture, requires treatment with an osteoporosis medication. There is currently no evidence that osteoporosis medications increase the risk or the severity of COVID-19 infections.
With the exception of bisphosphonates, which stay in your bones for a longer time after you stop taking them, stopping osteoporosis drug therapy is associated with bone loss and an increased risk of fracture. This means it is important to not stop osteoporosis therapy or delay the dose of medication without consulting your physician.
The COVID-19 vaccine may result in a mild flu-like reaction as well as a reaction at the injection site. This is true of all the vaccines available at this time.
Since intravenous zoledronate (Aclasta) or injected denosumab (Prolia) or romosozumab (Evenity) medications may also result in a flu-like reaction or local injection site reaction, it is advisable that these medications not be administered at the same time as the COVID-19 vaccine.
Although the timing of denosumab (Prolia) can be adjusted to accommodate vaccine timing, it is important to make sure that the denosumab (Prolia) dose is not more than seven months after the previous dose. An interval of one week between infusion of the intravenous bisphosphonate zoledronate (Aclasta) and COVID-19 vaccination is recommended. An interval of 4-7 days between an injection of denosumab (Prolia) or romosozumab (Evenity) and the COVID-19 vaccination is recommended.
As teriparatide (Forteo) is administered daily, it can be continued if it is well tolerated and has not resulted in any local injection site reactions. Osteoporosis Canada recommends administration of teriparatide (Forteo) in the abdominal wall or the thigh and not in the same location as the COVID-19 vaccine. Oral bisphosphonates (Actonel, Fosamax, Fosavance) and raloxifene (Evista) can be continued without any delay in their administration.
These recommendations are consistent with the joint recommendations made by the American Society of Bone and Mineral Research, the International Osteoporosis Foundation, the National Osteoporosis Foundation and other international organizations.
Osteoporosis does not cause pain. It is a broken bone (fracture) caused by the disease that may cause pain. In fact, osteoporosis has been called “the silent thief” because you can be losing bone gradually and not know it. A wrist fracture, especially among younger, active women, is often the first sign of osteoporosis. Shoulder, hip and spine are other common sites of fracture from osteoporosis.
Broken bones can be very painful. However, some people feel almost no symptoms from spinal compression fractures. The cracks (microfractures) in the bone happen so gradually over time that the pain is relatively mild or unnoticeable. In fact, two thirds of spine fractures do not cause pain and are often diagnosed through an x-ray for another reason. Or they may be misdiagnosed as something else, a pulled muscle for example.
But spine fractures can cause pain – sudden, severe back pain or pain when twisting or bending. Spine fractures can occur from the simplest of events – a fall from standing height, making a bed, lifting a heavy object, even a cough or sneeze.
The following information will focus on how to manage acute and sub-acute pain.
A fractured vertebra can take anywhere from 6 to 8 weeks for the bone to set and up to 12 weeks to heal completely. But recovery from a vertebral facture goes beyond healing the bone. Recovery becomes an ongoing process to regain strength and mobility and to resume your daily activities. Everyone experiences a slightly different recuperation. You may find your posture changing and feel some nagging pain. This is because a spine fracture results in a change in the shape of the vertebra itself, which can affect muscles, tendons, ligaments and nerves near the fractured bone. When a vertebra is damaged, the spine makes adjustments to keep the body in balance, which may cause muscle pain. The pain can subside over time as the body adjusts to its new shape.
Untreated pain can put you at risk for depression, anxiety, insomnia and unnecessary suffering. Treating your pain early can help you move and breathe more easily, eat and sleep better and improve your recovery. If your pain is such that you cannot sleep, you are eating very little and you find yourself sinking into depression, it’s important to contact your doctor to get help for recovery.
Understanding the pain you are experiencing can be the first step to relief. Get to know your body in terms of how it is dealing with the injury. Then you can choose the best approaches to manage your individual pain. Advocate for an overall treatment plan from your healthcare professional that includes medication, physical treatment and self-management tools.
Christine Thomas has lived with five vertebral fractures as a result of osteoporosis. Her journey has included learning how to manage her pain, instead of letting the pain manage her life.
“Pain can consume you. It can change your entire world. It can be relentless. Until I was diagnosed with five fractures in my spine, I had no symptoms of osteoporosis, even though it develops over time (years, even). What jolted me to its impact was the excruciating, debilitating constant pain just weeks after the birth of my daughter. Sharing my experience has brought back many horrible memories of living with searing pain and the struggle to get help to manage it.
Pain is hard to measure as it is a subjective experience. One person can never truly feel or understand another person’s pain. Many people with spinal fractures or other broken bones caused by osteoporosis are unaware of options available to them to manage pain and improve their quality of life.”
First try to put all your assumptions aside. Instead of focusing on a single solution, examine a combination of different approaches and treatments that complement each other. Something you have tried before that did not work may help when combined with different therapies. Both drug and non-drug treatments can be successful in helping to manage pain. Try exploring these options and see what works best for you.
Medication
Most pain medication is designed to manage acute pain. People recover more quickly when pain is better managed, so the goal is to take the medication that works best to reduce your pain, thereby allowing you to sleep better at night and be more mobile during the day. Most likely, your doctor will recommend an over-the-counter medication. If that sufficiently relieves your pain, you won’t have to try anything stronger. If it doesn’t, talk to your doctor, especially if you are in excruciating pain, and he or she may prescribe something stronger for you. As with any medication, talk to your doctor before trying anything. There may be side effects or interactions that you are unaware of, and you want to be safe as you try to deal with your pain.
Physical Treatments
Knowing what you should and should not do after your fracture is key to recovery.
During the recovery process, many types of movement may be painful even when you use correct techniques. An important part of your recovery is to learn to move safely in a way that does not put any additional strain on the spine.
Self-Management Tools – Mind and Body Therapy
Many studies show that the most effective way to conquer pain combines medication and self-care. The following are simple and effective tools that can complement what your doctor recommends:
There are several options to choose from to help manage your pain and regain your quality of life. The key is to listen to your body, take an active role in your recovery and choose tools and explore your options with your healthcare team.
For the past 9 years, Vancouver, BC has hosted Bones ‘n’ Beer – an event where men gather at a favourite pub for a hearty rib dinner, paired with craft beer and listen to healthcare professionals speak to the group about men and their risk of osteoporosis.
Emily Richards, Professional Home Economist demonstrates how to make the featured recipe – Paneer and Chickpea Stew with 27 g of protein and 350 mg of calcium per serving.
