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Author: Patrick O'Mara

OC’s First FLS Audit Report

The results from Osteoporosis Canada’s first national Fracture Liaison Service (FLS) audit demonstrate the positive impact of Canadian FLSs on the lives of fragility fracture patients. The promising results, released in September 2018, are included in the “Report from Canada’s first national FLS audit” which provides an overview of the audit for the cohort of patients enrolled in Canadian FLSs between April 1 and September 30, 2017.

The huge post-fracture care gap has been well documented in many Canadian jurisdictions. Without FLS, less than 25% of fragility fracture patients will be diagnosed and/or treated for their underlying osteoporosis.

By significantly improving osteoporosis care, FLSs help prevent future fractures, reduce patient suffering and increase their independence. With less than 50 FLSs in Canada, many more FLSs are needed to provide appropriate care to fracture patients.

To read the full report, click here

CAHC Fellow Award

The Canadian Academy of Health Sciences (CAHS) is a constituent of the Council of Canadian Academies, which was established in 2005. Fellows elected to the CAHS have a demonstrated history of outstanding performance in the academic health sciences in Canada. They are recognized nationally and internationally for their contributions to the health sciences.

Dr Sumit Majumdar, of the University of Alberta, has been elected 2017 Fellow of the prestigious Canadian Academy of Health Science.

This award is one of the highest honours for members of the Canadian health science community. We are extremely fortunate to count Dr. Majumdar among our SAC members and we extend him our heartiest congratulations!

Her Royal Highness The Duchess of Cornwall in Ottawa celebrating Canada’s 150th Anniversary

In celebration of Canada’s 150th anniversary, Their Royal Highnesses, The Prince of Wales and The Duchess of Cornwall were in attendance for many festivities in Ottawa on July 1st including the inauguration of The Queen’s Entrance at Rideau Hall.
 
The inauguration’s reception was hosted by Their Excellencies the Right Honourable David Johnston, Governor General of Canada and Mrs. Sharon Johnston with Dr. Famida Jiwa, President & CEO of Osteoporosis Canada in attendance.
 
During the reception, Dr. Jiwa had the honour of meeting and speaking with HRH The Duchess of Cornwall about the work of Osteoporosis Canada.
 
HRH The Duchess of Cornwall is the President of the National Osteoporosis Society in the U.K. and an active champion of osteoporosis, having lost her mother and grandmother to the disease.

2017 Lindy Fraser Award Presented To Dr. Stephanie Kaiser

Osteoporosis Canada’s Scientific Advisory Consultants and Osteoporosis Canada, would like announce this year’s Lindy Fraser Award winner as chosen by the members of the SAC.

Osteoporosis Canada established this award in 1993 to recognize individuals who have made an outstanding contribution to the field of osteoporosis research and education in Canada. The award is named in honour of Lindy Fraser, who in 1981 at the age of 87, started the first self help group for people with osteoporosis. She herself was an inspiration to others as she shared her struggle to get out of bed, into a wheelchair, then to walk again with a cane. In 1982, she answered a call from a small group in Toronto to take part in the first national symposium on osteoporosis. That appearance was the spark that gave rise to Osteoporosis Canada.

This year’s award winner has shown immeasurable dedication and determination in the collaborative effort to achieve the common vision of Canada without osteoporotic fractures. Osteoporosis Canada is happy to recognize Dr. Stephanie Kaiser as the 2017 Lindy Fraser Award Winner.

Dr. Stephanie M. Kaiser is the Head of the Division of Endocrinology and Metabolism at the Queen Elizabeth II Health Sciences Centre and Professor of Medicine at Dalhousie University in Halifax, Nova Scotia.

Dr. Kaiser is Past President of the Canadian Society of Endocrinology and Metabolism (CSEM), she chaired the Specialty Committee for Endocrinology and Metabolism of the Royal College of Physicians and Surgeons of Canada and then sat on the nucleus committee for an additional 6 years until June 2016. She was a co-author of the Osteoporosis Guidelines in 2002 and again in 2010, and she is also a co-investigator for the Canadian Multicentre Osteoporosis Study. Dr. Kaiser has over 50 publications in peer-reviewed journals.

Dr. Kaiser was the recipient of the CSEM 2009 Educator of the Year Award and was awarded the Queen Elizabeth II Diamond Jubilee Medal for her work in osteoporosis in 2012.

Dr. Kaiser has been a longstanding member of the Scientific Advisory Council for Osteoporosis Canada, and has worked on numerous OC publications and committees currently being the co-chair of the new Knowledge Translation Committee and a member of the Executive Committee. In the past, she has chaired the development committee and sat on the guidelines committee.

Congratulations Dr. Kaiser!

AUTHOR, SPEAKER, ACTIVIST

An article on Christine Thomas appeared in COPING May 10, 2013, access it here.
We thought it would be great to get caught up with Christine.

Background: Christine Thomas was only 42 when, bending to lift her newborn daughter, she fractured her spine. Diagnosed with five vertebral fractures as a result of unsuspected osteoporosis, she had no idea of the painful and transformative road she would have to travel to build stronger bones and reclaim her life.

What have you been up to since your diagnosis of osteoporosis and spinal fractures?

Since 2002, I have researched the disease extensively, launched my website and book Unbreakable, and now blog and tweet! I have been a volunteer in various roles with Osteoporosis Canada, but I have to say the most rewarding experiences come from meeting people at my seminars. Recently I attended the 100th birthday celebration of Pat Giff, whom I met at one of my speaking engagements and who was featured in the December 14, 2016 issue of COPING. She was so grateful for the knowledge and resources she gained from the event and I was in awe of meeting such an incredible woman who, despite having multiple fractures from osteoporosis, was living well with the disease at 100! In this crazy, busy world we live in, many of us do not take time for seniors; yet, we have so much to learn from them. Engaging with Pat is incredible. She is witty, vibrant and funny. There is something very humbling listening to her stories and rich wisdom.

What do you consider most challenging living with osteoporosis?

Pain! The spine, the body’s information superhighway, is our body’s central structure and tower of strength. Spinal fractures alter that tower and even after they heal, can cause intermittent chronic pain. Chronic pain can rob you blind. It can take away your livelihood, your friends, your activities and big chunks of your personality. In our household, when Momma is happy, everyone’s happy. When I am struggling, the whole family feels it!

I have learned so much about pain and how it is so important to be open to ways to manage my pain that complement medication. Massage therapy, meditation and breathing exercises are really helpful for me. They relax and calm those nasty tight muscles. They may not eliminate my pain but they sure help reduce it and improve my quality of life.

We asked Christine’s husband, Gerry, this question: How has your family adapted?

  • At one time, we had to be careful about everything. It seemed that every normal activity had an inherent risk. Now, we no longer notice how much our lives have changed. What we do just feels normal now – it is difficult to identify specific things that we do to adapt but here are a few examples that come to mind:
  • We always check winter weather to determine how (not if) we will deal with its worst conditions. We make sure there is always a steady hand to lend support in slippery conditions. Even on normal days, we drive a little slower than most on side roads to minimize the effects of the city’s many speed bumps, which can be jarring for Christine’s spine.
  • We take vacations like everybody else, and look forward to them like any other family. We are just careful to choose accommodations that provide maximum comfort for Christine. For example, she loves to swim in the ocean but she needs a gentle sea flow and a flat beach for easy entry, while our daughter Chanel loves to tackle the big waves and surf, so we alternate among beaches to accommodate everyone!
  • Our home is a large two-bedroom condo, which is common for a family in New York or Vancouver but unique for a family in Ottawa. It is in a fabulous neighborhood that has lots of parks and the building offers so much — a gym, pool and indoor parking, so no snow shovelling required! As fitness is a priority for Christine, she can roll out of bed and be in the gym in minutes. At first we were hesitant to make the move to the condo but realized it was best for all of us – especially Christine. We realized that kids need love and support. Our daughter can get that just as well in a condo as in a house!

Back to Christine: What has your daughter learned about osteoporosis?

Our daughter, Chanel, learned from a very young age about the building blocks to take care of her bones – calcium, vitamin D and exercise. The good news is that she has shared what she has learned with her friends. Many of them came to my book launch in 2010. I was thrilled they were there to celebrate this milestone and learn the importance of taking care of your bones. Chanel’s healthcare team is following her closely to ensure that her bones remain healthy.

And we have both learned how supportive our community can be. When my daughter was in kindergarten she had hip surgery as the cup of the hip was not shaped properly. After the operation, she was in a body cast for weeks! Because of my spinal fractures, I could not lift her. How was I to cope? Unbeknownst to me, friends organized a schedule to drop off meals and visit to help. I was so grateful!

What are you most passionate about?

The Canadian Osteoporosis Patient Network! COPN is an incredible gift that can be a lifesaver. You spend about 20 minutes with a doctor and then you need to learn to live well with the disease on your own. That’s tough! There is an invisible thread that forms a bond of understanding and empathy towards each other that we COPN members share that others may not quite understand. E-newsletters and webinars allow each of us to read about others’ fears, triumphs and emotional and physical relapses. COPN provides hope, helps reduce stress and helps all of us realize we are not alone living with this disease. That is so important for my emotional well being. I have learned the importance of paying it forward and ask all COPN members to reach out to friends and family and ask them to join COPN and help them build better bones!

What’s next in your osteoporosis journey?

My most powerful tool is my voice. I share my story and raise awareness for bone health wherever and whenever I can! I am driven to do what I can to stop fractures and save lives. I suffered tremendously from my broken bones. It is hard to explain, but I feel like this is my life’s purpose. Reaching out to others not only helps them but it helps me stay connected and energized to continue to advocate for better bone health and preventative care for Canadians. It is the least I can do.

As I said in 2013, what I am determined to do now, besides pay attention to my own bone health, is get the word out that osteoporosis is a big deal. It has terrible long-term ramifications, both individually and socially. And since it is often discovered after a sudden and surprising fracture, it seems to invade like a thief in the night.

“But bones, even declining ones, can be kept healthy. The first step is awareness. People just don’t think osteoporosis can happen to them. They think, “I’ll worry about it when I am 80 or 90.” I am here to tell them that waiting is not an option.”

Christine is a nationally recognized author and speaker in Canada. She is on the Osteoporosis Canada Board of Directors, has won numerous awards and is often seen in the Canadian
media delivering her message with the kind of conviction learned only through hard experience. She also uses her valuable communication skills as a passionate advocate for better bone health around the world.

Christine is the author of Unbreakable: A Woman’s Triumph Over Osteoporosis. To contact Christine and learn more about her book, visit www.christinethomas.com. To access her webinar Unbreakable, go to http://webcast.otn.ca/mywebcast?id=66526997

Vitamin D and Potential Impact on the Severity of COVID

By Aliya Khan MD, FRCPC, FACP, FACE, Rowena Ridout MD FRCPC, Heather Frame MD FCFP, Claudia Gagnon MD, Lianne Tile MD MEd FRCPC, Wendy Ward M.Sc., Ph.D., David A. Hanley, MD, FRCPC, Sandra Kim MD, FRCPC

Previously we have described the role of vitamin D in optimizing bone health and treatment strategies for osteoporosis. In light of the current COVID-19 pandemic, the effects of vitamin D on modulating the immune system are being reviewed.

Two recent studies have suggested that low levels of vitamin D may be associated with an increased risk of severe COVID-19 infections.

Ilie and colleagues from the UK noted that countries with low levels of vitamin D had a higher number of COVID cases, as well as the highest mortality rates from COVID (1)). Similarly, Daneshkhah and colleagues from Northwestern University(2) also found that severe COVID-19 infections appeared to be more common in countries where vitamin D deficiency is more common. We recognize that the number of cases of COVID identified in each country will clearly be affected by the number of tests completed, as well as preventive measures taken by the various countries which were not accounted for in these studies. In addition, linking an observation of low vitamin D levels in a population with an illness needs to be interpreted with caution due to the limitation of confounding factors. At this time it is not known if low vitamin D levels are causally associated with a higher number and severity of COVID infections. Keeping that caution in mind, the possible link between vitamin D deficiency and an impaired immune response to COVID-19 infections may have some support from earlier studies of vitamin D effects on the immune system.

Vitamin D deficiency reduces the ability of white cells to mature and to produce antigens necessary to prevent infections (3) Vitamin D may prevent macrophages from releasing excessive inflammatory cytokines and chemokines (4)). Vitamin D may also enhance expression of ACE2 (Angiotensin converting enzyme 2), which has been associated with improved outcomes with COVID-19 infections (5, 6 )

These early observations may suggest that adequate vitamin D levels are of value in the immune response to infections such as from COVID-19. This would be of particular importance in patient populations vulnerable to low vitamin D levels. These include those who are obese, have malabsorption or short gut syndrome, long term anticonvulsant use as well as the elderly. However, further research is needed to determine if low vitamin D levels are causally associated with a higher number and severity of COVID-19 infections.

While the relationship between vitamin D and COVID-19 is unclear, we know that vitamin D is critical for bone health. Osteoporosis Canada recommends that individuals with osteoporosis or with risk factors for fractures receive adequate vitamin D, as recommended at 800-2000 IU per day. This would also be important for those at higher risk of developing vitamin D deficiency. High dose vitamin D supplementation should be avoided due to potential harms..

References

  1. Ilie et al Aging Clinical and Experimental Research May 6, 2020
  2. Daneshkhah et al Northwestern University May 2020
  3. Abu-Amer et al 1993 Cell Immunol 151: 356-368
  4. Helming et al Blood 106: 4351-4358
  5. Kuka et al 2006 Curr Opin Pharmacol 6: 271-276
  6. Cui et al 2019 Redox Biol 26: 101295

COOKING WITH PANTRY STAPLES DURING COVID-19 WITH EMILY RICHARDS

Milk products including powdered milk, alternative fortified beverages, nuts, legumes and canned salmon and sardines with the bones are all a source of calcium. When running low on fresh ingredients, look to pantry staples – dried, canned or jarred foods – to help get the calcium and protein you need daily for strong and healthy bones.

This cooking webinar showcases meal ideas using shelf stable staples with calcium and protein. Learn how to make Oven Meatless Meatballs with Emily Richards, Professional Home Economist who also answered your cooking questions.

Emily Richards is a professional home economist, freelance food writer, chef and cookbook author who also enjoys culinary instruction for home cooks who want to learn more and have fun in the kitchen. She is the author and co-author of 9 cookbooks which include topics from Italian cuisine, weeknight dinners, glycemic index diets and comfort foods. Emily writes and develops recipes for cookbooks, print and online publications and websites that include everyday cooking and healthy eating.

All, Nutrition

EXERCISE AT HOME DURING COVID-19 WITH DR. LORA GIANGREGORIO

As we continue to practice physical distancing and self-isolate, it’s important to stay active to help manage your bone health and osteoporosis and to reduce your risk of breaking a bone during COVID-19.

Join Dr. Lora Giangregorio to learn about the types of exercise that are effective for fall and fracture prevention, and how to develop an exercise program at home. Dr. Giangregorio will lead a discussion where you can ask general questions about exercise.

Dr. Lora Giangregorio is a Professor and Schlegel Research Chair in Mobility and Aging in the Department of Kinesiology at the University of Waterloo, and an affiliated scientist with the Schlegel-UW Research Institute for Aging, the University Health Network, and the Geriatric Education and Research in Aging Sciences Centre.

All, Exercise

Osteoporosis Drug Treatments & Medication During COVID-19

As we work to adjust to our new normal during COVID-19, now more than ever, staying fracture-free is critical for anyone with osteoporosis. Healthcare systems are over-stretched, with general recommendations urging people to avoid hospitals and doctor’s offices unless absolutely necessary.

  • Prevent Falls: Ensure that your home environment is obstacle free and take care when walking.
  • Do not discontinue any osteoporosis treatment (including calcium and vitamin D supplements) which you have been prescribed. If you have concerns speak to your doctor or pharmacist.
  • Osteoporosis Drug Treatments and COVID-19Osteoporosis Medications – It is recommended that you have at least a one-month supply of your current medications including your osteoporosis medication on hand during this time of social distancing and self-quarantine.
  • If your doctor’s appointment for an injection or infusion of your osteoporosis treatment is cancelled or you’re too unwell to take your medication be sure to contact your doctor and reschedule as soon as possible so that the benefits of treatment are maintained.
  • While we are advised to stay at home, if you are in need of a prescription refill, contact your doctor to arrange a telephone appointment or contact your pharmacist to assist.
  • Ask for help when needed with shopping, getting prescriptions filled, or other errands.

OSTEOPOROSIS ORAL MEDICATION OR SELF-INJECTABLES

If you are taking the following oral medications or self-injectables to treat your osteoporosis, please check with your healthcare provider to make sure you have adequate amounts on hand:

  • Alendronate (brand names: Fosamax®, Fosamax Plus D®)
  • Risedronate (brand names: Actonel®, Actonel DR™)
  • Etidronate (brand names: Didronel®, Didrocal®)
  • Estrogen (multiple brands)
  • Raloxifene (brand name: Evista®)
  • Teriparatide (brand name: Forteo®) If you finish your 2 years of teriparatide or decide to discontinue the medication, please discuss an alternative medication so you do not have bone loss when you stop it.

OSTEOPOROSIS MEDICATIONS ADMINISTERED BY A HEALTHCARE PROVIDER

It is extremely important that patients taking the following medications administered by a healthcare provider stay on time for scheduled injections:

  • Denosumab (brand name Prolia®) – If you skip or delay taking a dose, you have an increased risk for breaking a bone, especially if you already have a broken bone in your spine. Discuss your schedule with your healthcare professional as soon as possible. If you miss or delay a dose of Prolia®, contact your healthcare provider as soon as possible to schedule your next dose. For more detailed information on Denosumab click here
  • Romosozumab (brand name Evenity®) – If you miss or delay a dose of EVENITY®, contact your healthcare provider as soon as possible to schedule your next dose. For more detailed information on Romosozumab click here
  • Zoledronic acid (brand name: Aclasta®): This is normally a once-a-year infusion and can be delayed for a short period of time since the medication lasts a long time. Discuss the schedule with your healthcare professional. For more detailed information on Zoledronic acid and bisphosphonates click here

SELF ADMINISTRATION OF PROLIA AND EVENITY

For two of the medications prescribed for osteoporosis and fracture risk reduction, Evenity® and Prolia®, the recommendation is that they be administered by a healthcare professional. However, in this time of physical distancing and with many doctors’ offices closed, it may be difficult to arrange or keep an appointment.

  • Evenity® is injected monthly. The option of home self-injection is available but this should be discussed with your healthcare provider to make sure it is appropriate for you.
  • Prolia® is injected every six months. It is not recommended to delay more than a month as you risk bone loss and possible fracture. The option of home self-injection is available but this should be discussed with your healthcare provider to make sure it is it is appropriate for you.

Healthcare providers will find detailed instructions for self injection in the product monographs of each medication.For all medications, if you have questions or concerns, be sure to discuss your osteoporosis management and treatment schedule with your healthcare provider.

Whether you are on a medication or not, everyone should strive for adequate calcium intake, preferably from food, and continue with the vitamin D from daily supplementation schedule that was established with your healthcare provider. It is also important to stay active and exercise safely.

WRITTEN BY

Hassan Vatanparast is a member of Osteoporosis Canada’s Scientific Advisory Council.  He is a Professor with Joint Appointment to the College of Pharmacy and Nutrition and School of Public Health, University of Saskatchewan. He is actively involved in research and health promotion initiatives targeting bone health. Hassan is leading several projects at the local, national, and global levels aimed to improve the nutritional health of the general population, newcomers and indigenous communities.

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