Osteoporosis Canada

Osteoporosis and Pain – Helping Your Body Help Itself

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.

There are three stages of pain that may occur after a fracture; however, not everyone who fractures will experience all these stages of pain.

  1. Acute pain starts suddenly and alerts us to the injury- the broken
  2. Sub-acute pain usually occurs the first few weeks after the fracture while the bone and surrounding soft tissue heal. For example, a broken leg will hurt right after the injury and during recovery, but as time goes on, it gets better.
  3. Chronic pain is pain that continues long after the bone and soft tissue have healed. Generally, it’s diagnosed after three to six months of pain.

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.”

What Can I Do to Help Relieve My Pain?

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.

  1. People in pain do not feel like moving. But sitting still is not good for the bones or the pain. It is important to find ways to move that are appropriate for your condition. Advice from a physiotherapist is important for safe movement. “Do’s” to help manage pain and “Don’ts” that can cause more harm/pain can be a lifeline! A physiotherapist can help re-evaluate your sleep posture and teach you techniques to help minimize pain. “Do’s” may include the log roll technique to get out of bed or putting a pillow between the knees at night to take pressure off the spine; “don’ts” may include bending forward or no lifting. An occupational therapist can suggest tools to help you better navigate your home during recovery, for example, a reacher to pick up items, raised toilet seat, grab bars and railings.

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.

  1. Heat and cold. Warm showers and hot packs to ease stiff muscles and cold packs to numb aching areas and reduce swelling can be helpful.
  2. Braces and supports. These should be used under the guidance of your healthcare professional for the short term only, as long-term use can lead to weak muscles. At some point it is important to start exercises to strengthen back muscles. A consultation with a physiotherapist can help.

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:

  1. Mindfulness
  2. Guided imagery
  3. Meditation
  4. Breathing and relaxation techniques
  5. Reaching out to others who have managed pain after a fracture caused by osteoporosis
  6. Sometimes it helps just to take your mind off the pain with music that you love or a good book or movie.

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.

Managing My Bone Health Over the Years

Throughout a full life with family and a demanding career, I did my best to stay fit, eat well and keep on top of health issues. But I did not think at all about bone density issues, even though I learned much later that I had a family history of osteoporosis.

When I was in my late 40s, I had the great good fortune to be referred to a wonderful gynecologist, who sent me for bone mineral density tests. I was under his care for about 14 years and I know that he had a transformative impact on my life. The other good stroke of luck I had was to be referred to the Bone Density Program (now the Centre for Osteoporosis and Bone Health) at Women’s College Hospital (WC) in Toronto.

It was then I first learned that I had bone density issues and would need to do all I could to manage this for the rest of my life. I wanted to avoid the serious effects not doing so could have on my health, mobility, independence and quality of life. I learned that I had osteopenia (now called low bone mass), a condition that begins as you lose bone mass and your bones start to get weaker. I learned that it is very common as you age. And I learned that people who have osteopenia are at a higher risk of having osteoporosis. But I was determined to try to stop my bones from deteriorating further if I possibly could.

So what did I do? And how have I tried to deal with this over the last 20 plus years?

First of all, I tried to find out all that I could about osteoporosis and bone density, to really understand what was happening to my bones and to understand how I could try to manage my own condition. I found an excellent source of information and self-management advice online at the Osteoporosis Canada website.

I knew I had to focus on diet, exercise and regular monitoring of my bone density. I drink lots of milk and eat yogurt, canned salmon with the bones, leafy greens and lots of fruit and vegetables. I try to make sure that I have protein at each meal through my day. I’m pretty good at managing my caffeine intake to the recommended level though not always as good at keeping to the recommendation on wine intake! I eat very little added salt or sugar and try to follow Osteoporosis Canada’s recommendations on calcium (getting it from my diet) and Vitamin D (through daily supplementation). Magnesium, vitamin K and potassium are also good for bone health. I try to get these through my diet. I’m really lucky that these are my favourite types of foods anyway, which makes it easier. And I’ll own up to never meeting a good French fry I didn’t like and potato chips are a big weakness!

I try to stay very active and to focus on weight-bearing high impact exercise. I love walking with my dog, Poppy, and usually find through my Fitbit that I walk between 12,000 and 15,000 steps in a regular day. I play tennis when I can and ski in the winter. And I do try to include both core work and strength training with free weights or using my body weight in my regular workouts. Sometimes I don’t get to those workouts when I’m really busy, to be truthful, but I know how important these are so I always seem to get back on track!

For many years, I took an osteoporosis medication on the recommendation of my doctor but then came off it some years ago when my bone density seemed to stabilize. I try to stay up to date on new available drugs.

Sometimes, in spite of all this, I have been discouraged when I lost bone mass from bone mineral density (BMD) test to BMD test. My husband Tom was great when this happened. He would say: “Just think how much worse it would have been if you did not do all the things you do to help yourself!” And, of course, he was right.

So where am I now after all these years of trying to manage my bone density challenges? As of my last test in October 2020, my results proved that my bone density has remained generally stable – which puts me in the low to moderate fracture risk category. This is great news for me, since when my mother was in her 70s, she broke her pelvis as a result of low bone density. My mother did not have the great advantage of the knowledge that is available to us all now. But I do and I plan to try my best to have this come out differently for me.

In summary, what is working for me are a bone healthy diet; regular weight-bearing exercise along with strength training; ongoing consults with my healthcare provider; and keeping up to date and taking advantage of the excellent information available on Osteoporosis Canada’s website.

Written by Mary Mogford

Osteoporosis Canada Supporter

PREPARING FOR YOUR VIRTUAL HEALTHCARE APPOINTMENT

Since the COVID-19 lockdown began and even now as things begin to open up across the country, many health professionals have been consulting with their patients on-line or on the phone to maintain social distance and help prevent the spread of the virus. Here are some tips to help you make those appointments more successful. Note that these tips are meant primarily for patients with osteoporosis.

  • Check your email the day before and day of the appointment to make sure there is no change in date or time, or in case information has been sent that is related to your call, and to make sure that your appointment is a virtual one.
  • If someone else is taking part, a relative or friend for support or a translator, make sure they know the date and time. If your appointment is by video (such as Zoom) or teleconference, if they are at another location, they will need to know the video link or the teleconference number.
  • If you are taking the call by phone, be in a safe, secure and quiet place. Do not do it while driving, taking transit, or on the beach. (Yes, people have been known to do this.)
  • If you are being called, pick up the call even if the call display shows an unknown or blocked number.
  • For a healthcare appointment by video, it is especially important to be in a well-lit place, with your face visible, not in front of a bright window.
  • Allow time before and after the stated time in case the healthcare provider is running late.
  • Make a list of questions to discuss ahead of time and have it with you so you don’t forget.
  • Make sure the hospital has your email or phone number.
  • Have close at hand eyeglasses and hearing aid if you use them, pen and paper to make notes, prescription bottles for easy reference, contact information for your pharmacist.

LET THE HEALTHCARE PROVIDER KNOW

  • If you are due for a Prolia® or Evenity® injection or an Aclasta® infusion
  • If you usually have a bone mineral density test before your meeting. This may have been cancelled, and may have to be rescheduled; however, the appointment can go ahead without one
  • If you are having unexplained back pain. This may require a spine x-ray to check for a possible spine fracture
  • If you have any new symptoms or changes in health since your last appointment.

YOUR HEALTHCARE PROVIDER WILL REVIEW WITH YOU

  • Your vitamin D dose
  • Your intake of calcium-rich foods and calcium supplements if you take them
  • Your physical activity or exercise
  • Whether you have fallen since the last visit
  • Whether you have had a new fracture

Whether you have had a new diagnosis or been prescribed a new medication. Some conditions and medications may contribute to bone loss or fall risk. If you are on an osteoporosis medication, are you taking it according to directions and are you experiencing any side effects.

During this lockdown, hospital emergency departments are still open. If you are having an emergency and need help, do not hesitate to go to the emergency department. Do not feel that you must wait for your virtual appointment.

ZOOMING MY WAY OUT OF ISOLATION

I am 75 years old. Six months ago, I thought that “zoom” was a word that little boys and girls used when they were playing with toy cars. However, since the COVID-19 lockdown began, the word has taken on quite a different meaning when, like thousands of others, I turned to Zoom, an online video communications tool to stay in touch with others. There are many other such tools, but Zoom is the one I am most familiar with and it is used by many organizations and individuals.

I have participated in Zoom meetings for work, with book club members, with friends, and to continue my involvement with various organizations to which I belong. I don’t know how to set up a Zoom meeting, but I have gotten pretty good at being a participant.

At first, I was anxious. I didn’t know if the link would work, if I had to download the app, which devices would work (I have a smartphone and a laptop). I didn’t know how to mute or unmute to take part in the discussion; how to turn off the video if I was having an awful hair day (that happened a lot). I didn’t know how the “raise hand” function worked. I got frustrated and confused when everyone talked at once. I didn’t know what “chat” was for, and when I did figure that out got very irritated with participants who kept chatting and distracting me from the presenter. I read disturbing stories about hackers, privacy concerns and unwanted guests interrupting meetings. But now that I’ve become more familiar with Zoom, I realize my worries were unfounded; Zoom is an effective way to stay personally and professionally connected.

During these challenging times, Osteoporosis Canada has increasingly turned to virtual tools like teleconferencing, videoconferencing and other Internet-based applications. For instance, support groups, educational sessions and other events are now being offered virtually, often via Zoom. Are you interested in participating but nervous about how to get started? Read on for some helpful hints, based on my experience, that may help you feel less anxious about accepting the next invitation to an Osteoporosis Canada Zoom event.

  • The organizer of the event will send you an email with a description of the event, a link and possibly a password. If a password is given, take note of it; you will need it. The purpose of the password is to prevent unwanted guests from taking part and to protect your privacy.
  • When you click on the link, if this is your first time you will be asked if you want to download the app. You do not need to do this in order to join a meeting. If you click yes, the download will be very quick. You also do not need to have a Zoom account to join a meeting.
  • If required, you will be asked to enter the event password. Then you will be prompted to “join meeting,” and there you are.
  • For those who do not have Internet access, or whose access is very spotty, a telephone number will be provided that allows you to phone in. If you are using a desktop computer, laptop, iPad or tablet, or smartphone, choose Internet audio for sound.
  • Depending on your device, somewhere on the screen you will see several icons: a video camera to show your image, a microphone if you want to speak, an icon of a couple to indicate participants. When you click on that icon, a list of all the participants will appear, along with more icons. One important one is the blue hand image, which you click on to indicate that you want to speak. The host will keep track of raised hands and let you know when it is your turn. To mute your microphone, which you should do whenever you are not speaking to avoid interrupting others with background noise, or to turn off your image, click on the icon. A red line through the icon will indicate that it is turned off. When it is your turn to speak, make sure to unmute.
  • If possible, find a quiet space for your Zoom meetings; let housemates know so they don’t  wander accidently into your screen space; keep your device stable; and if you need to move around turn your video off to avoid distracting other participants. Try to have good lighting so your face is visible and don’t sit in front of a bright window.

There are many reasons to learn to feel comfortable with Zoom: connection with family and friends, education, entertainment. One of the most important is to take care of your health. There is no need to wait until the pandemic is over; exercise programs, private physiotherapy sessions, counselling sessions for mental health and appointments with your healthcare provider(s) can all be offered through such platforms as Zoom.

For tips on how to have a successful virtual healthcare appointment, click here.

This is a very basic introduction to using Zoom. The Internet has many well-illustrated websites to help you. Google Zoom for Seniors, Help with Zoom, or just Zoom as their website has tutorials. Good luck and have fun. You know the saying – it’s never too late to teach an old dog (like me) new tricks.

WRITTEN BY

Tanya Long
Senior Manager, National Education
Osteoporosis Canada

Your Bone Health During COVID-19

Take action to make sure you are staying fracture-free and are taking care of your bone health. This pandemic has put enormous pressure on our healthcare systems stretching our resources to the limit and the general recommendation is for people to avoid hospitals and doctor’s offices unless absolutely necessary.

Remember that older adults and people who have certain chronic medical conditions such as diabetes or lung, heart or kidney disease are at higher risk of the more serious complications of COVID-19 illness. We urge you to stay safe by taking the necessary precautions as recommended by government health agencies.

PROTECTING YOUR BONES

WHAT YOU CAN DO

  • Fall Prevention: ensure that your home environment is free of clutter and any obstacles. Take care when walking outdoors.
  • Do not stop any osteoporosis treatment you have been prescribed. Talk to your doctor if you have any concerns.
  • Physical/Social Distancing does not mean self-isolating! Make sure to call and speak to friends or family at least once a day. Video chats are also a great way to stay connected.
  • The Government of Canada has advised you to stay home. Contact your doctor and/or pharmacy if you need a prescription filled or a consultation.
  • Ask for help! There are many ways to get the support you need for getting prescriptions filled and groceries delivered. Most grocers have a delivery service or an online order system where you can go pick up your order. If you do not have the ability to order online, many volunteer groups have popped up. Call your local elected representative and ask for help in locating such services. Also try contacting a neighbour to see if they can drop off supplies at your door or provide information on a service.

Be prepared to manage your bone health and osteoporosis and reduce your risk of breaking a bone during COVID-19.

  • Nutrition: Many pantry staple foods like beans and canned fish contain calcium and protein. Read product labels and also view the list of foods with calcium here. Click here
  • Get the amount of vitamin D you need daily. Click here
  • Stay active! Safely exercise daily by adapting exercises you can do at home. Click here

FROM THE PUBLIC HEALTH AGENCY OF CANADA

It’s important to follow recommendations from the Public Health Agency of Canada (PHAC) to stay safe and well informed.

PHYSICAL/SOCIAL DISTANCING

Together, we can slow the spread of COVID-19 by making a conscious effort to keep a physical distance between each other. Social distancing is proven to be one of the most effective ways to reduce the spread of illness during an outbreak.

This means making changes in your everyday routines to minimize close contact with others, including:

  • avoiding crowded places and non-essential gatherings
  • avoiding common greetings, such as handshakes
  • limiting contact with people at higher risk like older adults and those in poor health
  • keeping a distance of at least 2 arms-length (approximately 2 metres) from others

VULNERABLE POPULATIONS

There is an increased risk of more severe outcomes for Canadians:

  • aged 65 and over
  • with compromised immune systems
  • with underlying medical conditions

Think you may have COVID-19?

Click here to take the Government of Canada’s Self-Assessment

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.

VITAMIN D IN SUMMER: SUN, FOOD, SUPPLEMENT

Vitamin D is an essential nutrient for proper growth and formation of teeth and bones. We need vitamin D for the absorption of calcium and phosphorus from the foods that we eat. Vitamin D has some other roles in the body, and it is important for our muscles and our immune system. Low levels of vitamin D, known as vitamin D deficiency, has been linked to a wide variety of health issues such as osteoporosis, heart disease, depression, cancer, and multiple sclerosis.

How much Vitamin D do I need?

Osteoporosis Canada recommends healthy adults between 19-50 years of age, including pregnant or breast feeding women, require 400 – 1,000 IU daily. Those over 50 or those younger adults at high risk (with osteoporosis, multiple fractures, or conditions affecting vitamin D absorption) should receive 800 – 2,000 IU daily.

What are the sources of Vitamin D?

Food and Supplements

There are very few foods in the nature that contain significant amounts of vitamin D. These include the flesh of oily fish such as salmon, tuna, sardines, and mackerel and fish liver oils. We can also get small amounts of vitamin D from foods such as beef liver and egg yolks. Some yogurts contain vitamin D if they are made with vitamin D fortified milk. In Canada, vitamin D fortification is mandated for margarine, infant formula, formulated liquid diets, cow’s milk and its substitutes, egg products, foods for use on a very low energy diet, meal replacements and nutritional supplements. Fortification is voluntary for butter substitutes, condensed milk, goat’s milk and goat’s milk powder.

It is nearly impossible to get enough vitamin D from your diet. You would need to eat a lot of these foods to reach the recommended level. Osteoporosis Canada recommends that all Canadian adults take a vitamin D supplement (specifically, vitamin D3 or cholecalciferol) year-round. This is the most common type of vitamin D found in supplements in Canada.

Examples of foods rich in vitamin D

Food Serving Size IU’s per Serving
Cod Liver Oil 5 mL/1 tsp 426
Egg Yolk, cooked 2 Large 64
Margarine, fortified 5 mL/1 tsp 25-36
Milk (all types) 1 c/250 mL 103-105
Mushrooms, white 125 mL/ 1/2 c 4
Orange Juice, Fortified 1/2 c/125 mL 50
Salmon (Sockeye), Baked or Broiled 75 g 394
Salmon, pink, Canned, Drained with solids and bones 75 g 435
Snapper, Baked or Broiled 75 g 392
Soy Beverage, Enriched 1 c/250 mL 86

Sun exposure

Vitamin D and Sun ExposureVitamin D, the “sunshine vitamin,” is produced when the sun’s rays interact with our skin. It helps build stronger bones by increasing the absorption of calcium. It also improves the function of muscles, which can improve your balance and decrease the likelihood of falling and suffering a fracture.

Canadians, particularly women,  have reduced their sun exposure and use sunscreen (which blocks UV rays) to prevent damage from the sun.  As well, Because of our latitude, we cannot produce vitamin D between October and March.

Furthermore, the skin’s ability to make vitamin D decreases as we age.

All this supports the need to get vitamin D through food and/or supplementation.

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.

References:

National Institutes of Health. (2018). Vitamin D, Fact Sheet for Health Professionals. Retrieved from https://ods.od.nih.gov/factsheets/VitaminD-HealthProfessional/#en26 (assessed May 28, 2019)

Institute of Medicine. (2011). Dietary reference intakes for calcium and vitamin D: Washington, DC: The National Academy Press.

Janz, T., & Pearson, C. (2013). Vitamin D blood levels of Canadians: Statistics Canada Ottawa (Canada).

Libon, F., Courtois, J., Le Goff, C., Lukas, P., Fabregat-Cabello, N., Seidel, L., . . . Nikkels, A. F. (2017). Sunscreens block cutaneous vitamin D production with only a minimal effect on circulating 25-hydroxyvitamin D. Arch Osteoporos, 12(1), 66. doi:10.1007/s11657-017-0361-0

Wacker, M., & Holick, M. F. (2013). Sunlight and Vitamin D: A global perspective for health. Dermato-endocrinology, 5(1), 51-108.

Whiting, S. J., Langlois, K. A., Vatanparast, H., & Greene-Finestone, L. S. (2011). The vitamin D status of Canadians relative to the 2011 Dietary Reference Intakes: an examination in children and adults with and without supplement use. Am J Clin Nutr, 94(1), 128-135.

Canadian Food Inspection Agency. (2018). Foods to Which Vitamins, Mineral Nutrients and Amino Acids May or Must be Added. Retrieved from http://www.inspection.gc.ca/food/requirements/labelling/industry/nutrient-content/reference-information/eng/1389908857542/1389908896254?chap=1 (assessed May 31, 2019)

Pinault, L., & Fioletov V. Sun exposure, sun protection and sunburn among Canadian adults. Health Reports. Statistics Canada. Health ReportsCatalogue no. 82-003-X. ISSN 1209-1367.

Did you know?

A Registered Dietitian or your doctor can help you regarding supplementing vitamin D in your daily diet.

© Osteoporosis Canada, 2021
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