If you are on medication for osteoporosis, are you ever tempted to stop taking it?

If your answer is yes, you are not alone. Studies indicate that especially for those with chronic conditions such as osteoporosis, many patients do not take their medication as directed or for as long as they should.

Osteoporosis is a growing problem worldwide, with the greatest burden resulting from broken bones. There are several treatment options available that are effective in reducing fracture risk, but in order to see the benefit, patient adherence is required.

Like other chronic diseases, especially those with no symptoms, adherence to osteoporosis therapies is poor. Some articles have suggested that in general, rates of non-adherence can be as high as 50%. In a recent study that looked at people on Ontario Drug Benefits, only 63% of patients given a bisphosphonate prescription were still taking it after one year, and this dropped to 46% after two years.

Why don’t people take their medications as prescribed? Possibilities include:

• Memory loss. The individual forgets when and how to take the medication.
• Lack of symptoms.  The need for and benefits of a medication are not felt. This is true of osteoporosis, which is often called “the silent thief” because there are no symptoms unless and until one has fractured.
• Side effects. The individual may experience side effects or fear the potential for immediate or longer-term side effects in the future.
• Uncertainty about the benefit of drug treatment or preference for a “natural” approach.
• Lack of understanding of the disease and the value of medication.
• Poor communication between the patient and their healthcare provider.
• Cost of medication.
• Difficulty following the instructions for use.
• Complexity of treatment, especially if the patient has multiple conditions requiring multiple drug therapies.

Consequences

Not taking your medication as prescribed has far-reaching consequences.  Poor adherence means that the drug will not be as effective and health will decline. In addition, medical costs will rise.

In 2009, it was estimated that non-adherence cost the US healthcare system $290 billion. There is little data available for Canada, but in 1995 the cost of medication non-adherence was estimated to be $7 – 9 billion annually.

Patients who do not take their prescribed medication do not receive the benefits of that medication. Patients who only partially follow their medication regime may receive some benefit but are also at risk for serious complications. Patients who do not stick with their treatment plan are more likely to end up in hospital. Studies suggest that for people taking bisphosphonate therapy for osteoporosis, those that take 75% of their medication do not have the same reduction in fracture risk as those who take the medication as prescribed 100% of the time; and when patients take only 50% (or less) of their pills, no benefit is seen (it is the same as not taking any bisphosphonate).

Over 80% of fractures in people over 50 are due to osteoporosis. There are effective medications available to reduce the risk of fracture from 30 – 70% provided they are taken properly and 100% of the time. If you are at high risk of fracture, it is very important that you take your osteoporosis medication regularly and as recommended.

Addressing your concerns

If you have concerns about treatments or medications, you should speak to your doctor – and you should ALWAYS speak with your doctor before making any changes to your medications. 

Together, you can work out how best to handle any problems. This will help ensure that you have the most appropriate therapy strategy possible for your condition and receive the greatest possible benefit from it.

Learn more about drug treatments to treat osteoporosis here.

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Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis.

If you buy drugs online, you may be putting your health at serious risk. This is especially true if you order prescription drugs without being examined in person by a healthcare practitioner.

A simple Internet search will turn up hundreds of websites that sell drugs. Some Internet pharmacies are legitimate, but many offer products and services that are dangerous. Some sell drugs that are not approved for use in Canada because of safety concerns. Some take advantage of people desperate for relief by offering “miracle cures” for serious illnesses like cancer. Many offer prescription drugs based on answers to an on-line questionnaire. These sites tell you they will save you the “embarrassment” of talking to your doctor about certain prescription drugs, such as Viagra, or drugs to prevent hair loss, or promote weight loss. What they do not tell you is that it is dangerous to take a prescription drug without being examined in person and monitored by a healthcare practitioner to make sure the drug is helping you.

Risks Associated with Buying Drugs Online

Buying drugs from Internet pharmacies that do not provide a street address and telephone number may pose serious health risks. You have no way of knowing where these companies are located, where they get their drugs, what is in their drugs, or how to reach them if there is a problem. If you order from these sites, you may get counterfeit drugs with no active ingredients, drugs with the wrong ingredients, drugs with dangerous additives, or drugs past their expiry date. Even if these drugs do not harm you directly or immediately, your condition may get worse without effective treatment.

If you order prescription drugs without being examined and monitored by a healthcare practitioner, you may be misdiagnosed, and miss the opportunity to get an appropriate treatment that would help you. You may also put yourself at risk for drug interactions, or harmful side effects that a qualified health professional could better foresee.

Buying drugs on the Internet may also pose financial risks. In some cases, the product may not be shipped at all, or if it is coming from another country, it could be stopped at the border by Canadian authorities.

The Status of Internet Pharmacy in Canada

If you have questions about whether an Internet pharmacy is legitimate, contact the licensing body in your province or territory.

Minimizing your Risk

Do not take any prescription drug that has not been prescribed for you by a healthcare practitioner who has examined you in person.

Do tell your doctor and pharmacist about all of the health products you take, including vitamin and natural health products, as well as prescription and over-the-counter drugs. They need this information to assess and advise you about potential side effects and drug interactions.

If you decide to order drugs on line:

Do not do business with a website that:

• refuses to give you a street address, telephone number, and a way of contacting a pharmacist;
• offers prescription drugs without a prescription, or offers to issue a prescription based on answers to an on-line questionnaire;
• claims to have a “miracle cure” for any serious condition; or
• sells products that do not have a DIN (Drug Identification Number) issued by Health Canada.

Do make sure you are dealing with a Canadian-based website that is linked to a “bricks and mortar” pharmacy that meets the regulatory requirements in your province/territory. Finally, if you have a question or complaint about therapeutic drug products purchased on line, call Health Canada’s toll-free hotline: 1-800-267-9675

Health Canada’s role

Health Canada regulates therapeutic drugs in Canada through a rigorous licensing process, which includes an extensive pre-market review and the ongoing post-market assessment of a drug’s safety, effectiveness and quality. As part of this process, Heath Canada conducts risk/benefit assessments, monitors adverse reactions, and communicates information about risks to health professionals and the public. All drugs approved for sale in Canada have an eight-digit Drug Identification Number (DIN). The DIN assures you that Health Canada has assessed a drug, and considers it safe and effective when used as directed on the label. The DIN also provides a way to track adverse drug reactions.

Health Canada licenses and conducts regular inspections of companies that manufacture, import and/or distribute drugs. In addition, Health Canada investigates complaints related to the sale or use of therapeutic drugs, including complaints about websites that sell drugs, and takes action where appropriate. Also, Health Canada works with the Canada Customs and Revenue Agency to control the illegal entry of prescription and over-the-counter drugs. Individual Canadians are allowed to import a three-month supply of therapeutic drugs, subject to a number of restrictions.

©All Rights Reserved.  Buying drugs over the internet.  Health Canada, 2012. Adapted and reproduced with permission from the Minister of Health, 2022.

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Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis.

Do you use the Internet to search for information, particularly medical and health related information? Are you ever tempted to self-diagnose or even self-medicate because of something you have read on the Internet? This can be a very dangerous practice. Self-diagnosis based on information from the Internet and self-medicating with medications purchased on the Internet can lead to dire consequences.

In addition to these organizational websites, we now have personal blogs, “chat” rooms, Facebook, Twitter, Tik Tok, YouTube and other sites where individuals can post their questions, responses to questions, their experiences, comments and opinions.  The amount of electronic information available is overwhelming, frequently contradictory and very often wrong. How does one navigate through this jungle of information and filter out items that are not credible, up to date, scientifically accurate and appropriate? 

To help determine the reliability of information you find on the web, ask yourself the following questions:

1. Who runs the website? Are they concerned about health and wellbeing; are they reputable? You can usually find this under the “About Us” section on the site (the heading may be different, so look for the section whose purpose is to tell you about the host organization).
2. What is the purpose of the website? Is it to provide information or to sell products and/or raise funds? Remember that anything that seems too good to be true probably is.
3. What are the suffixes (endings) of the website names? For instance, websites that are sponsored by the U.S. government end with “.gov”; universities end with “.edu”; not-for-profit organizations end with “.org”; and Canadian sites end with “.ca” As an example, Health Canada’s website is www.hc-sc.gc.ca; Osteoporosis Canada’s website is www.osteoporosis.ca. 
4. Is the information current and evidence based? Reliable websites are frequently reviewed and updated. Check the copyright date on the bottom of the home page and the publication date of the articles posted. 
5. Are the links to other websites also reputable? If the answer is “yes”, the information being shared is usually accurate and your privacy is being protected.

Even after gathering reliable information from the Internet, ALWAYS discuss your health issues with your healthcare professional. It is important for you to receive up-to-date and scientifically sound information and advice from a professional who is trained to assess your individual needs, who knows your medical history, any other medical conditions you may have, and what medications you are taking. All of these factors are very important as each can have an impact on the other.;

While information gathering is often encouraged, self-diagnosis and self-medication are NOT recommended. The scientific and health related information available on the Osteoporosis Canada website in e-communications is checked for medical accuracy by Osteoporosis Canada staff and our Scientific Advisory Council.

Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis.

Although falls can happen to anyone, fall prevention is especially important for the elderly and individuals with osteoporosis who have a higher risk of breaking a bone during a fall, than those without osteoporosis. Among older adults, falls cause 63% to 83 % of hip and non-spine fractures and about 45% of spine fractures.

What are the primary causes of falls?

• Environmental hazards
  • In the home: scatter rugs, protruding objects, slippery floors, pets, standing on unstable items to reach high places, improper footwear, poor lighting, stairs with no handrails
  • Outdoors: ice, snow, wet leaves, uneven terrain, improper footwear

• Excess alcohol
• History of previous falls. A previous fall increases the risk of another fall threefold.
• Factors related to aging
  • Poor vision. Bifocal or multi-focal glasses distort depth perception. With age, clarity of vision is reduced, especially at night. Cataracts, macular degeneration and glaucoma affect vision.
  • Poor hearing
  • Poor reflexes
  • Poor balance
  • Kyphosis (rounded back) impairs mobility and increases the risk of falls and fractures.
  • Changes in muscle mass means reduced strength, frailty.
  • Some medications can increase fall risk – sleep aids, antidepressants, blood pressure medications can cause dizziness, confusion, slowed reflexes or reduced alertness.
  • Some medical conditions contribute to fall risk: hypoglycemia in diabetes, hypotension.

What can people do to prevent falling?

People with osteoporosis, and those at risk of developing it, can prevent bone loss, fractures and falls by following an exercise program that combines weight bearing, strength training, balance and posture exercises. Consider consulting a physical therapist with expertise in osteoporosis to design and implement an exercise program that reduces the risk of falls and fracture.

Other ways to reduce the risk of a fall include:

• Change the environment (e.g., removing slip and trip hazards)
• Avoid medications that increase the risk of falls
• Get regular medical checkups and vision and hearing tests to detect and treat conditions that increase the risk of falls
• Make use of appropriate mobility aids and assistive devices. A cane or walker can provide support and improve balance. A grab bar in the bathroom can help prevent falls.

Some specific things to be aware of in winter and especially during the holiday season:

• Most falls occur indoors, inside the home.
• Make sure your indoor shoes are just as safe as your outdoor boots, i.e., that they have a non-skid sole and can’t slip off your feet.
• Inside, be aware of obstacles and potential tripping hazards. Over the holiday season, more people visiting may mean more loose items on the floor such as shoes, purses, gifts, gift wrap and spilled drinks.
• If younger children are visiting be aware of toys, mittens, coats, sweaters, scarves, hats and anything else that isn’t attached.
• People may track snow into your hallway or foyer. Be sure to wipe up wet spots as soon as possible to avoid slipping on them. Door mats can also be used to absorb melting snow provided they are non-slip and non-trip with a good rubber backing.
• Outside your front door, wet or icy surfaces can be slippery and can cause a fall. Tread carefully and use handrails whenever ascending or descending stairs, no matter how few the number of steps.
• Keep the stairs and sidewalks of your home clear of snow and ice and sanded or salted to prevent slips.

What other measures can I take to reduce the risk of falls?

Nutrition
Bone strength can be maintained and possibly improved by eating well. Osteoporosis Canada recommends adequate dietary protein and calcium and adequate vitamin D supplementation all year round. Vitamin D supplementation has been shown to increase muscle strength and to reduce falls. It is also important to eat regularly, as skipping or delaying meals may cause you to feel weak or dizzy, further increasing your risk of falling.

Hydration
Poor hydration often lowers blood pressure, which can lead to dizziness, falls and fractures.

How To Take Medications
As we age or as our health changes, medications that we have been taking for a long time may need to be adjusted or changed in order to maximize their benefits and minimize their side effects. This is particularly important if you have already fallen.

Sleep
Proper sleep improves alertness, which improves balance and decreases fall risk.

Footwear
Make sure you walk safely by wearing proper shoes with good tread and firm support. Avoid walking on slippery surfaces, especially in socks or stocking feet. Whether walking indoors or outdoors, it is important to wear shoes with a non-skid sole that isn’t too thick.

Falls Clinics
Because there are many risk factors for falls, many healthcare centres have falls clinics that provide help with fall prevention in one program on an individual basis.

If you have fallen or are afraid of falling, do not ignore it or put it down to “just being nervous” or “clumsy” or “in a rush.”

• Consult with your doctor for a “falls” check-up.
• Your pharmacist can also review your medications (including any non-prescription remedies, natural health products or foods) for side effects and interactions that may increase your risk of falling.
• You may also consider wearing a personal alarm device around your neck or on your wrist. This will allow you to call for immediate assistance by pressing a button if you fall or get hurt.

In Partnership With

It is possible to travel safely and enjoyably with osteoporosis, but there are precautions that need to be taken, as well as those related to the pandemic. More tips and information in Travelling with Osteoporosis – Part 2.

2) Do not lift! – Remember that this is the time to be aware of your every movement. You will be in unfamiliar surroundings and may be distracted, in a hurry and impatient. Slow down and do it right. A broken bone can quickly spoil a trip. Budget for extra time so you don’t feel rushed. This includes budgeting for the chance that you may need to pay or tip for help if you need it and remember that it is only a small fraction of the cost of this wonderful trip.

3) Walking to gates – Airports often require long walks from gate to gate or gate to baggage pick-up. If you are uncertain about your ability to walk long distances, request wheelchair assistance in advance. You can always decline it when you arrive, but it may be very helpful if you find yourself stiff and sore after a long flight or if the destination airport is larger than you imagined with long distances from gate to gate. You may also arrange for pre-boarding so that you can request assistance with your carry-on bag and get settled into your seat before other passengers board. This also shortens the time you will be standing in a line-up while boarding the plane.

4) The carry-on bag – When flying, be aware that some flight attendants will not help you lift your carry-on bag into the overhead compartment for fear of injuring their back. Other travellers around you will almost always assist you instead, but you may need to explain why you are asking. Remember – osteoporosis is the silent disease that is usually not visible – so don’t be shy to ask your co-travellers for help.

5) Other considerations

a) Book an aisle seat so you can get up more easily. Try to get up every half hour to walk and do your stretching exercises.

b) Drink lots of water and be aware that coffee and alcohol may dehydrate you further.

c) Protect your back while sleeping. You may want to bring along a back support or purchase pillows or blankets on board. A well placed pillow or two can make all the difference during a long flight or ride.

d) In addition, a well fitted bean bag neck pillow or traveller’s pillow will support your neck as you sleep in a seated position. Some airlines sell inflatable pillows, but these may not be as supportive or as comfortable as the one you purchase from your home healthcare supplier.

e) Depending on your height, it may help to rest your feet on a raised surface, such as your carry-on bag or purse, to better align your hips and knees.

f) You may want to bring an iPod or MP3 player with music, stress reduction cassette tapes or a good paperback if you like to read.

g) If you need heating rubs to relax your muscles, try to bring unscented items. Co-travellers may have allergies to scents and you may not be permitted to use anything scented by the airline, rail or bus line. Unscented creams and massage oils are a good choice.

h) Be aware of and obey any pandemic policies, such as wearing a mask unless you are eating or drinking.

Exercising While Travelling

Try to move around as much as possible. This not only prevents stiff and sore joints and muscles but also prevents blood clots from developing in your legs.

1) When the aisles are not busy you can request permission from the cabin crew to walk or stand in the aisle or galley area so that you can do some stretching exercises that are safe for you.

· Walk up and down the aisles but be sure you are steady on your feet and holding on to the backs of seats so you don’t fall.

· Perform stretches at the ends of the aisles or in the galley areas. Again, steady yourself to make sure you don’t lose your balance and fall.

2) If you cannot exercise in the aisles, you may stretch in your seat as follows:

· While sitting, pull in your tummy and make circles with your wrists and ankles.

· Point your toes up and down to stretch your lower legs.

· Contract and relax your thigh (quadriceps) muscles.

· Lift your knees up one at a time and push them back down with your hands while lightly resisting this motion with your leg muscles to work your hips and lower back.

· Move your shoulders forward and back and then in a circle.

You Have Arrived!

1) Ground transportation – Can you get in and out of any car, taxi, bus or boat? Cruise ships often have little boats called tenders that go to shore to pick up passengers and then pull up against the ship to drop passengers off. Can you step into or out of these bobbing boats as required? These are details that need to be clarified prior to booking your trip. When booking a tour, ask about how long you will be required to sit and how many rest-stops there are along the way to help you plan accordingly.

2) Hotel rooms – When reserving a room consider these issues:

· Many hotels have rooms that will accommodate individuals with special needs, including grab bars, slip-proof tubs and accessible bathroom fixtures. Ask if you think you will need them.

· Is the accommodation accessible without having to navigate the stairs?

· Is there a refrigerator in the room?

3) Eat well and drink plenty of water – Proper nutrition with well-balanced regular meals is important even when you are on vacation. Avoid excess alcohol. Be sure to confirm the tap water is safe for drinking and brushing your teeth. Pay the same attention to the ice cubes that are put into your drinks and to the water used to wash your fruits and vegetables.

4) Treat your body well – Get your rest and do your exercises! When tired we tend to forget about our posture. Without good posture we do not move properly, which puts us at greater risk of fracture.

5) Pace Yourself – Remember that you cannot do everything. There will always be more to see, more to buy and more to eat. Trying to do too much is stressful and will tire you.

Finally, Have a Safe Trip! Remember that unfamiliar territory and changed routines can significantly increase the risk of falls and fractures. If you are thorough in your planning and pay attention to your surroundings you will have a great trip to talk about when you arrive back home safely.

Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis. Get Unbreakable, COPN’s e-newsletter.

As pandemic restrictions begin to lift, you may be thinking about travelling. Today, in addition to considering your plans to travel with osteoporosis you must also be clear on travel restrictions and protocols regarding Covid-19.

Do you know what the requirements are regarding vaccinations to enter another province or country? For example, do you need a vaccination passport or covid testing either before leaving or on coming back to Canada? Given that details surrounding travel during the pandemic can change as new information becomes available, make sure to check the Government of Canada website for the most current information on travel requirements at https://travel.gc.ca.

It is possible to travel safely and enjoyably with osteoporosis, but there are precautions that need to be taken, as well as those related to the pandemic.

Before You Start!

Have a clear understanding of your physical and medical needs, limitations and abilities. This understanding will help you to choose a suitable destination and means of travel. Consider using a travel agent who can assist in both planning and booking a trip that meets all of your requirements. You or your travel agent should contact the airline, train line, tour companies, hotels or cruise ship to be sure that they understand and can accommodate your needs.

Your doctor can also advise you about any necessary vaccinations (apart from covid) for your trip or if you need to update any previous vaccinations. Some vaccinations can take up to six months to administer, so be sure to start this process early rather than waiting until shortly before your departure.

Keep records so you know what to expect on each leg of your journey. Accessibility standards vary from country to country, so be prepared to describe in detail the support or features you may need. For example: wheelchair assistance at the airport, extra leg room on the airplane, a seat near the aisle, a special diet, etc.

Consider travel and medical insurance because medical care in a foreign country can be very expensive. When purchasing insurance, make sure you understand age restrictions and coverage for pre-existing conditions. See your doctor for a check-up well before your departure to minimize the chance of any changes to your medications and treatment shortly before your departure.

You will also need cancellation insurance because there is always the possibility that something may happen at the last minute that requires you to change your plans.

The All-Important List

It is never too early to start making a detailed list of the things you will need. Maintain a file of important papers, contacts, identification and travel documents. If you rely on your smart phone to store and manage these files, be mindful that some countries offer only limited internet access and ability to process phone transactions. Take with you a duplicate paper copy of the most important information.

List the items that you typically use and plan how to pack them so that they will be easily accessible on your trip. Are there special items that you use to help you in the kitchen, bedroom, bathroom or the car?

1) Mobility aids – Do you need a cane, walker or wheelchair all the time or just when you need to walk long distances such as in an airport, or a bus or train terminal? Consider the terrain of your destination – level ground, paved, cobblestones, lots of stairs? Will the destination be accessible with a walker or wheelchair?

Most airports and some other travel companies will provide wheelchair and other mobility services. Contact the airline, bus or train line in advance if you need this temporary service.

If you need a mobility aid all the time, consider bringing your own. You should contact the travel line ahead of time to ensure that they can accommodate your mobility aid, especially if it is a walker or wheelchair, because larger aids will require some form of storage while you travel.

If you do not need a mobility aid but you tire easily, consider bringing along a fold-up cane or lightweight folding chair, as tourist attractions often have long waiting lines. These items are available in home healthcare supply stores and/or in camping stores.

If you use aids to reach or pick up, don’t forget to bring your reacher, a daily living aid to help you grab out of reach items. Folding reachers are available.

2) Back and neck supports – If you are planning a long flight or a long bus or train ride and you suffer from back or neck pain, consider bringing along a portable back support that will fit into the seat of the plane or bus and a curved travel pillow to support your neck. These can be found in almost any home healthcare supply store.

3) Flashlight – A pocket flashlight may help you see where you are walking on unfamiliar streets or in an unfamiliar room. A small flashlight or book light can also be helpful when reading a book or menu in low-level lighting. Remember to take extra batteries.

4) Shoes – Every traveller needs a sturdy, comfortable pair of shoes. Shoes and sandals should have low heels and a rubber sole with a good tread. They should not slip off your feet. If you buy new shoes, wear them a few times before your trip to be sure they are comfortable and fit properly.

5) Baggage – Travel as lightly as possible. Perhaps use two lighter bags instead of one heavy one. Use bags and carry-ons with wheels and long pull handles that are easier to manage.

6) Medications

a) Make sure you pack an adequate supply of all your medications, vitamins and other supplements. Take enough for the duration of your trip plus a few days’ extra in case there is a change to your schedule. You must carry your medications in their original, labelled bottles and packaging.

b) If you take many medications and supplements and they are difficult to organize, ask your pharmacist to put them in a labelled blister pack. Pharmacy-labelled prescription medications will help you get through customs much more easily than unlabelled containers of “mystery” pills.

c) A note from your doctor may also help ensure easy passage for you and your medication through security and customs checkpoints, especially if you require the use of controlled substances, such as sleeping pills or narcotic pain killers, or need to carry needles for injectable medications such as insulin, Forteo® Prolia® or Evenity®. If your trip interrupts the timing of Prolia, ask your doctor if you can take it before or after the trip. If the timing of Evenity intersects with your trip, talk to your doctor.

d) Pay special attention to liquid medications. Without proper identification – the original prescription label and that note from your doctor – liquid medication may not be allowed through customs.

e) Does your medication need to be kept cool? Take it along in a small cooler with an ice pack. On the plane, you may be permitted to put your medication in a refrigerator while you re-freeze your ice pack in the plane’s freezer. Make sure you ask the airline ahead of time if they offer that service. Most hotels will offer you a small refrigerator.

f) Carry all of your medications with you in your purse or carry-on bag. This eliminates any problems if you are delayed or your luggage is lost.

g) Make a list with the names, addresses and contact information of all your doctors, family members and pharmacist to carry with you. Also bring a brief medical history, including a list of any allergies. Don’t forget to bring along any medic-alert information.

h) If you have concerns about travelling with medication, contact your airline provider to confirm details.

7) Insurance and emergency contacts – Carry your insurance coverage details and contact information with you and leave a copy with a friend or relative at home. Arrange to have someone whom you will contact if your ticket, passport or wallet is lost or stolen. Remember that telephones in other countries may work differently from in Canada. You may wish to carry the contact information for the Canadian Embassy of the country you are visiting.

Credit: COPN, the Canadian Osteoporosis Patient Network is the patient arm of Osteoporosis Canada, a national network of people living with osteoporosis. Get Unbreakable, COPN’s e-newsletter.

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.

2. 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.
3. 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.

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.