POSITION STATEMENTS

BÜBL X DAVID DIXON LAUNCHES TO A PACKED HOUSE AT TORONTO FASHION WEEK® X RE\SET™

February 6, 2019

Introducing a fashion line inspired by the two million Canadians affected by osteoporosis

TORONTO, Feb. 6, 2019  – Models clad in stylish bubble wrap strutted down the Toronto Fashion Week® x RE\SET™ runway at last night’s Bübl x DAVID DIXON world-debut at the Royal Ontario Museum. More than 400 guests viewed the collection, but it was only the beginning for Bübl.

A partnership between Osteoporosis Canada and acclaimed fashion designer, David Dixon, Bübl x DAVID DIXON incorporates bubble wrap – a universal symbol for protection – into runway pieces inspired by the two million Canadians affected by osteoporosis.

“I am thrilled to be partnering with Osteoporosis Canada to bring awareness to bone health,” says Dixon. “A big part of my job as a designer is to take the invisible and make it visible; that’s exactly what Bübl will do for this largely unseen disease.”

For those who missed the Toronto Fashion Week® x RE\SET™ premier, photos can be found here and the Bübl collection is viewable online at BüblFashion.ca. For Torontonians, Yorkville Village, on the top floor of 55 Avenue Road, will host select pieces for the next two weeks.

Alongside Bübl, Osteoporosis Canada has many resources aimed at raising awareness around bone health. Since 1982, the organization has supported those living with the disease, helping drive awareness, research, and advances in treatment.

“We are on a mission to make Canadians unbreakable,” says Dr. Famida Jiwa, President and CEO, Osteoporosis Canada. “Osteoporosis affects two million Canadians, including many young people that do not realize the risks they face; so, it is imperative that we reach a new generation and younger audience; David Dixon and Toronto Fashion Week® x RE\SET™ will help us do just that.”

Because many Canadians don’t realize the risks they face, Osteoporosis Canada launched the Know Your Risk quiz. A simple quiz, it identifies personal risk factors and helps Canadians work with their doctors to protect themselves.

Visit bublfashion.ca to find out more and take the Know Your Risk quiz (it’s the stylish thing to do).

About Osteoporosis Canada
Osteoporosis Canada is the only national organization serving people affected by osteoporosis. The organization works to educate, empower and support individuals and communities on bone health and in the risk-reduction and treatment of osteoporosis.

Commonly referred to as the “silent thief,” osteoporosis is an incurable disease that can cause bones to weaken over time, without any signs or symptoms leading to increased risk of breaking a bone.

Osteoporosis Canada provides medically accurate information to patients, health care professionals and the public. The organization has established clinical practice guidelines and long-term care and exercise recommendations. The Scientific Advisory Council (SAC) is made up of experts in osteoporosis and bone metabolism and is a volunteer membership. Comprised of clinicians, researchers and educators, the SAC advises Osteoporosis Canada’s board and staff on scientific and medical issues.

Two million Canadians are affected by osteoporosis and many do not even know they are at risk of the disease and the fractures it causes. Understanding the risk factors associated with osteoporosis can lead to early detection and improved management of the condition.

Website: osteoporosis.ca

About David Dixon
David Dixon goes where no one else does. After graduating from Ryerson University in 1995, he recognized a gap in the Canadian Fashion Industry: women’s contemporary evening wear and event dressing. With that, his eponymous label was born. Today, his designs are sold across Canada and in select boutiques around the globe. David’s latest collection, Bübl x DAVID DIXON, continues his history of breaking new ground in fashion. Throughout his career, David’s innovative designs have won him a following with many in film and fashion, including Meg Ryan, Meagan Follows, Jeanne Beker, Noot Seear, Linda Evangelista, Coco Rocha and more.

Website: daviddixon.ca

About Toronto Fashion Week® x RE\SET™
Toronto Fashion Week® x RE\SET™, an event showcasing fashion, art, music and culture takes place in Yorkville, Toronto’s revitalized and most prestigious luxury retail neighborhood. The bi-annual event hosts national and international designers, entertainers and the fashion community to create a touchpoint where fashion is embraced and celebrated. As the leading fashion event in Canada, Toronto Fashion Week® x RE\SET™ creates a catalyst for media engagement, retail activity and global connectivity.

The founding partners are Yorkville VillageThe Hazelton HotelFreed Developments and Hill & Gertner – an ownership group comprised of several of the country’s top companies in real estate, development and luxury hospitality.

Website: TFW.to

About RE\SET™
In February 2017, THE COLLECTIONS™ launched RE\SET™ a platform offering designers an opportunity to present their collections direct to consumer and the industry. RE\SET™ currently takes place bi-annually in September and February (prior to New York Fashion Week) and is in partnership with the official Toronto Fashion Week® x RE\SET™ located in Yorkville. RE\SET™ provides designers with a variety of presentation formats including: traditional runway, static presentations, a designer showroom model and has cumulatively featured over 100 participating designers.

Website: reset.fashion

SOURCE Osteoporosis Canada

For further information: Nora.Hickey@edelman.com, 416.850.0679 Ext. 5232 or Maryann.Nasello@Edelman.com, 647.252.2874

RELATED LINKS

Eating for Bone Health with the New Canada’s Food Guide

January 25, 2019

The new Canada’s Food Guide was released on Tuesday Jan 22nd. It is a modern approach to promoting healthy eating, making healthier eating choices easier for all Canadians. This new food guide focuses on what to eat and how to eat. It also includes updated recommendations on saturated fat, sodium, and sugars.

The food guide focuses on vegetables, fruits, proteins and whole grains. The new food guide encourages Canadians to choose plant-based proteins more often. According to the food guide, protein foods include legumes, nuts, seeds, tofu, fortified soy beverage, fish, shellfish, eggs, poultry, lean red meat including wild game, lower fat milk, lower fat yogurts, lower fat kefir, and cheeses lower in fat and sodium.

Canadians need adequate amounts of calcium, vitamin D and protein for optimal bone health. Milk products contain a high proportion of calcium per serving and are a great source of protein.  Calcium can also be found in other foods such as calcium-fortified food and drink, some vegetables and fruits, nuts and seeds, and legumes.  For suggestions regarding calcium containing foods, please click here.

Osteoporosis Canada continues to encourage adults who have osteoporosis or have risk factors for osteoporotic fractures, to get adequate vitamin D supplementation as it is difficult to obtain recommended levels through foods alone. Click here for more information on vitamin D.

Increased Risk of Vertebral Fracture After Stopping Denosumab

October 23, 2018

Denosumab (Prolia) has been shown to reduce the risk of fracture in postmenopausal women and men ≥50 years old with osteoporosis. It has also been approved for steroid induced bone loss.

Individuals who were in the FREEDOM study, which evaluated denosumab in comparison to placebo, were followed, and those who stopped denosumab had a subsequent reduction in bone mineral density (BMD) and an increase in the risk of fracture (Bone JCEM 2011).

Analysis of the data from the FREEDOM study as well as the Extension trial of denosumab up to a total of 10 years, confirmed that stopping denosumab was associated with an increase in rate of bone loss as measured by bone turnover markers, which rose 3 months after missing a scheduled dose. BMD decreased back to the baseline level 12 months after missing a scheduled dose of denosumab (Cummings JBMR 2017).

Individuals who had received ≥2 doses of denosumab or placebo, and stopped treatment but remained in the study for ≥ 7 months after the last dose, were reviewed. In the 1001 patients who stopped denosumab, the rate of spine fractures increased from 1.2/100 patient-years (while on treatment) to 7.1/100 patient-years, a similar rate to the placebo group. Multiple (>1) vertebral fractures appeared to be more common in the group stopping denosumab than the group stopping placebo (3.4% vs 2.2%). The risk of having multiple (>1) vertebral fractures after stopping denosumab was higher in those people who had already experienced a prior spine fracture, and also in those who had rapid rates of bone loss. The rates of non-spine fractures were similar in those stopping denosumab and those stopping placebo (2.8% denosumab, 3.8% placebo) (Cummings et al JBMR 2017).

Due to the increased risk of vertebral fractures associated with denosumab discontinuation, it is important not to miss scheduled doses of denosumab once treatment has started. Patients need to be advised of the increased risk of bone loss and vertebral fracture when therapy is stopped. If denosumab needs to be stopped, it should be replaced by an alternative osteoporosis medication to help prevent rapid bone loss and risk of fractures (Symonds CMAJ April 2018).

Osteoporosis Canada advises individuals on denosumab therapy to discuss their treatment with their physician prior to stopping therapy or missing a scheduled dose.

1. Bone HG et al JCEM 2011:96:972-980

2. Cummings et al JBMR vol 33, No2, Feb 2018 pp 190-198

3. Symonds C, Kline G CMAJ 2018 April 23 :190 pp E485- 486

Prepared by Aliya Khan, Sandra Kim, Rowena Ridout and Lianne Tile, on behalf of the Scientific Advisory Council of Osteoporosis Canada, Rapid Response Committee.

Increased Risk of Vertebral Fracture After Stopping Denosumab

October 23, 2018

Osteoporosis Canada advises individuals on denosumab therapy to discuss their treatment with their physician prior to delaying therapy, stopping therapy or missing a scheduled dose.  

Denosumab (Prolia) has been shown to reduce the risk of fractures in postmenopausal women and men aged 50 years or older with osteoporosis.  It has also been approved for steroid induced bone loss.

Individuals who were in the FREEDOM study, which evaluated denosumab in comparison to placebo, were followed, and those who stopped denosumab had a subsequent loss of bone mineral density (BMD) and an increase in the risk of fracture (Bone JCEM 2011).

Analysis of the data from the FREEDOM study as well as the Extension trial of denosumab (where treatment was continued up to a total of 10 years) confirmed that stopping denosumab was associated with an increase in the rate of bone loss, as measured by bone turnover markers, which rose 3 months after missing a scheduled dose. 12 months after missing a scheduled dose of denosumab, BMD decreased back to the baseline (pre-treatment) level (Cummings JBMR 2017).

Individuals who had received at least 2 doses of denosumab or placebo, and stopped treatment but remained in the study for at least 7 months after the last dose, were reviewed.  In the 1,001 patients who stopped denosumab, the rate of spine fractures increased from 1.2/100 patient-years (while on treatment) to 7.1/100 patient-years, a similar rate to the placebo group. Patient years is a statistical measure used to express the time at risk. 7.1 spine fractures/100 patient-years means that if you followed 100 people for 1 year, on average you would see 7.1 spine fractures. Multiple (more than 1) spine fractures appeared to be more common in the group stopping denosumab than the group stopping placebo (3.4% vs 2.2%). The risk of having multiple (more than 1) spine fractures after stopping denosumab was higher in those people who had already experienced a spine fracture, and also in those who had rapid rates of bone loss. The rates of non-spine fractures were similar in those stopping denosumab and those stopping placebo (2.8% denosumab, 3.8% placebo) (Cummings et al JBMR 2017).

Due to the risk of BMD loss and spine fractures associated with denosumab discontinuation, it is important not to miss scheduled doses of denosumab once treatment has started. Patients need to be advised of the increased risk of bone loss and vertebral fracture when therapy is stopped.  If denosumab needs to be stopped, it should be replaced by an alternative osteoporosis medication to help prevent rapid bone loss and risk of fractures (Symonds CMAJ April 2018).

Osteoporosis Canada advises individuals on denosumab therapy to discuss their treatment with their physician prior to delaying therapy, stopping therapy or missing a scheduled dose.

  1. Bone HG et al JCEM 2011:96:972-980
  2. Cummings et al JBMR vol 33, No2, Feb 2018 pp 190-198
  3. Symonds C, Kline G CMAJ 2018 April 23:190 pp E485-486

Vitamin D and Effects on Fractures, Falls and Bone Mineral Density

October 16, 2018

The recent study by Bolland and colleagues published in the Lancet Diabetes Endocrinology (Oct 4, 2018) is an updated meta-analysis that evaluated the effects of vitamin D supplementation on fractures, falls and bone mineral density (BMD) in adults. This study analyzed the pooled findings of 81 randomized control trials, collectively involving more than 50,000 participants.

The majority of the trials included in this analysis were of vitamin D alone, with daily doses of more than 800 IU daily, vs. untreated controls, in community-dwelling women age 65-years or older. Trials of high-dose vs. low-dose vitamin D, as well as co-administration of calcium with vitamin D were also included. Study duration was 1 year or less. The primary outcomes were fractures and falls; and the secondary outcome was change in BMD from baseline at the lumbar spine, total hip, femoral neck, total body, and forearm (1).

This meta-analysis found that vitamin D supplementation did not have an effect on the risk of fractures or falls, and there were no meaningful effects on BMD. The authors also concluded that there were no differences between the effects of higher and lower doses of vitamin D (1).

In more than half of the trials, subjects had a baseline vitamin D level (25OHD) of <50 nmol/L (a cutoff considered by many including the Endocrine Society (2) to indicate vitamin D insufficiency), and almost all had a baseline 25OHD <75 nmol/L. Only four trials (6%) studied people with vitamin D deficiency (25OHD <25 nmol/L), in whom vitamin D supplementation may produce different results. Since there is large variability in how vitamin D levels respond to fixed doses of vitamin D (most studies used 1000 IU per day or less), 25OHD levels may not have reached the target range of interest in these studies. The finding that vitamin D alone may not prevent fractures, falls or improve BMD is consistent with prior published studies. While studies have shown little impact on outcomes when vitamin D or calcium are used separately, a review of trials of calcium and vitamin D used together in individuals living in long-term care showed benefit (3). The current meta-analysis by Bolland included only 20 trials (25%) of vitamin D taken with calcium vs. calcium alone, and did not include studies that compared vitamin D used together with calcium vs. no treatment. Although the major strength of the current study lies in the large number of studies included in the analysis, it is important to recognize potential limitations including the heterogeneity of populations, study designs and results of the studies in the meta-analysis. Importantly, this study did not specifically address the vitamin D requirements of individuals with osteoporosis, those with risk factors for osteoporotic fractures, or those with risk factors for vitamin D deficiency. It is important to remember that vitamin D is needed for optimal calcium absorption from the gut, and plays an important role in calcium balance and bone mineralization. Inadequate vitamin D can result in poor bone mineralization, as well as bone loss due to a rise in parathyroid hormone levels. Although this study suggests that routine vitamin D supplementation, in particular, high dose vitamin D, may not be necessary for healthy individuals in the general population, these findings cannot be applied to people with osteoporosis, or to those with risk factors for fractures or vitamin D deficiency. 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 (4), however vitamin D dosing may require adjustment in order to achieve the adequate 25OHD level needed for optimal calcium homeostasis. Further studies are needed to clarify the optimal 25OHD level for those with osteoporosis or with risk factors for fracture. High dose vitamin D supplementation should be avoided due to potential harms (5). There are large randomized trials currently ongoing to help answer questions about effects of vitamin D supplementation on other aspects of health (6). Appropriate osteoporosis medication may be required for those at high fracture risk. It is important to note that clinical trials showing the effectiveness of osteoporosis medications all included vitamin D and calcium as part of the treatment regimen. References: 1. Bolland et al Lancet Diabetes Endocrinol Oct 2018 2. Evaluation, Treatment, and Prevention of Vitamin D Deficiency: an Endocrine Society Clinical Practice Guideline. Michael F. Holick et al The Journal of Clinical Endocrinology & Metabolism, 2011 96 (7): 1911-1930. 3. Papaioannou et al CMAJ 2015 187: 1-11. 4. Vitamin D in adult health and disease: a review and guideline statement from Osteoporosis Canada by David A. Hanley MD et al CMAJ 2010 5. Smith et al 2017 J Steroid Biochem Mol Biol173:317-22 6. Pradhan AD Manson JE Update on the Vitamin D and OmegA-3 trial (VITAL). Study J Steroid Biochem Mol Biol. 2016 Jan;155(Pt B):252-6. 7. Manson JE et al. Vitamin D supplements and prevention of cancer and cardiovascular disease. N Engl J Med 2018 Nov 10; [e-pub]. (https://doi.org/10.1056/NEJMoa1809944) Prepared by Aliya Khan, Sandra Kim, Rowena Ridout and Lianne Tile, on behalf of the Scientific Advisory Council of Osteoporosis Canada, Rapid Response Committee.

Scientific Advisory Council

Osteoporosis Canada’s rapid response team, made up of members of the Scientific Advisory Council, creates position statements as news breaks regarding osteoporosis. The position statements are used to inform both the healthcare professional and the patient. The Scientific Advisory Council (SAC) is made up of experts in Osteoporosis and bone metabolism and is a volunteer membership.

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