Osteoporosis - Part 1: The Silent Thief
by Dr. Jason Kwok
You can listen to an audible version of this article.
Osteoporosis is a disease characterized by a decrease in bone mass and deterioration of bone tissue, resulting in weak and porous bones that are more susceptible to fractures. The most common fractures associated with osteoporosis occur in the hip, wrist, spine, and shoulder. Osteoporosis is often referred to as the "silent thief" because bone density can decline without symptoms until a fracture occurs. Fractures caused by osteoporosis are known as "fragility fractures" and can occur with minimal trauma, such as sneezing, coughing, reaching for a light object, bending over to pick something up, or falling from a standing or low height. Almost all fragility fractures are caused by osteoporosis, and patients typically have no symptoms prior to the fracture. Osteoporosis should not be confused with osteoarthritis, even though the English names of the two conditions are similar. Osteoporosis is a bone disorder, while osteoarthritis is a joint and surrounding tissue disorder.
Osteoporosis is a very common condition in Canada. Each year, the number of fractures caused by osteoporosis is higher than the total number of heart attacks, strokes, and breast cancer cases. There are approximately 30,000 cases of hip fractures each year, as well as many more fractures in the wrist, spine, and shoulder. Osteoporosis is not just a disease that affects women; men can also develop osteoporosis. In Canada, one in every three women will experience a fracture due to osteoporosis in her lifetime, while the ratio for men is one in every five. Osteoporosis can affect people of any age, but over 80% of fractures in people over the age of 50 are caused by osteoporosis.
At the societal level, osteoporosis significantly increases the burden on healthcare. In 2010, the treatment of osteoporosis and its associated fractures cost $23 billion, including emergency care, medication, follow-up visits, and other expenses. If the cost of nursing homes is included, the number will be even higher. It is estimated that the average hip fracture patient requires a hospital stay and rehabilitation center for 23 days, which costs the healthcare system more than $20,000. If a patient needs to move into a nursing home, the cost increases to over $40,000 per year.
Osteoporosis seriously affects patients' quality of life. It damages their appearance, causes them to shrink in height, develop a humpback, and deform their wrists, among other issues. This can damage their self-esteem, reduce or impair their mobility, and increase their dependence on family members. Statistics show that only 44% of hip fracture patients return to their own homes after being discharged. 10% are transferred to other hospitals, 27% are transferred to rehabilitation centers, and 17% are transferred to long-term care facilities. After a hip fracture, 28% of women and 37% of men will die within a year. Even if they survive, one-third of patients will suffer another fracture within a year, and about two-thirds will suffer another fracture within five years. After a wrist fracture, 14% of patients will suffer another fracture within three years. After a spine fracture, 20% of patients will suffer another fracture within a year. These figures show how serious the complications of fractures caused by osteoporosis can be.
In fact, osteoporosis is a problem that begins in youth, but often only manifests in middle and old age. The peak bone mass is reached in youth; for females, this occurs at ages 16 to 20, while for males it occurs at ages 20 to 25. After that, bone mass begins to decline gradually for both genders, with women losing bone mass more quickly after menopause, at a rate of 2-3% per year on average. Therefore, strengthening bones during childhood and adolescence is a preventative measure against developing osteoporosis later in life. 
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