Osteoporosis: prevent bone fragility starting at age 40

A hip fracture after a simple fall. A vertebra that collapses without trauma. Chronic back pain whose cause is only identified years later. Osteoporosis often manifests in these ways, through its complications, without having shown any prior signs. This is precisely why prevention and early screening are so important for this disease.

In Canada, approximately two million people live with osteoporosis, and osteoporotic fractures are a major cause of morbidity, loss of independence, and mortality in older adults (Osteoporosis Canada, 2023).

What happens in the bone

Bone tissue is in constant renewal. Cells called osteoclasts break down old bone, while osteoblasts form new bone. Until about age 30, formation outweighs resorption, and bone mass increases. Afterward, the balance stabilizes, and then with age, and particularly after menopause in women, resorption gradually outweighs formation.

Osteoporosis results from this prolonged imbalance: bone loses density and microarchitecture, becoming more porous and fragile. A fracture can then occur from minimal trauma, known as fragility fracture, such as a fall from one's own height or even a simple sudden movement for vertebral fractures.

Risk factors to be aware of

Age and female sex are the most important non-modifiable factors. Menopause accelerates bone loss due to the drop in estrogen, which has a protective effect on bone tissue. A family history of osteoporotic fractures, particularly a hip fracture in a first-degree relative, significantly increases the risk.

Regarding modifiable factors, a diet low in calcium and vitamin D, a sedentary lifestyle, smoking, excessive alcohol consumption, and a very low body mass index are associated with lower bone density. Certain medications, particularly long-term corticosteroids, aromatase inhibitors, and some antiepileptics, reduce bone density and warrant specific monitoring.

Bone density screening

Bone densitometry by dual-energy X-ray absorptiometry, or DXA, is the gold standard for measuring bone mineral density. It is painless, fast, and exposes the patient to a very low radiation dose. In Quebec, it is systematically recommended for all women aged 65 and older, and earlier if risk factors are present. Men aged 70 and older or those with significant risk factors are also eligible.

The result is expressed as a T-score. A T-score between 0 and -1 is normal. Between -1 and -2.5, it is a case of osteopenia. Below -2.5, the diagnosis of osteoporosis is made. These values are interpreted in the overall clinical context, integrating other risk factors to calculate the ten-year fracture risk.

Prevention from age 40

Adequate calcium intake, about 1000 mg per day for adults, and vitamin D, 800 to 2000 IU per day depending on the individual, are the foundations of prevention. Weight-bearing physical activity, such as walking, dancing, or weight training, stimulates bone formation and improves coordination and balance, thus reducing the risk of falls.

Starting at age 40, these habits have a measurable long-term impact on bone density. The foundations are built well before menopause.

Frequently Asked Questions About Osteoporosis

Are dairy products essential for bones?
They are an easily digestible source of calcium, but not the only one. Leafy green vegetables, legumes, tofu, fortified plant-based drinks, and canned fish with bones are other sources. The important thing is to meet the recommended daily intake, regardless of the source.

Does osteoporosis also affect men?
Yes, though less frequently than women. Men over 70 years old, or those with specific risk factors such as hypogonadism, prolonged corticosteroid therapy, or a history of fragility fracture, are affected.

Are osteoporosis medications necessary?
Not systematically. The decision to treat is based on calculated fracture risk, not solely on bone density. For high-risk cases, bisphosphonates and other drug classes have demonstrated solid efficacy in reducing fractures.

When to consult a healthcare professional

If you are 65 years or older, have had a fracture after minimal trauma, are taking corticosteroids long-term, or have significant risk factors, a medical consultation to assess your bone density is recommended.

A physician or a specialized nurse practitioner can prescribe a bone density scan, interpret the results, and propose an appropriate prevention or treatment plan. An in-person or remote consultation teleconsultation at one of our Omicron Clinic in Quebec gives you immediate access.

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