Calling out a “silent” disease

November is osteoporosis month and the Schroeder Arthritis Institute at University Health Network (UHN) has one of Canada’s top clinics specializing in osteoporosis treatment and clinical research.

Founded by Dr. Angela Cheung, the clinic offers state-of-the-art diagnostic and expert care services to patients with osteoporosis and metabolic bone diseases. More than 3,000 patients come to the clinic each year for treatment that focuses on fracture risk reduction and quality of life improvement.

Dr. Shirine Usmani recently joined the Osteoporosis Program as a clinician investigator. In her new role, she splits her time between seeing patients and conducting clinical research. With her specialty training in internal medicine and endocrinology, she has a keen interest in understanding the how the body’s organ systems and skeletal structures function. In this article, she explains more about this condition and shared with us what excites her about being part of the osteoporosis team.

Osteoporosis develops when the balance between bone formation and bone removal becomes skewed and bone is lost faster than it can be replaced. “Osteoporosis is often described as a “silent disease” so many people don’t know they have it, or at risk for it, until they have a fracture,” explains Dr. Usmani.

One in three women and one in five men will have a fragility fracture in their lifetime. They are called fragility fractures because even a slight minimal trauma, such as falling from standing height, is sufficient to cause a break in the affected bones. In people over the age of 60, at least 80 per cent of fractures are linked to osteoporosis.

This can occur naturally due to an insufficient intake of bone-building nutrients such as calcium and vitamin D; low levels of estrogen in women after menopause; a general decline in bone health as a result of old age, or due to secondary causes such as taking medications that cause bone loss. Younger patients and those with complex medical problems are a greater risk for bone loss and fractures. These could be transplant, kidney, diabetic and cancer patients, as well as people on steroid medications.

For individuals who are at moderate to high risk for fracture, lifestyle changes are emphasized in order to protect bones from breaking. These include weight-bearing aerobic exercises, exercises that focus on balance for those at risk of falls, as well as adequate intake of calcium and vitamin D.

For patients at high risk of fracture, and for some patients at moderate risk as well, medications and infusions may be necessary for fracture prevention.

“With the potential collaborations and expertise at UHN, there is unlimited potential for research going forward. We have diverse patient populations and also unique sub-categories such as transplant and cancer patients whose treatments have an effect on bone density. This gives us the opportunity to study unique groups and develop more personalized approaches to treatment,” says Dr. Usmani.

“What excites me most is the potential to push this research forward. With our ongoing clinical trials, a positive work environment, and collaborations across different specialties, I can’t think of a better place to advance osteoporosis research.”