Bone Mineral Density and Osteoporosis#

Osteoporosis is a condition that weakens bones, making them more likely to break. It happens when bone density falls below a defined threshold and bone structure deteriorates. It often has no symptoms until a fracture occurs, usually after a minor fall or sometimes spontaneously.

Both describe lower-than-normal bone density:

• Low bone mass (osteopenia): T-score between -1.0 and -2.5. Bone density is lower than average for a healthy young adult, but not low enough to be called osteoporosis. Many people with osteopenia do well with lifestyle and supplements alone.
• Osteoporosis: T-score -2.5 or lower, or any fragility fracture regardless of T-score.

The decision to start treatment depends more on your overall fracture-risk estimate than on the T-score alone.

A fragility fracture is a bone break that occurs more easily than expected - typically from a fall from standing height or less, or with no identifiable trauma at all. Common sites: hip, spine (sometimes felt as sudden back pain after lifting), wrist, upper arm. A fragility fracture is a strong sign that your bones are weaker than they should be, and is treated as definite osteoporosis regardless of your T-score.

Bones constantly remodel - old bone is broken down and new bone is built up. When breakdown outpaces building, bone density falls. The most common drivers are:

• Falling estrogen after menopause (the single largest factor in women)
• Falling testosterone with age (in men)
• Aging itself - bone mass peaks around age 30 and slowly declines after
• Some medications (steroid pills, some anti-seizure medications, long-term acid-suppressing medications, certain prescription cancer treatments)
• Some health conditions (celiac disease, inflammatory bowel disease, hyperthyroidism, hyperparathyroidism, Cushing's syndrome)
• Heavy alcohol use, smoking, low body weight

• Primary osteoporosis is what most people get with aging and hormonal changes (especially after menopause in women, and with age in men).
• Secondary osteoporosis is caused by another medical condition or medication, not by aging alone. Examples: long-term steroid-pill use, celiac disease, hyperthyroidism, Cushing's syndrome, hypogonadism.

When osteoporosis is found in a younger person or when the picture does not fit "expected aging," your clinician will look for a secondary cause and may order blood and urine tests to find it.

Several prescription medications can accelerate bone loss with long-term use:

• Steroid pills (such as prescription glucocorticoids) - the most common culprit
• Some anti-seizure medications
• Some thyroid hormone doses that are higher than the body needs
• Long-term injectable progestin contraceptives
• Certain prescription hormone-suppressing medications used for breast or prostate cancer
• Some immune-suppressing medications used after organ transplant
• Long-term injectable blood thinners
• Long-term high-dose acid-suppressing medications (the evidence for this is debated - see below)

If you have been on any of these long-term, your clinician will weigh whether earlier BMD testing makes sense.

The evidence is mixed. Long-term use of strong acid-suppressing medications has been associated with a small increased risk of fractures in observational studies, but a definitive causal link has not been proven. Current guidance is to use these medications at the lowest effective dose for the shortest necessary period, and to maintain calcium and vitamin D adequacy.

The pillars of bone health for everyone:

• Calcium: Most adults need 1,000 to 1,200 mg per day. Aim to get this from food first (dairy, fortified plant milks, leafy greens, canned fish with bones, tofu set with calcium). Supplements only if dietary intake is consistently low.
• Vitamin D: Most Canadians need 800 to 2,000 IU per day in supplement form, especially in winter. Vitamin D is required to absorb calcium from food. See the vitamin D testing page for details.
• Weight-bearing exercise: walking, jogging, dancing, stair-climbing, tennis - any activity where your skeleton works against gravity. At least 150 minutes per week.
• Resistance/strength training: 2 to 3 sessions per week. Strong muscles pull on bones and stimulate bone-building.
• Balance training: yoga, tai chi, or simple balance exercises - reduces falls.
• Limit alcohol: 2 or fewer standard drinks per day; 3 or more per day raises osteoporosis risk significantly.
• Don't smoke.
• Maintain a healthy body weight. Low body weight (under 60 kg / 132 lbs) is a risk factor.

When fracture risk is high enough to warrant medication, several classes of prescription treatment exist:

• Anti-resorptive medications (taken by mouth weekly or monthly, or given as an annual intravenous infusion) - the most commonly used first-line treatment. They slow the breakdown of bone.
• Anti-resorptive injection (given every 6 months) - an option for people who cannot take oral anti-resorptives or have advanced disease. Once started, this medication should not be stopped without a plan to switch to another medication, because rapid bone loss can occur after discontinuation.
• Selective estrogen receptor modulators (SERMs) - taken by mouth daily. May be considered when spine-fracture prevention is the main goal and there is no need to reduce hip-fracture risk.
• Bone-building (anabolic) medications - daily self-administered injections, typically reserved for severe osteoporosis or after a recent fragility fracture. Limited duration (usually up to 2 years).
• Hormone therapy - sometimes considered in younger postmenopausal women for symptom management; bone density is a secondary benefit.

All of these have specific indications, side-effects, monitoring requirements, and contraindications. TeleTest can prescribe and renew osteoporosis medication for patients with a clear diagnosis, recent BMD results, and an appropriate clinical profile.

For some long-term anti-resorptive medications, the medication deposits in bone and continues to work for years after stopping. After several years of treatment (typically 3 to 5 years for oral medications, 3 years for IV), your clinician may discuss a planned pause to reduce long-term side-effect risks. This decision is individualized and requires regular bone-density monitoring during the pause.

For some medications, yes - especially oral anti-resorptive medications, where the bone-protective effect lasts beyond the dosing period. For other medications (especially the every-6-month injectable anti-resorptive), stopping without a plan to switch can cause rapid bone loss. Always discuss any pause or stop with your prescribing clinician.

Being at risk of falls means several factors combine to make falls more likely:

Health factors: aging, muscle weakness, poor balance, vision problems, low blood pressure on standing, cognitive issues, polypharmacy (many medications).

Medication factors: sleep medications, anti-anxiety medications, some blood-pressure medications, opioid pain medications, alcohol.

Environmental factors: poor lighting, loose rugs, clutter, lack of handrails, slippery surfaces.

If you are at risk of falls, a clinician will recommend specific steps: physiotherapy, balance training, home safety review (sometimes through community programs), vision check, and a review of your medications.

Components of an effective fall-prevention plan:

• Environmental modification: remove loose rugs, improve lighting, install grab bars in bathrooms, use non-slip mats, keep walkways clear.
• Strength and balance exercise: physiotherapy, tai chi, supervised exercise classes designed for older adults.
• Medication review: identify and adjust medications that cause dizziness, low blood pressure, or sedation.
• Footwear: supportive, non-slip, well-fitting shoes; avoid high heels or worn-out slippers.
• Vision: annual eye exam, up-to-date glasses.
• Mobility aids: a cane or walker if needed - properly fitted, not borrowed from someone of a different height.
• Bone-protective measures: calcium, vitamin D, and treatment if indicated, so that any fall is less likely to result in a fracture.

Standard intervals in Canada:

• Low-risk individual, normal first scan: 5 years.
• Moderate risk: 2 to 3 years.
• High risk or on treatment: every 1 to 2 years to monitor response.
• After starting or stopping treatment: typically 1 to 2 years.

Provincial coverage rules differ. For example, Ontario covers a baseline plus a repeat at 36 months, with subsequent low-risk scans covered every 60 months; high-risk patients are covered more often. Check with your provincial plan for the exact schedule.

Yes. Osteoporosis Canada (aligned with current Canadian alcohol guidance) flags that regular consumption of three or more alcoholic drinks per day raises osteoporosis risk through several mechanisms: reduced calcium and vitamin D absorption, hormone disruption, poor nutrition, and increased falls. Occasional moderate drinking is not significantly harmful for bone health, but cutting back is one of the few modifiable risk factors that helps both bone density and fracture risk.

When osteoporosis is found or suspected, common bloodwork includes:

• Calcium (corrected for albumin)
• Vitamin D (25-hydroxyvitamin D)
• Alkaline phosphatase (a bone-turnover marker)
• Thyroid function (TSH)
• Kidney function (creatinine and eGFR)
• Complete blood count (CBC)
• Liver enzymes
• Sometimes parathyroid hormone (PTH)
• In men, sometimes total testosterone
• Sometimes celiac antibodies (if there are clues to malabsorption)
• Sometimes a 24-hour urine collection for calcium

TeleTest can order this bloodwork.