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Back to Bone Health and Osteoporosis

Definitions, Situation of Osteoporosis in Canada and Risk Factors

Osteoporosis is a disease with its roots in childhood, as bone size, strength, and mineralization peak in one's 20s. Since bone mass declines with advancing age and menopause, individuals who attain optimal peak bone mass during their younger years will have an advantage as they get older. Although it is largely genetically predetermined, peak bone mass is not always attained due to inadequate calcium and vitamin D intakes, poor overall nutrition, lack of physical activity, and other factors such as smoking.


Osteoporosis, which literally means porous bone, is a disease in which the density and quality of bones are reduced.2 The World Health Organization (WHO) has defined osteoporosis as “a disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.”3 Clinically, osteoporosis has been defined as bone mineral density (BMD) of 2.5 or more standard deviations below peak bone mass for young adults, i.e. T-score ≤ -2.5.4

One of the most serious manifestation of osteoporosis is fragility fracture, defined as “a fracture caused by injury that would be insufficient to fracture normal bone” by the WHO.5 In other words, it is a fracture that would not otherwise occur to normal, healthy bone.

The situation in Canada

Osteoporosis is a major health problem in Canada, and its prevalence is increasing as the population ages.1 About 1.5 million Canadians aged 40 years or older reported having been diagnosed with osteoporosis.6 According to Osteoporosis Canada, at least 1 in 3 women and 1 in 5 men will suffer from an osteoporotic fracture during their lifetime.7

The prevalence of osteoporosis increases with age: over 80% of all fractures in adults over 50 years are caused by osteoporosis.7 The Canadian Multicentre Osteoporosis Study (CaMos) estimated the prevalence of osteoporosis in those over age 50 to be:8

  • 21.3% in women, and
  • 5.5% in men.

The major public health and clinical impact of osteoporosis lies in the fractures caused by the disease. About 28% of women and 37% of men die within 1 year after a hip fracture.7 It has been estimated that 50% of women who sustain a hip fracture become functionally dependent in their daily activities, and 19% require long-term nursing home care.1

Risk factors for osteoporosis

Osteoporosis Canada recommends that all women and men older than 50 years be assessed for the presence of risk factors for osteoporosis.4 Risk factors for low BMD, fractures and falls include:4

  • prior fragility fractures,
  • parental hip fracture,
  • glucocorticoid use,
  • current smoking,
  • high alcohol intake (≥3 units per day),
  • rheumatoid arthritis,
  • falls in the previous 12 months, and
  • impaired gait and balance.

As childhood habits have an impact on this disease, the best approach is prevention via the attainment and maintenance of optimal bone health.


  1. Brown JP et al. Canadian Consensus Conference on osteoporosis, 2006 update. J Ostete Gynaecol Can 2006;28(2 Suppl 1):S95-S112.
  2. International Osteoporosis Foundation. 2015. What is osteoporosis? Accessed October 20, 2016.
  3. Szulc P and Bouxsein ML. International Osteoporosis Foundation – Vertebral Fracture Initiative. 2010. Overview of osteoporosis: epidemiology and clinical management. Accessed October 20, 2016.
  4. Papaioannou A et al. 2010 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: summary. CMAJ 2010;182:1864-1873.
  5. Brown JP and Josse RG. The Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002;167(10 suppl):S1-S34.
  6. Public Health Agency of Canada. 2010. Fast facts from the 2009 Canadian Community Health Survey - Osteoporosis rapid response. Accessed October 20, 2016.
  7. Osteoporosis Canada. 2016. Osteoporosis facts & statistics. Accessed October 20, 2016.
  8. Papaioannou A et al. 2010. The Scientific Advisory Council of Osteoporosis Canada.Clinical practice guidelines for the diagnosis and management of osteoporosis in Canada: background and technical report. Accessed October 20, 2016.

Keywords: osteoporosis , health studies

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