The Toronto Star, January 29, 2009 -

Early Testing helps identify "the blind thief".

Woman uses diet, physio and hormone injections to cope with bone disease

Paul Dalby, Special to the editor

Christine Thomas navigates the icy sidewalk outside her home with a mixture of extreme caution and absolute dread. Her daughter reaches out to steady her as she gingerly steps forward, the clamp-on-treads on her boots trying to find a safe purchase The daily ritual would not be that unusual for a senior, but Christine Thomas is only 49 and the daughter steadying her passage is a 7 year old youngster. This is the stark reality of life for a woman diagnosed with osteoporosis after she slipped and feel fracturing her spine in 5 places.

"I'm super cautious around ice because you never want a fracture againbut the fear is always looming over your head." Thomas says.

Once a high-flying mediator with Revenue Canada and now permanently retired on medical grounds, Thomas is one of 1.4 million Canadians suffering from osteoporosis. Once considered an elderly person's disease, osteoporosis strikes one in four women over the age of 50 years. The cost of treating the disease and the fractures it causes is estimated to be $1.9 billion per year in Canada. Osteoporosis is characterized by low bone mass and deterioration of bone tissue.It leads to bone fragility and risk of fractured bones, mostly in the hips,spine and wrist.

For Thomas who lives in Ottawa with husband Gerry Derouin and daughter Chanel, the arrival of osteoporosis came early - right after the birth of her baby in 2002. During the last eight weeks of her difficult pregnancy, she had been confined to a hospital bed and placed on blood thinners. Neither Thomas nor her doctors realized that she was probably in the early stages of osteoprosis at that time, so the bed rest and the blood thinners proved a devastating combination, robbing her of her bone density, which may not have been good going into pregnancy. It didn't take long for Thomas to discover the extent of her condition. Soon after arriving home with baby Chanel, she suffered a minor fall and found herself in excruciating pain. Diagnosis and a battery of tests revealed she had five spinal fractures,the direct result of severe osteoporosis. "The pain is just so awful, I had to go on antidepessants. But I told myself if I am ever going to get out of this,to survive as a mother and a spouse, I've got to do something to go forward" she recalls.

Thomas was determined not to retreat into herself, but she had to balance her own precarious health with the growing demands of a highly energetic daughter. "For someone like me who has had spinal fractures, you can't bend forward even to tie your shoelaces", she says. "Since she was young Chanel has learned to crawl up in my lap because I don't pick her up. She will just point to my lap when she wants a hug." Thomas says the little girl has adapted well to her mother's condition. "When I'm around the school she will always tell her friends that she 'has to go back and help her Mom'", she says. "The other day in the car, she asked me 'Mommy, is your back ever going to get better?' and it was hard for me to explain that the fractures that I have have altered the shape of my spine forever," Thomas says. "I told her that it will never go back to normal. Ever." But this certain knowledge encourages Thomas to be as active as possible and play a full role in her daughter's life. A strict regimen of careful diet and exercise, daily hormone injections, sessions with a physiotherapist and a personal trainer all help to keep her mobile. "I'm better than I was but I don't golf anymore, I don't skate anymore, and I don't ski anymore" she says.

It's up to her husband to accompany Chanel on all high energy activities. Thomas is pragmatic about her condition and the slow steady progress that she has made to better mobility. "Just being able to get out of bed and not use a walker or a cane or a back brace and being out of pain is a blessing" she says. Armed with a good education but no career to apply it to, she has channeled her skills into becoming a champion for getting the message out about osteoporosis to other women. She is the chair of the Ottawa chapter of Osteoporosis Canada, a national charitable organization for public education and has been honored for her efforts. "I have to say that this is very rewarding because I gained knowledge on my treatment and then in turn I share my story so that it doesn't happen to other people." Thomas says.

Her story is a powerful illustration of the need for early testing and early detection of osteoporosis. "The problem with osteoporosis is that it is called the "Silent thief" because you slowly lose bone density without knowing it" explains Dr. Sophie Jamal, director of the multidisciplinary osteoporosis program at Women's College Hospital in Toronto and a scientific researcher. "The next thing you know, you have a fracture, and what we do want to prevent above all else are fractures because they can lead to disablity and can actually increase your risk of dying. The problem." says Jamal, "is that osteoporosis is under-recognized and undertreated."

Bone Density Scan Key to Diagnosis

The most important strategy doctors use to diagnose the onset of osteoporosis is a bone density test.

Bone density machines are now increasingly part of every hospital's arsenal. But statistics prove many women still do not ask their doctors for the test.

We have data that there is a whole group of patients who are seen in fracture clinics in Ontario with what sounds like osteoporotic fractures (but) are not being tested or being treated for osteoporosis. says Dr. Sophie Jamal,of Women's College Hospital.

She says the one time test is quick and painless- 15-20 minutes with very low -level radiation.

It involves lying on a table while a small x-ray detector scans the spine, one hip or both. From the scan, a 10 year Absolute Fracture Risk known as a T-score can be detected, which takes into account such factors as age and gender.

Bone density tests can tell us how much bone you have, the bone quantity, and that is a good indicator of your fracture risk", Jamal says.

She recommends that all women over the age of 50 should get the test done as well as any woman over 40 who has suffered a recent fracture.

The bone mineral density (BMD) tests accurately measure the density of your bones in the spine, hip,total body and wrist and calculate their density of minerals (such as calcium).

The MBD test can tell whether you have osteoporosis or how likely you are to develop it, and can help you and your doctor make decisions that may help prevent fractured or further bone loss.

-Paul Dalby