JointHealth™ insight   June 2005

This issue of JointHealth™ monthly focuses on diet, nutrition and exercise for people with arthritis and osteoporosis. The next issue of JointHealth™monthly will be published in September 2005. ACE wishes all its community members a healthy, safe and pleasant summer. Be well!


Osteoarthritis and osteoporosis: they are different diseases

Osteoarthitis and osteoporosis are different diseases but often there is confusion between these two conditions. This is especially true among older adults. Research by Burgener et al. suggests that although many older adults have heard of osteoporosis, many know very little about it. This is important as having a good understanding of osteoporosis helps to prevent and treat the disease. Below is a chart highlighting the differences between osteoporosis and osteoarthritis.

Question Osteoporosis
(bone+thin=thin bones)
(bone+joint pain=joint damage)
What is it?
  • thin fragile bones that can break easily
  • bone mass loss can occur without any symptoms
  • often a fracture is the first symptom OP is present. Typical fracture locations are the wrist and the hip
  • a frequent cause of height loss and acquired spine curve 'dowager's lump'
  • early detection is important to prevent OP
  • a loss of cartilage in the joint, extra bone formation and reduced joint movement
  • most common form of arthritis
  • typical symptoms are pain, loss of movement, and stiffness
  • common joints: hands, base of thumbs, neck, back hips, knees and first toes (bunion)
  • does not affect other organs
Who gets it?
  • 1.4 million Canadians have OP
  • 1 in 4 women over the age of 50
  • 1 in 8 men over the age of 50
  • however, the disease can strike at any age
  • 2.9 million Canadians have OA
  • women more than men (2 out of 3 women)
  • hip and knee OA usually occurs after age 50
  • affects 30% of people over age 75 but is not simply apart of getting old
  • genetic factors and obesity
Who is at risk?
  • being female
  • fracture with minimal trauma after the age of 40
  • small and thin body frames
  • anyone with rheumatoid arthritis speeds up the rate of OP
  • family history of OP
  • some medications including heparin (blood thinner), anti-seizure drugs and long term use of corticosteroids (such as Prednisone)
  • links to persons with obesity, diabetes and cartilage disorders
  • occupational trauma over time
  • sports injuries
Things that increase your risk.
  • loss of menstrual cycle in young women
  • lack of vitamin D and calcium
  • chronic diseases like rheumatoid arthritis and Hepatitis C
  • excessive intake of alcohol and caffeine
  • poor nutrition
  • lack of exercise
  • being Caucasian or Asian
  • obesity increases risk of OA of the hand 3 times
  • a weight gain of 10kg (22 lb) almost doubles one's risk of OA of the knee


Bone and joint health: the role of calcium and vitamin D

Good nutrition plays a key role in both the prevention and treatment of osteoporosis. It is important to get the right amounts of calcium and vitamin D. Calcium has been shown to decrease bone loss and risk of fracture. Vitamin D helps to absorb the calcium.

Building strong bones starts when we are born. It is important to have a good store of calcium before the age of thirty. The reason is because with aging changes begin to happen in our bones. One of these changes is a decrease in the amount of calcium and water in the bones. This makes the bones less dense and more brittle.

By age 35 our bones have reached their peak bone mass. Women begin to lose bone mass at a faster rate than men. By age 65 most women will have 20-30% less bone mass than they did at age 35. This decrease in bone mass increases one's potential for fractures.

Osteoporosis occurs when there is progressive decrease in bone density making bones more brittle, thin and easily fractured. These bones are more thin and porous than usual bone. Osteopenia is the term used for bone loss that is not severe enough to be called osteoporosis. Vitamin D and Calcium are the building blocks that are essential in preventing and treating osteoporosis and subsequent fractures.

Other lifestyle behaviours that help prevent or treat osteoporosis are:
  1. Quitting smoking because smoking can:
    • cause a 5-10% loss of bone mass
    • decrease estrogen and lead to bone loss in women before menopause
    • can lead to early menopause and increase risk of osteoporosis
    • can negatively affect the use of estrogen replacement therapy
  2. Decrease alcohol and caffeine intake as either may increase bone loss. Try to have only one alcoholic drink or one cup or coffee or tea per day.
  3. Get enough vitamin D and calcium each day.
    • Vitamin D: take 800-1000 IU
    • Calcium: older men and women need 1500 mg of elemental calcium each day
Sources of Calcium
Dietary Sources of Calcium: the following chart provides examples of dietary sources of calcium.

Food Group Amount Calcium (mg)
Dairy Products
Swiss cheese
Cheddar cheese
Plain yogurt 1-2% milk fat
Milk - skim
Milk - 2%
Yogurt with fruit 1-2% milk fat

50g or 1.75 oz
250 ml (1 cup)
250 ml (1 cup)
30 ml (2tbsp)

Fruits and Vegetables
Fruit juice enriched with calcium
Spinach, cooked

250 ml (1 cup)
125 ml (1/2 cup)

Meat and substitutes
Pink salmon with bones, canned

100g or 31/3 oz
125 ml (1/2 cup)


What about calcium supplements?
Many Canadians - especially females - do not get enough calcium in their regular daily diet. Calcium supplements can help but it is important to know what and how much you are taking.

The two most common calcium supplements are calcium carbonate and calcium citrate. Take supplements dividing the total amount into two or three doses throughout the day so the body has less to absorb at one time. Example: For 1500 milligrams of calcium supplement, take 500 milligrams, three times a day.

Calcium can be constipating so increase the amount of fluids you drink and build up your calcium supplement until your system adjusts.

Calcium carbonate:
  • Least expensive and most widely used
  • Contains 40% elemental calcium (the calcium that is absorbed)
  • 1000 milligrams of calcium carbonate = 400 milligrams of elemental calcium
  • For best absorption take while eating or just after eating
Calcium citrate:
  • Easier to digest than calcium carbonate but more expensive
  • Contains 21% elemental calcium so more pills are needed to get the same amount of elemental calcium as in calcium carbonate
  • For persons with less stomach acid calcium citrate is a good choice as it is absorbed quickly by the small intestine
  • It can be taken on an empty stomach any time of the day
*** On all calcium supplements look for a DIN number, usually on the front label. This number means that the contents of the bottle has been tested for lead content and is considered safe*** For more information go to: and access the natural food site.

Vitamin D
Vitamin D is essential for the absorption of calcium. Adults, 19-50 years need 400 IU per day and adults 51 years and older require 800 IU per day. Vitamin D can be obtained through dietary sources such as milk (100 IU/cup). If you need to supplement your vitamin D intake, use a multivitamin. Remember that milk used in coffee, cereal, soups, puddings etc. counts too.

It is important to remember not to exceed the recommended dosages of calcium and vitamin D. Although vitamin D is essential, research has shown that doses higher than 2000 IU can have side effects of toxicity and create other complications, including bone loss.

Also, it is important your doctor is aware of all medications you are taking or considering taking for possible negative side effects. This includes over the counter supplements like calcium and vitamin D.

Vitamin D is also absorbed through our skin from sunlight. However, as we get older our skin's ability to make vitamin D decreases. Canadians, because of our physical location on the Earth, cannot make Vitamin D through our skin from early November until early March.

Try to take advantage of the warm weather. Try to sit out in the sunlight 10-15 minutes a day and expose your arms and legs. Remember to apply sunscreen to your face but not to your arms and legs during this time. Sunscreen blocks the absorption of vitamin D.

Research suggests that if you have sensitive skin, sit out twice/week for 10-15 minutes and use a sunscreen with SPF 6-8. For this short time you will not burn or predispose yourself to skin cancer. If you have an existing skin condition, you should speak to your doctor before sitting out in the sun.


Exercise, arthritis and osteoporosis

The research literature on exercise is growing, and it is now generally accepted that there are many benefits of exercise for arthritis and osteoporosis. General benefits of exercise include improved heart and lung function, weight control, and improvement of self-esteem and self-confidence.

Before starting an exercise program, at home or at a gym, it is important to speak to a health professional trained in exercise for arthritis and osteoporosis. They can help you to design an exercise program that will be both safe and effective.

Before, during and after exercise:
  • It is important to warm-up and cool down before and after exercising. Use range of motion or heat.
  • If you are still experiencing pain more than two hours after exercise - you may have done too much.
  • Use slow, planned movements when doing ROM and strengthening exercises.
  • Practice in front of a mirror until you feel confident you are doing the exercise as demonstrated by your health professional.
Types of Exercise
  1. Range of Motion (ROM): These exercises help maintain or increase joint flexibility, reduce stiffness and pain and helps one perform daily activities. ROM should be done twice a day. If morning stiffness is present, having a warm shower helps loosen joints before exercising. Some helpful hints include:
    • each joint should go through 3-10 repetitions in the morning and evening.
    • each time the ROM should take about 10-15 minutes in total.
    • for inflammatory arthritis's if your joints are inflamed just do the ROM through one repetition to keep the joints mobile.

  2. Muscle Strengthening Exercises: These exercises should be done 2-3 times per week, 8-10 repetitions per exercise. When you are able to complete the full set of exercises, you can add weights and/or increase the number of repetitions.

    Isometric: Involves contracting a muscle without any movement of the joints. These type of exercises are great because they can be done each day, any time, any place. These types of exercises maintain muscle size and improve muscle tone, develop muscle strength that is needed to carry out weight bearing activities and develop strength for joint surgery.

    Isotonic: Involves both muscle resistance and joint movement. Because joints are involved, extra care is needed to perform these exercises correctly and note how the body responds to these exercises. This type of exercise increases endurance, improves blood flow, promotes strong bones and cartilage and maintains or improves muscle strength.

  3. Cardio/Fitness: should be done 3-4 times per week, 20-30 minutes without stopping. When just starting this type of exercise, work your way up to this level over a period of 4-6 weeks.
There are both weight-bearing and non-weight-bearing aerobic exercises. What is most important is that you find an exercise or activity that suits you. In other words, an activity you enjoy. Weight bearing exercise is better for prevention of osteoporosis, but may be more difficult if you have arthritis of the weight-bearing joints.

All exercise should include a warm-up and cool-down portion. The part of the exercise in between is increasing your heart rate and maintaining that rate for 20 minutes. If you are just starting an exercise program it takes about 5 weeks to build up your heart rate to the a good rate.

A good heart rate during aerobic exercise is between 60-70% of the heart rate maximum.

To find out what your range is:
Take 220 minus your age x .60 =
Take 220 minus your age x .70=

These two figures will give you the range of heart rate/minute during the aerobic part of your exercise program.

220 - 50 years= 170  |  170 x .60= 102
220 - 50 years= 170  |  170 x .70= 119

Therefore, the heart rate this person wants to maintain during the aerobic part of the exercise is a rate between 102 and 119.

***Whether range of motion, isometric, isotonic or aerobic exercises it is important to consult with your doctor, physiotherapist or fitness consultant to ensure that you are exercising safely.***

Types of weight-bearing aerobic exercises:
  • walking/hiking
  • cross-country ski machines and elliptical trainers
  • stair-stepping machines
  • exercise classes
  • exercise videos for use in the home
Types of non-weight-bearing aerobic exercises
  • biking
  • rowing
  • swimming
  • water aerobics: check your local recreational centre for water exercises specifically designed for people with limited mobility and/or arthritis
Remember to note how you feel during and after the exercise. If you are in pain more than two hours after, you may need to do less the next time. This allows you to gradually develop your strength and length of exercise time while maintaining joint and muscle safety.

One final and important point about exercise: One must keep up exercising as improvements are lost if exercise is not done on a regular basis.

For information on local exercise programs contact:
  • The Arthritis Society at 1 866 414 7766 (toll free) or
  • Local community centers often have exercise programs designed for people with arthritis and mobility challenges.
We are also pleased to recommend the following books on arthritis and osteoporosis.

Strong Women and Men Beat Arthritis by Miriam E. Nelson, Ph D., et al., Oxford University Press, 2002

Rheumatoid Arthritis Plan to Win by Cheryl Koehn, Taysha Palmer and John Esdaile, M.D., The Berkley Publishing Group, 2003


Fall 2005 Workshop Schedule

Every Spring and Fall, ACE offers free workshops in communities across Canada. These researched-based education workshops are conducted by leading rheumatologists (arthritis specialists) and patient advocates. The workshops are held at times which are convenient for people with commitments during the work week.

***Please note the workshop locations will be announced in future issues of JointHealth™ and on the ACE website as they become available***

Plan to Win with Rheumatoid Arthritis (RA) workshop

These workshops provide you with the critical information you need to know to take control of rheumatoid arthritis, one of the most common forms of inflammatory arthritis. Topics covered include:
  • What rheumatoid arthritis is and about its effects
  • Developing your own customized treatment plan (health care team, medications. exercises, work)
  • Healthy living strategies
  • Access to treatment and services in your community
  • Latest arthritis research news
  • "Question and Answer" session
Charlottetown, PEI
St. John's, NB
Halifax, NS
Ottawa, ON
Sudbury, ON
Victoria, BC
Thunder Bay, ON
September 13
September 14
September 15
September 19
September 20
September 27
September 28 (F)
October 13
(F) = workshops conducted in French

Plan to Win with Ankylosing Spondylitis (AS) workshop - new
New for 2005, the Plan to Win with Ankylosing Spondylitis workshops will focus on ankylosing spondylitis, a common type of inflammatory arthritis, that commonly affects the spine and other large joints in the body.

Montreal, QC
Toronto, ON
Calgary, AB
Winnipeg, MB
St. John's, NF
Hamilton, ON
September 22
September 29
October 11
October 12
October 18
October 19

JointHealth™ workshops

JointHealth™ workshops will focus on two of the most common chronic diseases in Canada - osteoarthritis and osteoporosis. These diseases affect millions of Canadians making this a very popular workshop.

Taking an integrated approach to managing these two health challenges requires a whole-body perspective. More than ever, people need to develop a strong health care team to take advantage of all the opportunities to manage their health. These workshops will help you learn about prevention strategies and focus on what you can do to live well with osteoarthritis and osteoporosis.

Halifax, NS
Coquitlam, BC
September 17
October 6

Over the past 12 months, ACE received unrestricted grants-in-aid from: Abbott Laboratories Ltd., Amgen Canada / Wyeth Pharmaceuticals, Bristol-Myers Squibb Canada, GlaxoSmithKline, Hoffman-La Roche Canada Ltd., Merck Frosst Canada, Pfizer Canada and Schering-Plough Canada, UCB Pharma Canada Inc. ACE also receives unsolicited donations from its community members (people with arthritis) across Canada.

ACE thanks these private and public organizations and individuals.