“Fracture Risk Syndrome” - Moving beyond Osteoporosis

As Seen on Midlife Matters with Renee Morissette, MD

For many older adults, the main fear about aging is the possibility of losing independence. One of the most common and underestimated conditions threatening independence is breaking a bone. After a hip fracture, 45% of people are permanently unable to walk without a walker, and 35% of people need a nursing home. Fractures can also lead to a shortened lifespan; 25% of people die within the first year after having a hip fracture.

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Nutrition Through the Life Cycle


By Nikole Tattrie, RD

Part 1: Menopause & Beyond

Nutrition needs change through the life cycle. Numerous articles, books, blogs, and resources have been written about infant and childhood nutrition, and guidelines have been put in place to ensure children - naturally helpless and therefore vulnerable - are well-nourished. Nutrition needs for adults, however, can seem vague and confusing. Nutrition opinions and advice are free-flowing on the internet, which makes it hard to know which information applies to who and when.

Including a delicious recipe -

Veggie Stuffed Squash Bowls


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Pelvic Floor Physical Therapy   


By Bree Rutten, BScPT, BScPE

at Craven SPORT Services

Craven SPORT Services has expanded their services to include specific treatment for pelvic floor health dysfunction. Bree Rutten, BScPT, BScPE has advanced training and special interest regarding aspects of pelvic health for men and women. Her focused knowledge allows for accurate evaluation of your condition and appropriate treatment. All treatments are individually designed after thorough evaluation.

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Osteoarthritis and Exercise


By Chris Sturge, B.Sc. (Kin), CSEP-CEP


Osteoarthritis (OA) is a condition that is characterized by the degeneration of various joint structures such as cartilage, bone, ligaments, and the joint capsule. Most commonly affected are the knee, hip, and hands, but OA can occur in any joint. Symptoms vary widely from person to person. They tend to include pain and stiffness, decreased mobility, balance and strength loss, and a general decrease in confidence. While there is no singular cause of OA, there are several contributing factors, one of which is being female.

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Continued....“Fracture Risk Syndrome” - Moving beyond Osteoporosis

Many people are aware of osteoporosis, which is a condition of low bone mineral density leading to weakened bones and increased bone breaks. Because the bones are fragile, they can break with a small bump or sometimes even sneezing. One in three women will break a bone due to osteoporosis.

However, treating osteoporosis alone is not enough, because 1/6 of people with “fragility fractures” (or fractures that occur with less force than usual) have a normal bone mineral density. Bone specialists are now urging us to start assessing for “Fracture Risk Syndrome” or “Dysmobility Syndrome,” rather than just osteoporosis.

It is analogous to treating “Metabolic Syndrome” to avoid heart attack. Doctors don’t just concentrate on the heart on its own, but manage blood pressure, diabetes, obesity, cholesterol and smoking to give people the best chance of avoiding heart disease.

So, beyond bones themselves, other factors that contribute to fractures are: muscle loss (sarcopenia), diabetes, obesity and falls.

Sarcopenia is age-related, gradual loss of muscle mass and strength. It happens to men and women. Muscles pull on the bones every time they contract; this strengthens bones over time. So as muscles shrink, there is less pull on the bone and less maintenance of bone strength.

Being overweight has traditionally been thought to protect a person from osteoporosis. Though this still remains true, both obesity and diabetes negatively affect bone architecture in ways not yet fully understood. Obese people are at specific risk for ankle and upper leg fractures.

Falls are the most common cause of injury in people over 65. Risk factors for falling include: increasing age, muscle weakness, history of previous falls, problems with balance, vision problems, arthritis, lack of physical activity, Parkinson’s disease and poor bladder control.

Here are a few things that people on their own to prevent falls and broken bones:

1. Exercise regularly. Strength training with weights or resistance bands once or twice a week is particularly good for your bones. Tai Chi is excellent for improving balance and yoga is helpful for keeping your core strong.

2. Optimize your nutrition. Men and women need more protein as they age to help prevent muscle loss. Older adults may need up to 1g of protein per kg of body weight. Women over age 50 should aim for 1200 mg of Calcium and 1000 IU of Vitamin D per day. Be careful, because taking more than the recommended dose of Vitamin D can actually cause more falls.

3. Minimize caffeine, alcohol and certain medications. Too much caffeine decreases your body’s ability to absorb calcium, which helps keep your bones strong. Alcohol is associated with more falling. Medications that cause drowsiness or dizziness like narcotics and blood pressure medications, among others, can also lead to more falling.

4.Treat any visual problems. See an optometrist at least every two years continued on the back page... for routine screening. Do not walk with your bifocals on, because that can make going up steps quite tricky.

5. Wear good footwear and address any foot problems. Low heeled shoes with non-slip soles decrease the risk of falling. Consider getting traction cleats or ice grippers for your shoes, like “Yaktrax,” in the wintertime. See your doctor if you have painful feet or are losing feeling in your feet.

6. Modify your home environment. You can find a home safety checklist at www.livestronger.org.nz to decrease tripping hazards and to improve your ability to get around your home. You can also be referred by your doctor to an Occupational Therapist who can assess your home for you.

7. Get screened for osteoporosis at age 65 or sooner if you have risk factors. Osteoporosis risk factors include: smoking, having a parent with osteoporosis, being underweight, having menopause before the age of 45, using certain medications long term (like steroids, Depo-Provera, etc.) or having certain health conditions (like rheumatoid arthritis, hyperthyroidism, hyperparathyroidism, Crohn’s or celiac disease).

With a little bit of foresight, fractures are almost entirely preventable. Keeping your muscles and bones strong and avoiding falls will help you stay independent for as long as possible.

Please visit the following websites for further information:

www.livestronger.org.nz for ways to prevent fracture

www.osteoporosis.ca for a dietary calcium calculator, fracture risk assessment and more information on treating osteoporosis

https://www.saskatoonhealthregion.ca/locations_services/services/Falls-Prevention/ for local resources to help prevent falls

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Continued....Nutrition Through the Life Cycle Part 1: Menopause & Beyond

If you are an adult woman in your middle-aged years, you are most likely facing a busier schedule and more responsibility than you might have envisioned at this stage of life. Focusing on yourself at all can be difficult enough; considering your own unique nutrition needs can become even less of a priority. Here we look at key nutrients to focus on for your health in this stage of life, as well as some simple tips to keep in mind.

1. Take care of your heart. After menopause, your risk of heart disease increases. Eating a heart healthy diet includes reducing saturated and trans fat intake. These types of fat are found in red meat, high-fat dairy products, butter and lard. Instead, focus on mono- and polyunsaturated fats, including omega-3 fatty acids. Food sources of these include olive oil and other plant oils, fatty fish, flaxseed, nuts, and avocadoes. A heart healthy lifestyle also includes eating more vegetables and fruit, keeping active, and finding enjoyable activities to lower stress.

2. Get enough calcium and vitamin D. The hormonal shifts that occur during menopause cause your bone density to decrease more rapidly. This can lead to osteoporosis in women as they get older, which is why it is important to focus on calcium and vitamin D earlier on. As your mother once told you, “drink your milk!” - it is the best source of dietary calcium and an easy and affordable way to meet your needs. Don’t be afraid of milk myths and misperceptions: the Canadian milk industry is well-regulated and our milk supply is not laced with harmful hormones and chemicals as is often thought. If you do prefer not to drink milk, or have trouble tolerating it, make sure your milk substitute is fortified with calcium and vitamin D - the packaging should state if it is. Supplements may be recommended for some women if they are unable to meet their requirements through food.

3. All foods can fit. One of life’s greatest pleasures is eating, and though it may seem concerning when your body size and shape changes, enjoying mealtimes is important for your psychological and physical health. Fad diets, though marketed heavily to women, rarely produce long-term benefits. There are a variety of healthy ways to eat, and it’s important to give yourself flexibility when it comes to food choices. Special diets that limit or restrict certain foods can sometimes help treat certain conditions or diseases (for example, eating vegan to manage high cholesterol). However, like other treatments, they can have side effects like not supplying enough calories or nutrients. If you are given a new diagnosis and you think restricting certain foods or food groups may help, consider seeking guidance from a health professional who specializes in that area so they can make sure your nutrition needs are met.

New life stages and transitions can lead to great opportunities to improve your diet and your health. Take time to ponder what you want the next phase of your life to look like and how you make small changes now in order to achieve or maintain your best health in the coming years.

Lastly, be aware that the natural health product industry in Canada is loosely regulated, and testing various probiotic supplements has revealed that products may not contain the number of live bacteria they claim to. It is important to determine which brands are reputable in terms of the production, processing, and storage of probiotic supplements before you invest your money and health into them.

The following recipe uses fresh, local, seasonal ingredients that you can grow yourself or pick up at the local Farmers Market. Consider making this meal with a partner or a friend to fully appreciate the mealtime experience.

Veggie Stuffed Squash Bowls

From http://www.canadianliving.com/food/lunch-and-dinner/recipe/veggie-stuffed-squash-bowls

Prep time: 25 minutes

Total time: 1 hour & 15 minutes

3 butternut squashes (about 1.6 kg total)
2 tbsp olive oil, divided
1 large zucchini, cut in ½ inch chunks
1 sweet yellow pepper, cut in ½ inch chunks
½ large red onion, cut in ½ inch chunks
1 cup cherry tomatoes
1 tbsp chopped thyme
½ cup Fresh Thyme Vinaigrette (recipe below)
1 cup shredded mozzarella cheese
1 cup chopped walnuts
1 140g pkg goat cheese, crumbled
8 cups spring mix

Position racks in top and bottom thirds of oven; preheat to 400°F. Line 2 baking sheets with parchment paper. Halve squash lengthwise and remove seeds. Brush cut sides of squash with 1 tbsp of the oil; arrange on prepared pans, cut sides down. Roast squash, turning once and switching and rotating pans halfway through, until fork-tender, 40 to 50 minutes. Remove from oven; let stand until cool enough to handle, about 5 minutes. Scoop flesh from 4 of the squash halves, leaving 3/4-inch border. Set flesh aside. Scoop flesh from remaining halves into large bowl; add reserved flesh and mash until smooth. Refrigerate in airtight container for up to 3 days.

While squash are roasting, in large non-stick skillet, heat remaining oil over medium-high heat; cook zucchini, yellow pepper and red onion until softened, about 4 minutes. Add tomatoes and thyme; cook until tomatoes begin to soften, about 1 minute. Remove from heat; let cool slightly. Toss together zucchini mixture, 1/4 cup of the Fresh Thyme Vinaigrette, the mozzarella and walnuts.

Mound mixture into 4 hollowed-out squash halves, slightly packing. Sprinkle with goat cheese. On the same pans, bake until warmed through and cheese is beginning to brown, 10 to 15 minutes. Halve crosswise; serve with spring mix tossed with remaining Fresh Thyme Vinaigrette.

Makes 6 to 8 servings.

Fresh Thyme Vinaigrette

In a small bowl, whisk together:
⅓ cup olive oil
3 tbsp lemon juice
1 tbsp chopped thyme
2 tsp Dijon mustard
2 tsp liquid honey
¼ tsp each salt & pepper

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Continued....Pelvic Floor Physical Therapy at Craven SPORT Services

Pelvic Pain Pelvic floor tension or pain can occur in the sling of muscles that support the bladder, uterus, rectum and abdominal wall. This discomfort can be caused by muscle, nerve, joint or hormonal issues.

Urinary incontinence is the involuntary leakage of urine. Bowel incontinence involves leakage of stool or gas from the rectum. Intervention involves education on lifestyle factors that contribute to this concern, including diet, activity levels and hormonal factors.

Chronic Low Back / Hip / Pelvic Girdle Pain
Pain that persists over time can be related to a weakness or tightness in the deep pelvic region. Both men and women can experience pain in the pelvic region, or in the abdominal wall. Diastasis recti, a separation of the abdominal wall and hernias or general weak core strength can cause strain or instability in the pelvis and back areas.

Pelvic Organ Prolapse/Hernia
When one of the pelvic organs, which include the bladder, uterus and rectum, drop into the vaginal opening, a pelvic prolapse results. This can be due to pelvic floor muscle weakness or to damage to the supportive tissues in the pelvic region. A weakness in abdominal wall strength and integrity can also contribute to an abdominal hernia in men and women.

Pregnancy and Post-Partum Care
Ensuring that the pelvic floor and core strength is maintained through pregnancy is essential in a healthy pregnancy and once baby arrives. An assessment in pregnancy is helpful in teaching proper pelvic floor and core contraction as the body continues to change in hormone status and in size. In Post-partum, the abdominal wall for a diastasis recti can be checked and pelvic floor health can be reassessed.


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Continued...Osteoarthritis and Exercise

Females are more susceptible to developing osteoarthritis for primarily hormonal and biomechanical reasons. There is increasing evidence showing that estrogen plays an important role in the maintenance of joint health; therefore, early and post-menopausal women are particularly vulnerable to the degenerative changes of OA due to estrogen deficiency.

Additionally, females tend to have a wider pelvis and therefore a greater angle from their hips to their knees. In biomechanical terms, this is known as a Q angle. This Q angle creates the potential for rougher interaction between the bones of the knee and over time, these forces contribute to cartilage degradation. This reinforces the importance of learning optimal movement patterns to minimize inappropriate forces at the joint level!

Osteoarthritis has been described as a “wear and tear” condition in the past, but recent research has shifted this characterization to “joint failure”. This is a critical distinction! The concept of wear-and-tear logically leads to ceasing activity in order to lessen the offending forces on the joint. However, multiple studies have shown that exercise is the single most effective treatment for OA.

In fact, the way cartilage receives nutrients is through repeated loading and unloading, not the circulatory system. Loadbearing activity creates a sponge-like effect in the cartilage, allowing fluids to be squeezed out and pulled back in. This means that ceasing activity altogether deprives cartilage of its nutrient system. This is true of both healthy joints and in the presence of OA.

The main challenges with maintaining cartilage health are knowing how much loading is appropriate, as well as managing pain levels. Unfortunately, pain is a very common companion to osteoarthritis and creates an understandable amount of uncertainty about exercise. Ensuring that the type and amount of exercise is just enough to receive the benefits without overshooting and causing more harm than good is crucial. This is best learned with the guidance of a qualified healthcare professional.

Craven SPORT Services is pleased to offer multiple osteoarthritis exercise intervention programs, both in group and individual format. For more info, please visit our website at www.cravensportservices.ca or call 306-934-2011.


1. S, Largo R, Herrero-Beaumont G. Osteoarthritis associated with estrogen deficiency. Arthritis Research & Therapy. 2009;11(5):241. doi:10.1186/ar2791.

2. Kim Y-M, Joo Y-B. Patellofemoral Osteoarthritis. Knee Surgery & Related Research. 2012;24(4):193-200. doi:10 .5792/ksrr.2012.24.4.193.

3. Roos, Ewa M, Skou, ST. GoodLife with osteoArthritis in Denmark Canada Training Manual. 2016.


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News, Event and Special Messages

Mid-Life Matters Series
Watch for Dr. Renee Morissette on CTV News at Noon with Jeff Rogstad. A series of short segments, Midlife Matters, on women’s health topics will be
presented on some Tuesdays during the noon show. Each topic will have a handout which will be on our website www.menopausecentre.org.

Craven SPORT Services Programs 2018
For program descriptions, please see www.cravensportservices.ca or call us at 306-934-2011

Body Tune Up: ($200) @ CSS Join anytime. By appointment only

Fit 4 Life: (12 weeks - $360+GST) @ CSS Start Date: June 28
Mondays & Thursdays 6 pm - 7 pm
Mondays & Thursdays 7 pm - 8 pm

Strong (HER) Phase 1: (6 weeks - $180+GST) @ CSS Start Date: June 4
Tuesdays 7 pm - 8 pm
Saturdays 11:30 am -12:30 pm

Strong (HER) Phase 2: (6 weeks - $180+GST) @ GYTC Start Date: June 4
Mondays 7 pm - 8 pm
Thursday 7 pm - 8 pm

Strong (HIM): (6 weeks - $180+GST) @ GYTC Start Date: June 2
Tuesdays 7:30 pm - 8:30 pm
Saturdays 10:00 am - 11:00 am

Osteoarthritis Program: (8 weeks - $320+GST) @CSS Start Date: June 4
Mondays 5 pm - 6 pm
Wednesday 6 pm - 7 pm
*INCLUDES: 2 education sessions*

Fit For OA: (8 weeks - $240+GST = $252) @CSS Start Date: June 4
Mondays 5pm - 6 pm
Wednesdays 6 pm - 7 pm

May 7, Monday 6 pm - 7 pm
June 11, Monday 6 pm - 7 pm
May 9, Wednesday 7 pm - 8 pm
June 13, Wednesday 7 pm - 8 pm

Supervised Training: (10 sessions - $100+GST) @CSS
Tuesdays & Thursdays 7 am - 8 am
Mondays, Wednesdays & Fridays 12 pm - 1 pm
Tuesdays & Thursdays 5pm - 6 pm

Donate your Hygiene Supplies
by Darla Cheetham 306-655-4494

The Street Health Team of Population and Public Health works with some of the most marginalized individuals in Saskatoon. Many of our clients go without even the basics. Each year the Street Health Team hands out supplies in hopes of meeting some of their basic needs. Donations of basic personal hygiene items are needed (tampons, pads, shampoo, conditioner, toothbrush, toothpaste, deodorant).

If you have unused single unit items of tampons and pads that you no longer need, they can be donated to the Street Health Program by contacting the Disease Control Supervisor of Population and Public Health at 306-655-4494 or drop supplies off at 100 - 310 Idylwyld Drive North - Attention: Street Health Program. All donations are greatly appreciated!

Hidden Attic Communications

Hidden Attic Communications was founded in 2000 to create multi-media graphic design solutions for small to medium sized businesses and organizations. Hidden Attic started working with Women’s Mid-Life Health soon after their beginning. Their vision and passion for the program has made working with them a great pleasure and over the years has inspired many creative solutions for their communications. Together we have worked on websites, brochures, and banners as well as with fond memory for me, power point presentations and programs for the Art and Adventure Gala events. Hidden Attic would like to wish WMLH Program all the best as they continue to help countless people within the community and I look forward to many more years of partnership together.

For more information about Hidden Attic Communications, please contact me or visit the website.

Lynda Derksen

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