What is Trabecular Bone Score (TBS)?

Trabecular Bone Score or TBS provides information about the quality of bone structure in the spine bone. This information complements bone mineral density measurement, and can be helpful to clinicians in determining fracture risk and discussing lifestyle management or treatment options with patients. It is conveniently measured during a standard bone density test. We are pleased to announce that our program, the Osteoporosis Program at University Health Network, has recently installed innovative software to measure TBS in our clinic patients. Click on the image below to learn more about TBS.


TBSBy Luba Slatkovska, PhD

Our Research – Does vitamin E help bone health?

Aging causes an increase in oxidative stress and inflammation in our bodies. Along with declining estrogen levels, these changes may lead to bone loss in postmenopausal women. The effects of estrogen on bone have been investigated in great detail, but not much is known about the effects of antioxidants and anti-inflammatory substances on bone. Since vitamin E has both antioxidant and anti-inflammatory properties, it may be beneficial to bones. In order to assess whether vitamin E can affect bone loss, our group studied the relationship between vitamin E and bone turnover markers in postmenopausal women. Bone turnover markers are chemicals in the body that can provide information about bone formation and bone resorption (bone loss) and are measured by either a blood test or urine test.  Bone turnover markers can be used in research studies to test the short term effects of diet on bone health. The bone turnover markers that we looked at were :  1) bone alkaline phosphatase (BAP) which is a bone formation marker in the blood and, 2) urinary N-telopeptides/creatinine (uNTx/Cr) which is a bone resorption maker in the urine.

In our study, we looked at relationships between blood levels of two forms of vitamin E and bone turnover markers in a sample of healthy postmenopausal women in the US who participated in a national survey in years 1999-2002. These two forms of vitamin E were alpha-tocopherol and gamma-tocopherol, and are described below in more detail:

Alpha-tocopherol: Has a high antioxidant activity and is the most common form in dietary supplements.

Unfortified food sources: sunflower seeds, almonds, hazelnuts, peanuts; sunflower, safflower and grapeseed oils; avocados; green vegetables

Gamma-tocopherol: Has a high anti-inflammatory property and is the major form of vitamin E in North American diets

Unfortified food sources: Pecans, peanuts; soybean and canola oils

We also looked at the relationship between alpha-tocopherol intake (data was not available for intake of gamma-tocopherol from food sources) from food and supplements and bone turnover markers.  It has been shown that high intakes of alpha-tocopherol from dietary supplements can lower blood levels of gamma-tocopherol. We do not know how this change can affect our health. The results of our study were published in June 2012 in the Journal of American Bone and Mineral Research.  There were no relationships between alpha-tocopherol intake from food sources and bone turnover markers. As expected, we found that women who used vitamin E supplements had high blood levels of alpha-tocopherol and low blood levels of gamma-tocopherol. These women also had lower levels of BAP (a bone formation marker). We found no relationships between blood levels of alpha-tocopherol and gamma-tocopherol and uNTx/Cr (a bone resorption marker). These results suggest that vitamin E supplements may not help bone health. More research is needed in this area to find out if vitamin E intake from food sources can improve bone health or not.

So what is the bottom line?  As long as you have a balanced diet, and do not overeat or completely eliminate one food group, you will not be causing imbalances in your blood levels of various nutrients. Also, unlike supplements, whole and unprocessed foods contain a mixture of different types of vitamin E as well as many other nutrients all of which may play a role in our health.  For example almonds are high in vitamin E but they are also high in calcium and magnesium two other important nutrients in bone health. In conclusion, we believe the best way to get nutrients, including vitamin E, is to get them from food sources.



By Maryam S. Hamidi, PhD and Hajera Khaja, M.Sc

Our director, Dr. Angela M. Cheung, has been awarded the Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health

Congratulations to our director Dr. Angela M. Cheung for being awarded the Tier 1 Canada Research Chair in Musculoskeletal and Postmenopausal Health! The Canada Research Chair program attracts and retains the world’s most accomplished and promising scientists. The focus of Dr. Cheung’s work is to improve the quality of life, health and healthcare of people with musculoskeletal conditions, especially postmenopausal women.

Dr. Cheung is a professor of medicine at the University of Toronto, a staff physician at the University Health Network and the founding director of Osteoporosis Program, Centre of Excellence in Skeletal Health Assessment and Women’s Health Program at the University Health Network and Mount Sinai Hospital.

We are all very proud to be part of her team.

UHN news release

Dr. Angela M. Cheung


Resources for healthy eating


There are many resources on the internet these days, but not all of them provide reliable, evidence-based information.  Check out some of the Reliable Resources that our Osteoporosis Program staff at the University Health Network and Mt Sinai Hospital use to help educate patients and blog readers.  Today’s Reliable Resources are for healthy eating. Click on the image below to upload the handout.

Resources_healthy eating_final

We hope you found this information helpful. If you have any other questions, feel free to comment in the box below or email us at osteoporosis@uhn.ca.

Good Moves


New Year, new beginnings and resolutions…

Are you looking to move and exercise more this year to help prevent osteoporotic fractures? We applaud you! Physical activity is important for people with osteoporosis or low bone mass. It can help improve strength and balance, and prevent falls and injuries that lead to osteoporotic fractures.

Are you hesitant to get started, because you have osteoporosis, and are worried about fracturing as you move and exercise? It is wise to be cautious. There are certain movements and exercises that are unsafe for people with osteoporosis. But don’t let this caution hinder you completely!

Are you keen to learn which movements and exercises are “bone-unsafe”, and which are “bone-healthy”? You’re in the right place. Consider our Good Moves handouts. Each Good Moves handout aims to describe one bone-unsafe move (and how it increases risk for osteoporotic fracture) or one bone-healthy exercise (and how it can improve muscle strength or balance).

Without further ado, here is our first Good Moves handout. It focuses on a common, bone-unsafe movement: spine rotation or spine twisting. Click on the image below to upload the handout.

Good moves _Spine twisting v5

Stay tuned for more Good Moves handouts in the upcoming months. Also, consider learning more about exercise and osteoporosis from these resources:

  • OsteoConnections pages that describe the link between osteoporosis and exercise
  • Osteoporosis Canada’s exercise recommendations for people with osteoporosis or low bone mass
  • Osteoporosis Canada’s tips for getting started for individuals who are not accustomed to exercise

Osteoporosis in men

It’s that time of the year when wearing a mustache is more than just a fashion statement – the Movember movement seeks to make a contribution to “men living happier, healthier, longer lives”.

Even though osteoporosis affects men less commonly than women, men are also burdened by it. To learn more about osteoporosis and maintaining healthy bones in men, click on the image below and upload a two-page handout.

_men  op infographic_final

We hope you found this information helpful. If you have any other questions, feel free to comment in the box below or email us at osteoporosis@uhn.ca.