Anna DiMarco Physio

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Winnipeg, MB
Anna DiMarco Physio

Anna focuses on physiotherapy and the Art and Science of Living Well.

She is particularly interested in the human response to nature, the arts and beauty, and how these topics all meet at the intersection of whole person wellness ... mind, body and soul.

$Osteoporosis in MenMOST SURPRISING FACTS:One in five men over the age of 50 will experience an osteoporotic fracture in ...$

11/17/2025

Osteoporosis in Men

MOST SURPRISING FACTS:

One in five men over the age of 50 will experience an osteoporotic fracture in their lifetime.

Unfortunately, osteoporosis in men tends to go unscreened, undiagnosed and untreated in all parts of the world.

While the rate of fragility fractures in women rise sharply after age 60, men will see an increase after age 70.

Men with osteoporosis who sustain a hip fracture have a higher rate of mortality and increased morbidity than women who suffer the same fate.

Using a female referenced database to diagnose osteoporosis offers some global consistency and convenience, but may put men at higher risk of going undiagnosed entirely or delay a diagnosis.

CLINICAL SIGNIFICANCE:
Remember to always treat low-energy fractures as potential fragility fractures. Take a thorough medical and lifestyle history, conduct a fracture risk assessment (FRAX or CAROC) to ensure patients are appropriately educated about their risk for future fractures. Advise patients to seek a consultation with their primary medical care provider.

See slides for further info.

11/14/2025

RISK FACTORS FOR OSTEOPOROSIS

Appearances can be deceiving…..

Our bone density tends to peak around 30 ish years old and then naturally starts to decline with age with a rapid decline at menopause for women. Women can lose up to 20% of their bone mass in the 5-7 years post menopause.

Men generally do not have a drastic decline related to aging, but may experience one due to hormonal changes (androgen deprivation therapy for prostate cancer for example) or an accelerated rate of loss due to medical conditions which may affect nutrient absorption (Chron’s , Celiac’s Disease for example).

Essentially, the greater bone density you have at your “peak” and the rate at which you lose bone density are the essential factors that determine whether or not one will develop osteporosis.

There are many modifiable and non-modifiable risk factors that will determine the rate at which you will lose bone density.

I truly believed that with my lifelong love of high impact cardio and strength training activity. I could “out muscle” and “out run ” my known risk factors. I delayed a post menopause DEXA until I fractured my wrist at 57 years old and considered the possibility that in fact, I likely did have osteoporosis or at least osteopenia.

This is your reminder that if you have known risk factors (see the slides in this post) you do qualify for a DEXA scan before you reach the age of 65. Please speak to your primary care provider for a referral. If you choose to bypass the wait for a publicly funded DEXA, most cities have privately run machines and the cost will range between a nice lunch or a dinner out ($100-$300).

**Your repeat DEXAS should be done on the same machine for greater reliability and accuracy.

📸selfie taken on a beautiful day, post outdoor workout, post wrist fracture and pre osteoporosis diagnosis in 2022. I was reminding myself that I am strong, I am brave and a potential osteoporosis diagnosis was not going to scare me out of a root riddled forest trail or off my mountain bike.

11/11/2025

Remembrance Day

“All gave some. Some gave us. Remember them.”

$Over 80 % of all fractures in people over 50 are caused by low mineral bone density .The risk of having a major fracture...$

11/10/2025

Over 80 % of all fractures in people over 50 are caused by low mineral bone density .

The risk of having a major fracture from osteoporosis in Canada is among the highest in the world .

Fragility fractures occur most often in the hip, spine, wrist, shoulder and pelvis .

One in three women and one in five men will suffer a broken bone related to osteoporosis or osteopoenia ( low bone density but not yet at the level of osteoporosis).

Despite all the knowledge and guidelines in place regarding diagnosing , managing and preventing osteoporosis, there remain large gaps in care .

For example, uptake on testing for low BMD after a fragility fracture is only about 20 %.

And many people are unaware of their own level of risk or are not well informed about reducing their risk of developing osteoporosis .

Know your risk ...take the quiz from Osteoporosis Canada (link in stories ) and advocate for yourself if necessary with your primary care provider .

📸 taken by my husband in 2021 ...first aide management of my wrist fracture on the afternoon I tripped over a root while running after my grand doggie in the forest . I was a fit, lifelong "mover" at 57 and while my mechanism of injury didn't feel like a "fragility" type of fracture (high velocity , mega impact), it was in fact one.

11/07/2025

Today we are shedding some light on the bone density benefits of walking….what have we learned over the years ?

While walking may be a reasonable exercise approach to help maintain or improve bone density in the hip region, it is not going to have an impact on the spine, which is equally vulnerable to fractures related to osteoporosis.

And even its impact on the hip area is dependent upon many factors, including walking speed and duration, genetic predisposition to bone loss, use of adjunctive pharmaceutical therapies or hormone replacement therapy.

Swipe through the slides for a quick summary and stay tuned for more osteoporosis content during National Osteoporosis Month in Canada.

11/04/2025

We often say that osteoporosis is “silent” because it progresses undetected with no obvious symptoms (subjective experience of patient/client) until a fracture occurs.

However, there are often subtle signs (objective evidence) that may hint at a loss of bone density.

Loss of height
While a loss of height can occur with normal aging due to loss of muscle mass, decreased height of intervertebral discs, and poor posture, we should consider the possibility of osteoporosis as the cause if the loss is equal to or greater than 2cm (3/4”). This increased loss of height is related to compression fractures in the spine, which may be painless or misdiagnosed .

Developing a Thoracic Kyphosis
Not all rounding of the upper back is caused by osteoporosis, but it is the most common cause in adults. In the case of osteoporosis, the excessive curvature occurs due to the fracture or collapse of the weakened vertebrae.

Sudden or Chronic Back Pain
Many times, the pain associated with a spinal compression fracture gets misdiagnosed as general back pain, muscle strain, or normal age-related degenerative changes. The literature suggests that 66% of all spinal fractures remain undiagnosed.

Receding Gums
Low bone density in the jaw can lead the gums to recede and the teeth to become looser. The link between periodontitis and osteoporosis was first made in 1960 and “increasing evidence strongly supports a correlation between systemic and alveolar bone loss, while moderately suggesting a correlation between systemic bone mineral density and periodontal attachment loss”. (Yu, B and Wang, C., Osteoporosis and periodontal diseases- an update on their association and mechanical links, Periodontal 2000)

Decreased Grip Strength
In research studies, low grip strength correlated with low Bone Mineral Density and was a strong indicator for osteoporosis in post menopausal women (Yi-zhong Li et al, Orthopaedic Surgery, 2018 February).

Brittle nails
Weak brittle nails or ridges on your nails may be an indication of nutritional deficiencies or hormonal changes that may also affect bone health.

11/03/2025

November is Osteoporosis month in Canada, a time to raise awareness about this very common bone disease and to dispel some myths, offer some new insights and generate some hope for those living with this disease.

This video was taken, paparazzi style, by my husband who loves to surreptitiously take photos or videos of me while I am working out or hanging out to praise me for my strength gains and offer encouragement.

He understands the fears and frustrations I am experiencing with my diagnosis of osteoporosis. And he understands the level of dedication and commitment I have to doing all that I can to ensure I don’t suffer fragility fractures due to this unexpected diagnosis.

This video was particularly uplifting because he managed to sneak up on me the day after a particularly distressing doctor’s appointment….my last Prolia injection.

I had reluctantly agreed to use Prolia approximately 3 years ago when oral bisphosphonates were causing GI distress (ulcer ?). It is an expensive ($450) injectable drug that is administered biannually. My family doc has injected it for me for over 3 years.

When I showed up at my doc’s office with my Prolia package in hand, my doc shockingly declared “You know this drug doesn’t work, right? Who prescribed it for you?”

Despite being stunned by her poor memory and shocking assessment of its efficacy,I was able to quite calmly respond “ You did.” And then I went on to explain that perhaps pharmaceuticals “fail” with osteoporosis diagnosis because patients aren’t being well informed about all they need to do (beyond medication) to manage their osteoporosis…..sleep, nutrition, strength training, mindful movement, fall prevention strategies, etc.

Certainly, as a physiotherapist, this has been my experience with patients who are seeking care for their osteoporosis…..not well informed about the lifestyle end of osteoporosis management .

And the lifestyle end of it is where the true “magic” happens and where the ultimate goal of “reducing fracture risk’ actually lies.

Stay tuned for some osteoporosis content over the next month as we shed some light on myths and offer up some hope with this scary diagnosis.

10/29/2025

I responded with “I love you right back, truly “.

Context is key. But not essential perhaps ?

In this case, my patient is well known to me over many years of intermittent care. She has just returned to the city after living abroad and is struggling in all the ways.

She found a safe landing place with me and thus, her heartfelt gratitude and sincere proclamation at the end of our session.

I do aim to foster a genuine connection with all my patients as I do believe it is essential to a therapeutic alliance.

And most often, genuine feelings of compassionate love and appreciation for the being that has shared their journey with me does develop.

10/20/2025

Yup, the cougars are still stalking the hikers in the Whistler Blackcomb area.

Two cougars (the same two siblings who have been around since June) were last seen near homes in the Blackcomb area, with one of the cougar blocking a human’s path in front and the second cougar blocking from behind . 😱

We did not know about this recent sighting when we embarked n our ASCENT hike yesterday up Blackcomb mountain. .

Conservation officers have been unsuccessful in trapping the cougars despite repeated attempts.

We were thrilled to have done this hike as we missed all opportunities over the summer due to the cougar activity, and honestly, had we known about the most recent sighting, we would have changed our plans.

Grateful to have had the chance to do this gorgeous gruelling hike with my hubby during shoulder season…..too cold for road biking and not enough snow for downhill skiing yet…..the season I am most likely to have him hike with me !

10/19/2025

Just. Do. It.

I didn't feel like "doing a run" yesterday.

I was admittedly mentally and spiritually exhausted but I was physically well rested with a good night's sleep and a travel/ rest day the day before .

So I forced myself to get to the local gym in Whistler (way too rainy for this Toban to do an outdoor run) .

And I hit a new sprint pace level and unlocked a higher heart rate response !

The lesson that repeats itself to me like a broken record all these years is to Just. Do. It.

Just get started and see what happens . If you can drag yourself out for ten minutes , you might be surprised how quickly that turns into 30 or 60 minutes .

And even if it doesn't , what have you lost ? A few minutes of time ?

10/12/2025

Gratitude

As we gather to celebrate Thanksgiving, may we recognize the power of Gratitude in our daily lives.

Research has long demonstrated that Gratitude provides significant mental, physical and social benefits. More recently, Gratitude has also been linked to longevity.

The neurochemical and physiological responses that occur with expressing Gratitude include enhanced serotonin and dopamine production and release (let those “happy hormones” fly !) reduced cortisol production (“stress hormone”) and an activated parasympathetic nervous system (“rest and digest” response ).

This all leads to such benefits as :
Improved immune function
Improved sleep quality
Decreased stress
Improved social and emotional wellbeing
Reduced risk of depression
Improved cardiovascular health

More recently, a 2024 study (Chen et al, JAMA Pshychiatry, Vol 81, No. 10) revealed that Gratitude may play a role in extending our lives. Data collected from over 40K women in the US revealed that those who had Gratitude scores in the highest third at the beginning of the 4 year study had a 9 % reduced risk of dying during the study period than those who scored at the bottom third. Researchers did control other variables that may impact longevity such as economic status, mental wellbeing and physical factors.

📸 see slides for some tidbits to help you foster a daily practice of gratitude

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Winnipeg, MB
R3P0N5

Website

http://www.tuxedophysiotherapy.com/

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Tuxedo Physiotherapy

Tuxedo Physiotherapy (formerly Anna DiMarco Physical Therapy) has been providing quality care since 2003. We are a physiotherapist-owned and managed rehabilitation clinic located in the heart of Tuxedo. We offer orthopaedic/musculoskeletal physiotherapy, acupuncture treatment for pain, occupational therapy and massage therapy.

We will conduct a thorough assessment of your particular situation and provide you with a customized treatment plan to address your personal needs. We are dedicated professionals with a firm commitment towards listening with empathy, acting with integrity and providing quality care. We will provide effective, evidence-based services in a comfortable environment and empower you with the knowledge to live well and stay strong.