hchoices osteoporosis - amazon s3
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Osteoporosis
§ Literally means �porous bone�§ A silent disease in which the density and
quality of the bone is reduced. § Can lead to bone weakness and increase in
fracture risk§ In the U.S., about 8 million women and 2
million men are affected
Osteoporosis
§ Affects 200 million women worldwide– 1/3 of women aged 60-70– 2/3 of women aged >80
§ About 30% of women over the age of 50 have one or more vertebral fracture
§ About 1 out of 5 men over the age of 50 will have an osteoporosis related fracture
BONE
§ Living tissue– Constantly being
• made (bone formation) • removed (bone resorption)
§ Peak bone mass mid 20�s– Lifestyle, hormones, genetics, nutrition
§ By the mid 30�s • Bone removed > bone made
Osteoporosis
§ No early warning symptoms– Loss of height– Forward curvature of the spine– Paraspinal muscle pain
Osteoporosis
§ The first presentation may be only after you break a bone
§ Most common fractures– Spine– Wrist– Hip
Osteoporosis
§ Spine• Back pain, loss of height, deformity, breathing problems
§ Hip• Unable to perform at least one independent activity of daily
living, walk independently, permanent disability
Risk Factors for Osteoporosis
§ Advanced age§ Female§ Non-Hispanic and Asian ethnic background§ Small bone structure or low body mass§ Family history of osteoporosis
– Osteoporosis-related fracture in parent or sibling
Risk Factors for Osteoporosis
§ Previous fracture <50yr§ Sex hormone deficiency§ Anorexia or malnutrition§ Cigarette smoking§ Excessive alcohol use
Risk Factors For Osteoporosis
§ Low dietary intake of calcium and vitamin D§ Sedentary lifestyle or immobility§ Medications
– Steroids (30-50% occur)– Excessive thyroid replacement– Anti-seizure medications– Heparin– Chemotherapy
Risk Factors for Osteoporosis
§ Certain Diseases– Endocrine disorders (hyperparathyroidism, hyperthyroidism,
Cushing�s Disease, hypogonadism, type I diabetes)– GI disorders - Celiac disease and other causes of malabsorption– Liver or kidney disease– Genetic Disorders – Systemic inflammatory disease (RA)– Cancers (Multiple myeloma)
Osteoporosis in Men
§ Primary Osteoporosis (50%)– Unknown cause
§ Secondary Osteoporosis (50%)– Steroid use– Low testosterone– Alcohol– High calcium– Smoking– GI disorders– Immobilization– Others…
Who should have bone mass measured?§ X-ray evidence, loss of height, history of
fracture, risk factors,§ National Osteoporosis Foundation 2003
– All women age 65 and older and all men 70 and older– Postmenopausal women under age 65 with a risk
factor– Men 50-70 with > 1 risk factor– Postmenopausal women or men >50 who present with
fractures– Postmenopausal women who have stopped hormone
replacement
How do you diagnosis Osteoporosis?
§ X-ray– May note signs of decrease bone mass
• 25-50% bone loss has already occurred§ Dual-energy x-ray absorptiometry (DEXA)
– X-ray with very low radiation exposure, precise, safe
Osteoporosis Treatment
§ Stop smoking§ Avoid excess alcohol intake§ Fall prevention§ Treat underlying medical conditions§ Limit medications that cause osteoporosis
Osteoporosis Treatment
§ Calcium– Premenopausal women require 1000mg/day– Postmenopausal women 1200mg/day– Different types
• Calcium carbonate • Calcium citrate
§ Vitamin D– <60 years 400IU/day– >60 years 800IU/day– D2 vs D3
Osteoporosis Treatment
§ Calcitonin– Hormone made by the thyroid gland that inhibits bone
breakdown– Nasal spray or subcutaneous injection
§ Estrogen or Hormone Replacement Therapy– Decreases bone breakdown – Increase risk for breast cancer, strokes, heart attacks, and
clots
Osteoporosis Treatment
§ Selective Estrogen Receptor Modulators - Raloxifene (Evista)– Mimic estrogen without the side effect of breast cancer– Decreases bone breakdown
§ Teriparatide (Forteo)– A form of parathyroid hormone– Stimulates cells to build bone– Daily injection for up to 2 years
Osteoporosis Treatment
§ Bisphosphonates (Oral and IV)– Decreases bone breakdown– Oral
• Must be taken on an empty stomach with water• Remain upright for at least one hour after taking because of
potential for irritating the espophagus• Common side effects à GI symptoms, musculoskeletal pain