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Osteoporosis Prevention And Management
 

Osteoporosis Prevention And Management

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Osteoporosis overview: etiology, diagnosis, prevention and treatment

Osteoporosis overview: etiology, diagnosis, prevention and treatment

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    Osteoporosis Prevention And Management Osteoporosis Prevention And Management Presentation Transcript

    • Osteoporosis Prevention and Management Margarita Correa MD FAAPMR Physical Medicine and Rehabilitation Pain Medicine Physical Medicine Institute
    • Osteoporosis
      • Osteoporosis is a systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with a consequent increase
      • in bone fragility
    • Incidence
      • Osteoporosis is three times ( 3 X ) more common in women than in men, partly because women have a lower peak bone mass and partly because of the hormonal changes that occur at the menopause
    • Incidence
      • In addition, women live longer than men and therefore have greater reductions in bone mass
      • In osteoporosis, the morbidity of the disease arises from the associated fractures
      • The pathogenesis of fractures depends on many factors other than osteoporosis
    • Causes of Osteoporosis
      • Low calcium diet
      • Lack of physical activity
      • Family History : If someone in your family has or had osteoporosis, you're more at risk
      • Gender : Women are simply more likely to develop osteoporosis
      • Ethnicity : White and Asian people are more likely to be affected by osteoporosis
    • Causes of Osteoporosis
      • Glucocorticoid medications (ex cortisone, prednisone)
      • Hypogonadism (low testosterone levels)
      • Excessive alcohol consumption
      • Smoking
      • Chronic obstructive pulmonary disease (COPD) and asthma
      • Gastrointestinal disease – malabsorption, prolonged use of PPI’s
      • Hypercalciuria (loss of calcium by urine)
      • Anticonvulsant medications (ex. Dilantin)
      • Thyrotoxicosis (hyperthyroidism)
      • Hyperparathyroidism (increased parathyroid hormone levels)
      • Neoplastic disease – cancer (ex. multiple myeloma)
      • Ankylosing spondylitis
      • Rheumatoid arthritis
    • Osteoporosis Fracture
      • The most serious osteoporotic fracture is that of the hip
      • Hip fractures typically result from falls, but some occur spontaneously
      • Women are more often affected than men and the incidence rates rise exponentially with age
    • Osteoporosis
      • Until recently, osteoporosis was an under-recognized disease and considered an inevitable consequence of ageing
      • However, perceptions have changed, as epidemiological studies have highlighted the high burden of the disease and its costs to society and health care systems
    • Diagnosis – Bone Mineral Density
      • The cornerstone of diagnosis is the measurement of bone mineral density
      • Diagnostic thresholds offered by the WHO have been widely accepted:
      • Osteopenia = <2.5 SD T score
      • Osteoporosis = ≥2.5 SD T score
    • Osteoporosis Diagnosis: DEXA
    • Osteoporosis Diagnosis: CT scan
      • A special type of spine CT that can show loss of bone mineral density, quantitative computed tomography (QCT) may be used in rare cases
    • Osteoporosis Diagnosis: x-rays
      • In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones
      • However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis
    • Treatment
      • The goals of osteoporosis treatment are to:
      • Control pain from the disease
      • Slow down or stop bone loss
      • Prevent bone fractures with medicines that strengthen bone
      • Minimize the risk of falls that might cause fractures
    • Treatment
      • STOP UNHEALTHY HABITS
      • Limit alcohol intake
      • Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone
      • Quit smoking, if you smoke
    • Treatment
      • PREVENT FALLS
      • Avoid sedating medications
      • Remove household hazards to reduce the risk of fractures
      • Make sure your vision is good
      • Other ways to prevent falling include:
      • Avoiding walking alone on icy days
      • Using bars in the bathtub, when needed
      • Wearing well-fitting shoes
      Prevent Falls
    • Treatment
      • DIET
      • Get at least 1,200 milligrams per day of calcium, and 800 - 1,000 international units of vitamin D3
      • Vitamin D helps your body absorb calcium
    • Treatment
      • High-calcium foods include:
      • Cheese
      • Ice cream
      • Leafy green vegetables, such as spinach and collard greens
      • Low-fat milk
      • Salmon
      • Sardines (with the bones)
      • Tofu
      • Yogurt
    • Treatment
      • High-vitamin D foods:
      • Fish oil, cod liver : Vitamin D 2217 IU
      • Fish herring, Atlantic raw : Vit D 2061 IU  
      • Fish catfish, wild raw : Vit D 1053 IU  
      • Mollusks, oysters raw : Vit D 941 IU 
      • Fish salmon sockeye : Vit D 920 IU 
      • Fish salmon pink : Vit D 898 IU  
    • Treatment
      • EXERCISES
      • Regular exercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include:
      • Weight-bearing exercises -- walking, jogging, playing tennis, dancing
      • Resistance exercises -- free weights, weight machines, stretch bands
    • Treatment
      • EXERCISES
      • Balance exercises -- tai chi, yoga
      • Riding a stationary bicycle
      • Using rowing machines
    • Treatment
      • EXERCISES
      • Postural retraining
      • Improve core muscle strength, extensor muscles (back)
      • Spinomed support
    • Treatment
      • Medications are used to strengthen bones when:
      • Osteoporosis has been diagnosed by a bone density study (DEXA)
      • Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred
    • Treatment
      • BISPHOSPHONATES
      • Bisphosphonates are the primary drugs used to both prevent and treat osteoporosis in postmenopausal women
      • Bisphosphonates taken by mouth include Alendronate ( Fosamax ), Ibandronate (Boniva), and Risedronate ( Actonel )
      • Most are taken by mouth, usually once a week or once a month
    • Treatment
      • A novel approach for the treatment of osteoporosis has just been approved by the FDA: Reclast ( Zoledronic acid)
      • This IV medication is a once a year, 15 minute infusion, which will allow the easiest available intake of an osteoporosis medication, with excellent efficacy, and a good safety profile 
      • Serum creatinine (renal function) should be measured before each Reclast dose
    • Treatment
      • CALCITONIN
      • Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection . The main side effects are nasal irritation from the spray form and nausea from the injectable form.
      • Calcitonin appears to be less effective than bisphosphonates
    • Treatment
      • HORMONE REPLACEMENT THERAPY
      • Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis
      • Many experts recommend that long-term estrogen replacement therapy only be considered for women with a significant risk for osteoporosis that outweighs the risks of taking HRT
    • Treatment
      • PARATHYROID HORMONE
      • Teriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures
      • The medicine is given through daily shots underneath the skin. You can give yourself the shots at home
    • Treatment
      • RALOXIFENE
      • Raloxifene ( Evista ) is used for the prevention and treatment of osteoporosis.
      • Raloxifene is similar to the breast cancer drug tamoxifen
      • Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip
    • Treatment
      • RALOXIFENE
      • It may have protective effects against heart disease and breast cancer, though more studies are needed
      • The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus)
    • Monitoring
      • Your response to treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years
      • Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears
    • Related Procedures
      • A procedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis.
      • It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column.
      • The procedure involves injecting a fast-hardening glue (bone cement) into the areas that are fractured or weak.
    • Related Procedures
      • Kyphoplasty , is a similar procedure, the bone is drilled and a balloon, called a bone tamp, is inserted on each side.
      • These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed.
      • The balloon SIMPLY CREATES A CAVITY FOR THE CEMENT AND ALSO HELPS EXPAND THE COMPRESSED BONE
    • Osteoporosis