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Osteoporosis Prevention And Management


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Osteoporosis overview: etiology, diagnosis, prevention and treatment

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Osteoporosis Prevention And Management

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