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Osteoporosis is a disease in which bones become fragile and can easily break. It has no symptoms in its early stages and is a public health threat to more than 44 million Americans. In this community lecture given live on our Berkeley Heights, NJ campus, Dr. Toscano-Zukor, explains how to identify your risk factors for osteoporosis as well as prevent and treat this disease.

Published in: Health & Medicine
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  1. 1. Osteoporosis Dr. Amy Toscano-Zukor, DO Summit Medical Group Berkeley Heights, New Jersey (908) 273.4300
  2. 2. What is bone?• It’s living, growing tissue made up of collagen, a protein that provides a soft framework, and calcium phosphate, a mineral that adds strength and hardens the framework.• The combination of collagen and calcium makes bone strong yet flexible to withstand stress.
  3. 3. Bone is constantly active!• Your bone health is maintained by a process know as “remodeling:” replacement of old bone with new bone.• Throughout your lifetime, cells called osteoclasts remove old bone (resorption), while cells called osteoblasts produce a new bone matrix (formation).• Bone loss occurs when resorption exceeds formation.• Bone formation occurs at a fast pace until your peak bone mass is attained at about age 30.
  4. 4. More facts about BMD• On average, BMD is higher in men (who reach a higher peak BMD) than in women, and higher in blacks than in whites.• Age-related bone loss occurs at about 0.5-1% per year.• With menopause, bone loss accelerate to about 1-2% loss per year; this phase last 5- 10 years.• Age-related bone loss continues for the rest of life, with bone density going down to pre- adolescent levels.
  5. 5. What is osteoporosis?• It occurs when bone resorption occurs too quickly or if replacement occurs too slowly.• It is more likely to develop if you did not reach your peak bone mass during your developing years.• It can strike at any age.• Often called “the silent disease” because bone loss occurs without symptoms (until a fracture occurs).
  6. 6. • Factsand lowFigures are Osteoporosis and bone mass estimated to affect almost 44 million US men and women over age 50.• Of the 10 million Americans estimated to have osteoporosis, eight million are women and two million are men.• It was responsible for approximately 2 million fractures in 2005.Source:NOF.org
  7. 7. Facts and Figures• Approximately one in two women and up to one in four men over age 50 will have an osteoporosis- related fracture in their remaining lifetime.• A womans risk of a hip fracture is equal to her combined risk of breast, uterine and ovarian cancer.• The rate of hip fractures is two to three times higher in women than men; however, the one year mortality following a hip fracture is nearly twice as high for men as for womenSource: NOF.org
  8. 8. Where do fractures occur?• Of the 2 million fractures that occurred in 2005:  297,000 were hip fractures  547,000 were vertebral (spine) fractures  397,000 were wrist fractures  135,000 were in the pelvis  675,000 were at other sites  The number of fractures due to osteoporosis is expected to rise to more than 3 million by 2025.
  9. 9. Consequences of fractures• Vertebral--back pain, height loss, deformity, decreased lung function, diminished quality of life, increased mortality.• Hip--increased mortality; immobility leading to bed sores, pneumonia, blood clots, urinary infections, and muscle wasting; bone deformity; nerve injury; non-healing fracture.
  10. 10. Risk Factors• Certain factors are linked to the development of disease. These are known as “risk factors.”• Many people with osteoporosis have several risk factors, while other have no identifiable risk factors.• Some risk factors can be changed while others cannot.
  11. 11. Risk factors you cannot change• Gender--women have less bone tissue and lose bone more rapidly• Age--bones become less dense and weaker as you age• Body Size--small, thin women are at greater risk (particularly those weighing less then 127 lbs).• Ethnicity--Whites and Asians are at highest risk.• Family history--people with a parent who fracture seem to have reduced bone mass and higher fracture risk.• Rheumatoid arthritis, liver disease, IBD
  12. 12. Risk factors you can change• Sex hormones--abnormal absence of menstrual periods, low estrogen (menopause), and low testosterone in men.• Anorexia• Low calcium and Vitamin D diet• Certain meds, such as glucocorticoids and anticonvulsants• Inactive lifestyle; extended bed rest• Cigarette smoking• Excessive alcohol use.
  13. 13. Prevention: Calcium• Many studies show that low calcium intake appears to be associated with low bone mass, rapid bone loss, and high fracture rates.• Recommended adult Calcium intake  Age 19-50 : 1000 mg/day  Older than 50: 1200 mg/day  Pregnant or lactating: 1000 mg/day.
  14. 14. Prevention: Calcium• Sources of calcium:  Low fat dairy (milk, yogurt, cheese, ice cream)  Green, leafy vegetables (broccoli, collard greens, bok choy, spinach)  Sardines and salmon  Tofu  Almonds  Fortified OJ  There are 300 mg of Ca in 1 C milk, 1 C yogurt, 1 C fortified OJ, and 1.5 oz. cheese
  15. 15. Prevention: Vitamin D• Vit D plays an important role in Ca absorption and in bone health.• It is made in the skin through sunlight exposure and obtained in the diet.• Vit D skin production is lower in elderly people, sunscreen users, those who avoid sunlight, housebound people, and during winter months.• Higher Vitamin D levels are associated with lower risk of breast, prostate, colon cancer, and multiple sclerosis.
  16. 16. Prevention: Vitamin D• Recommended daily allowance of Vitamin D (200 IU age 19-50; 400 IU age 51-70; 600 IU age 70+) is probably too low.• You should be getting 800-1200 IU per day, depending on your sun exposure, dietary intake, and race (darker skinned individuals require more).• Vit D containing foods: fortified milk, cereal, or OJ; eggs; sardines; salmon; tuna.• Should get 15 minutes sun exposure to arms and leg three times a week
  17. 17. Prevention: Exercise• It improves bone health, muscle strength, coordination, and balance• It should not be too strenuous as to put sudden or excessive strain on your bones.• Weight-bearing exercise is the best for your bones because it forces you to work against gravity.• Examples include walking, hiking, stair climbing, weight training, tennis, low-impact aerobics, gardening, and dancing.
  18. 18. Prevention: Limit Alcohol• Regular consumption of 2-3 oz. a day may be damaging to bones.• Those who drink excessively are at higher fracture and bone loss due to poor nutrition and increased risk of fall.
  19. 19. Prevention: Stop Smoking• Women who smoke have lower estrogen levels compared to nonsmokers; they often go through menopause sooner,• Smokers absorb less calcium from the diet.
  20. 20. Preventing Falls• Keep floors free of clutter• Wear supportive, low-heeled shoes• Keep stairwells and hallways well-lit• Don’t use area rugs• Install grab bars on bathroom walls• Keep a flashlight at your bedside• Use a rubber bath mat in the shower• Use a portable phone that can be carried from room to room• If you live alone, contract with a monitoring company that will respond to you 24 hours
  21. 21. Detection: bone density measurement (DXA)• A noninvasive and painless test• Your doctor may order it if you’re:  Females over 65 and males over 70.  Under 65, postmenopausal, and have 1 or more risk factors  Males 50-69 with risk factors.  Postmenopausal and have had a fracture  Are being monitored after starting treatment for osteoporosis
  22. 22. DXA• Normal T score >or = to -1• Osteopenia: T score between -1 to -2.5• Osteoporosis: T score < or = to -2.5• The lower the T-score, the lower your BMD, and the higher your fracture risk
  23. 23. Treatment• Calcium• Vitamin D• exercise
  24. 24. • Treatment: Estrogen Reduces bone loss, increases bone density in spine and hip, reduces risk of hip and spinal fracture in post-menopausal women• Given with progesterone to decrease risk of endometrial cancer• Relieves menopausal symptoms• Especially recommended for women who have had ovaries removed before age 50• Benefits and risks must be discussed with your doctor
  25. 25. Treatment: Raloxifene (Evista®)• Prevention and treatment• Antagonizes estrogen in breast and endometrium, but agonizes estrogen in bone.• Lowers risk of breast cancer• Increases risk of blood clots• Less effective than estrogen and bisphosphonates
  26. 26. Treatment: Calcitonin• A naturally occurring hormone available as an injection or nasal spray• A relative weak medication to prevent fracture and only modest effect on BMD
  27. 27. Bisphosphonates: Actonel®, Fosamax®, Boniva®, Reclast®, Atelvia®• Increase bone mass and decrease fracture risk• Inhibit osteoclasts (bone resorption)• Used for treatment and prevention• Boniva® and Actonel® available in once monthly• Boniva® and Reclast® available in intravenous
  28. 28. Bisphosphonates: Actonel®, Fosamax®, Boniva®, Reclast®, Atelvia®• GI side effects (nausea, heartburn, irritation of esphagus) are uncommon if properly administered• Take on empty stomach first thing in AM with 4-8 oz plain H20, while upright. No food, drink, meds for half hour (Fosamax, Actonel) to 1 hour (Boniva). Remain upright at least 30 min.• Avoid in patients with known esophageal strictures or impaired esophageal motility.
  29. 29. Parathyroid Hormone: Forteo ®• A daily under-the-skin injection available for those with high fracture risk• Unlike bisphosphonates and estrogen, it stimulates new bone formation (osteoblasts)• Approved for use up to 24 months• Not given with bisphosphonates
  30. 30. Prolia ®• Twice a year injection given under the skin in your doctor’s office• For patients with history of osteoporosis fracture, multiple fracture risk factors, or who have failed other osteoporosis treatments.
  31. 31. Summary• Bone is an active organ, constantly being formed and removed by cells.• Bone density decreases as we age• Osteoporosis occurs when bone resorption exceeds formation• There are factors that can increase your risk of developing osteoporosis (low Ca/Vit D diet, smoking, excessive alcohol, certain medications, inactivity, anorexia)• Fall prevention is KEY!!!• Diagnosis involves a painless, noninvasive test known as DXA.
  32. 32. Summary• If you have or are at risk for osteoporosis, your doctor can help you determine the best medication, change in lifestyle, or intervention for you by weighing the risks and benefits of each option.• Always check with your doctor before starting any exercise regimen.