Preventing and Managing

Osteoporosis

Jessica Ewen, MS

Exercise Physiologist

Alaska Regional Hospital

What Is Osteoporosis?

• Osteoporosis is a disease of the bones that occurs when:

• You lose too much bone

• Make too little bone

• Both

• Causes bones to become weak leading to potential fractures

• Most common fractures occur in the hip, wrist or spine.

Osteoporosis means “porous bone”

Osteoporosis Continued…

How Common is Osteoporosis?

• About 54 million Americans have osteoporosis and low bone mass.

– Low bone mass

• Greater risk to develop osteoporosis in the future.

• After age 50, percentage of men and women estimated to break a bone due to osteoporosis

– 1:2 women

– 1:4 men

• Bone is living tissue. – When we are young, body has ability to break

down old bone and rebuild new bone.

• About age 30, bone mass stops increasing. – Goal - Maintain bone mass

• Women - rate of bone loss increases for several years after menopause then slows down.

• Men – bone loss slow progression

• Age 65-75 most men and women lose bone at same rate.

How does bone loss occur?

Vertebral Compression Fracture

• Occur in nearly 700,000 patients each year

• Vertebrae weaken from osteoporosis progression

• Too much pressure is placed on weakened vertebrae and cracks

• Do not feel bones getting weaker

• Bone loss occurs without symptoms

Silent Disease – Without Symptoms

First Sings of Osteoporosis: Potentially Resulting in:

-breaking a bone -trip to hospital

-getting shorter -surgery

-upper back curving forward -long-term disabling condition

How costly is Osteoporosis?

• Combination of all osteoporotic fractures cost the U.S. health care system about $19 billion/year.

– 2 million fractures

• Expected to increase to $25 billion/year in 2025.

– 3 million fractures

• Diagnosed by clinical screening or having osteoporotic fracture.

• Emphasis on early prevention, detection and treatment.

Non-Modifiable Risk Factors Modifiable Risk Factors

Gender Poor Diet

Age Physical Inactivity

Ethnicity Smoking

Family History Medications

History of Previous Fracture Low Body Weight

Risk Factors

Diagnosis

Who should get tested?

• Women age 65 +

• Men age 70+

• Women 60 + at increase risk for osteoporosis-related fracture

• Physician deems it necessary

• Medicare usually covers cost of bone density test and follow-up test every 2 years for females and for males with risk factors for osteoporosis

Bone Density Tests

• Measures how strong (dense) your bones are

• Compare your bones to bones of healthy adult

– Determine if you have • Healthy bones

• Osteopenia

• Osteoporosis

• Helps physicians determine risk for future fractures

• Most important diagnostic test to predict fracture risk

• Physical Examination – Determine height loss / spine curvature

• X – RAYS – Can show breaks in spine

• Bone Scan/CT Scan/MRI – Follow up to abnormal x-ray

• Laboratory Tests (Blood and urine) – Blood-Calcium Levels – 24-hour urine calcium measurement – Thyroid function tests – Parathyroid hormone levels – Testosterone levels in men – Vitamin D – Biochemical markers

Other Diagnostic tools

• No cure for osteoporosis, but it can be PREVENTED and TREATED.

Goal of Treatment – To prevent Fractures (maintain bone health)

• Medication

• Nutrition

• Exercise

• Fall prevention

Prevention/Treatment/Management

• Several medications are approved by the Food and Drug Administration for osteoporosis

• Talk to your doctor about which medication is right for you

TYPES OF MEDICATIONS

– Bisphosphonates

– Estrogen

– Raloxifene

Other Medications

• Calcitonin

• Teriparatide

• Denosumab

Medication (Treatment)

Alendronate, risedronate, ibandronate, zoledronic acid

What they do –

• Slow bone loss, reduce fracture risk, sometimes increase bone density.

• Decrease the activity of bone dissolving cells

Bisphosphonates

Side Effects –

• Nausea, heartburn, stomach pain

• Muscle, bone, joint pain

• Flu-like symptoms

• Rare cases –

– Deterioration of jawbone or unusual type of broken bone in femur

• FDA recommends periodic reevaluation

• Approved for treatment of menopausal symptoms and osteoporosis in women after menopause

• Should only be considered for women at significant risk for osteoporosis

• Nonestrogen medication should be considered first

Estrogen

Side effects – • Breast cancer, stroke, blood

clots, heart attack • FDA recommends taking

lowest effective dose for shortest periods possible

• Approved in postmenopausal women

• Selective estrogen receptor modulator (SERMs)

– Nonhormonal drug with estrogen-like effects on skeleton

– Blocks estrogen effects on breast and uterus

• Slows bone loss and reduces the risk of fractures in spine

– No effect on hip fracture has been seen

Side effects –

– hot flashes and increased risk of blood clots in some women

Raloxifene

• Calcitonin – approved for treatment for osteoporosis in women who are at least 5 years post menopause

– Hormone produced by thyroid gland

– Slows bone loss and reduces the risk of spine fractures

– No serious side effects

• Teriparatide – stimulates new bone formation.

– Daily injection up to 24 months

– Increases bone tissue and bone strength

– Reduce risk of spine and other fractures

– Approved for use in post menopausal women and men who are at high risk of fracture

– Side effects – leg crams/dizziness

Other Medications

• Denosumab –

– Available as an injection every six months for men and postmenopausal women

– Side effects – low calcium blood levels; infections; skin and jawbone problems; and pain in the muscles, back, arms, and legs

Other Medications Continued…

• Consume a diet that contains variety of:

– Calcium

– Vitamin D

Nutrition

• Helps to build and keep bones strong

• 99% calcium is in our bones and teeth

– Lose calcium through nails, hair, sweat, urine and feces

• Body cannot produce calcium

• Need to get calcium from the food we eat

• Not enough calcium each day can lead to bone loss and low bone density, and possible broken bones

Nutrition - Calcium

How much calcium do I need?

Men

Age 70 and Younger

1000 mg/day

Age 70 and Older

1200 mg/day

Women

Age 50 and Younger

1000 mg/day

Age 51 and Older

1200 mg/day

• Low fat dairy products – milk, yogurt, cheese

• Calcium fortified orange juice

• Dark green, leafy vegetables (broccoli, collard greens, bok choy)

• Sardines and canned salmon

• Almonds

• Foods fortified with calcium (tofu, cereals, orange juice)

• Supplements

– Aim to get recommended amount of calcium from food first

– No added benefit in taking more calcium than recommended

Where can I get my calcium?

• Also helps to protect your bones

• Needed to absorb calcium

• Adults need it to keep bones strong and healthy

• Not enough vitamin D each day can lead to bone loss, lower bone density, and possibly broken bones.

Vitamin D

Women and Men

Under age of 50 600 IU* daily

Age 50 and older 800 IU* daily *IU – international unit

How much vitamin D do you need?

• Some people need

more vitamin D.

• Safe upper limit of

vitamin D is 4,000 IU

per day for most adults

• Sunlight – Skin makes vitamin D from UVB rays

– Cancer risk – most people get vitamin D from other sources

• Food – Fatty fish (wild caught mackerel, salmon, and tuna)

– Also added to milk and other dairy products, orange juice, soymilk and cereals

– Check food labels for % daily value of vitamin D

• (based on 400IU of vitamin D)

• Supplements – Both vitamin D2 and vitamin D3 are good for bone health

– Check other supplements (multivitamins or medications) to see if they contain vitamin D

Sources of Vitamin D

• Goal of exercise during adulthood

– To gain bone strength and offset bone loss

• Exercise to preserve bone health during adulthood

– Weight-bearing exercises – help build bone and keep them strong. Include activities that make you move against gravity while staying upright. • high-impact – dancing, high-impact aerobics, hiking, jogging/running, stair

climbing, tennis

• Low impact – elliptical training machines, low-impact aerobics, stair step machines, fast walking on a treadmill or outside

Exercise

Muscle-Strengthening Exercises – resistance exercises – move body, a weight or other resistance against gravity

– Lifting weights

– elastic exercise bands

– Weight machines

– Lifting your own body weight

– Functional movements • (standing and rising up on toes)

*Yoga and pilates can improve strength, balance and flexibility

– Some exercises may not be safe for individuals with osteoporosis or those with increase risk of broken bones

Exercise

• Help to improve balance, posture and how well you move

• Help increase muscle strength and decrease the risk of falls and broken bones

– Balance exercises – strengthen legs and test balance (Tai Chi)

– Posture exercises – improve posture and reduce rounding or “sloping” shoulders can decrease chance of breaking a bone in the spine

– Functional exercises – improve how well you move each day

Non-Impact Exercises

How much exercise do you need?

Weight-bearing exercises > 30 minutes on most days of the week.

Muscle-strengthening exercises

Two to three days per week.

Balance, posture, and functional exercises

Every day or as often as needed.

• Falls increase chances of fracturing bone in hip, wrist, spine or other part of the skeleton.

• Important to be aware of any physical changes that may affect balance or gait and discuss chances with health care provider.

– Impaired vision

– Impaired balance

– Chronic diseases that affect mental/physical functioning

– Changes in medications • (sedatives and antidepressants)

Fall Prevention

Fall Prevention

Tips to eliminate environmental factors that lead to falls:

Outdoors

• Use a cane or walker for stability

• Wear rubber-soled shoes for traction

• Walk on grass when sidewalks are slippery

• In winter, carry salt or kitty litter to sprinkle on slippery sidewalks

• In winter, wear cleats on your shoes when walking on icy sidewalks and parking lots

• Be careful on highly polished floors that become slick and dangerous when wet

• Use plastic or carpet runners when possible

Tips to eliminate environmental factors that lead to falls:

Indoors

• Keep rooms free of clutter, especially on floors

• Keep floor surfaces smooth but not slippery

• Wear supportive, low healed shoes, even at home

• Avoid walking in socks, stockings, or slippers

• Be sure carpets and area rugs have skid-proof backing or are tacked to the floor

• Be sure stairwells are well lit and that stairs have handrails on both sides

• Install grab bars on bathroom walls near tub, shower, and toilet

• Use a rubber bath mat in shower or tub

• Keep a flashlight with fresh batteries beside your bed

• Use a sturdy step stool with handrails and wide steps to get to hard to reach areas

• Add ceiling fixtures to rooms lit by lamps

• Consider purchasing a cordless phone and carrying it around with you to call for help if you do fall.

• National Osteoporosis Foundation

– www.nof.org

• National Institute of Arthritis and Musculoskeletal and

Skin Diseases

– www.niams.nih.gov

• National Institute of Health Senior Health

– www.nihseniorhealth.gov

• American College of Sport Medicine

– www.acsm.org

References