Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 +...
Transcript of Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 +...
![Page 1: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/1.jpg)
![Page 2: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/2.jpg)
Preventing and Managing
Osteoporosis
Jessica Ewen, MS
Exercise Physiologist
Alaska Regional Hospital
![Page 3: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/3.jpg)
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.
![Page 4: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/4.jpg)
Osteoporosis means “porous bone”
Osteoporosis Continued…
![Page 5: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/5.jpg)
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
![Page 6: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/6.jpg)
• 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?
![Page 7: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/7.jpg)
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
![Page 8: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/8.jpg)
• 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
![Page 9: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/9.jpg)
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.
![Page 10: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/10.jpg)
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
![Page 11: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/11.jpg)
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
![Page 12: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/12.jpg)
• 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
![Page 13: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/13.jpg)
• 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
![Page 14: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/14.jpg)
• 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)
![Page 15: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/15.jpg)
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
![Page 16: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/16.jpg)
• 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
![Page 17: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/17.jpg)
• 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
![Page 18: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/18.jpg)
• 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
![Page 19: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/19.jpg)
• 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…
![Page 20: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/20.jpg)
• Consume a diet that contains variety of:
– Calcium
– Vitamin D
Nutrition
![Page 21: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/21.jpg)
• 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
![Page 22: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/22.jpg)
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
![Page 23: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/23.jpg)
• 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?
![Page 24: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/24.jpg)
• 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
![Page 25: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/25.jpg)
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
![Page 26: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/26.jpg)
• 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
![Page 27: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/27.jpg)
• 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
![Page 28: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/28.jpg)
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
![Page 29: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/29.jpg)
• 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
![Page 30: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/30.jpg)
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.
![Page 31: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/31.jpg)
• 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
![Page 32: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/32.jpg)
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
![Page 33: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/33.jpg)
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.
![Page 34: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/34.jpg)
• 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
![Page 35: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/35.jpg)
![Page 36: Preventing and Managing Osteoporosis · 2015. 2. 16. · Who should get tested? • Women age 65 + • Men age 70+ • Women 60 + at increase risk for osteoporosis-related fracture](https://reader034.fdocuments.us/reader034/viewer/2022051919/600bb50827d1d25547569b1f/html5/thumbnails/36.jpg)