Presentation on theme: "Osteoporosis: The Silent Killer"— Presentation transcript:
1 Osteoporosis: The Silent Killer Joseph F. Scordino, MD
2 Lincoln County Maine oldest state in the country Lincoln county oldest county in the state
3 OsteoporosisOsteoporosis is a disease that causes the bones to become brittle and fragile and more likely to break.It is a silent disease in that it does not cause pain until the bone breaks.Osteoporosis is most likely to cause fractures of the spine, hip or wrist which can lead to hospitalization or loss of independent living. Spine fractures can cause spinal deformity and severe pain in the back
4 Osteoporosis Under the Microscope Build bone early in teens and twentyConstantly remodeling Normal Bone
5 PrevalenceApproximately one in two women and one in four men over age 50 will have an osteoporosis related fracture in their remaining lifetime.Major threat for 44 million Americans or greater then 50% of Americans over age 50Osteoporosis can affect any individual of any age80% of this pool of patients are womenOsteoporosis is more predominant in White and Asian ethnic groups then in other groups
6 Here we see the true burden of osteoporosis among postmenopausal women. Among women of all ages, there are an estimated 180,000 new cases of breast cancer annually.Among women over age 20 there are 400,000 strokes annually and 370,000 new or recurrent heart attacks (MI) annually.When compared to the incidence of osteoporosis-related fractures in women over the age of 50, we see how significant the condition is. More than 1.4 million osteoporosis- related fractures occur annually.1Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and Economic Burden of Osteoporosis-Related Fractures in the United States J Bone Min Res 2007;22:2 American Heart Association. Heart Disease and Stroke Statistics – 2009 Update Accessed April 21, 2009.3 American Cancer Society. Cancer Facts and Figures Accessed April 21, 2009.6
7 ConsequencesOsteoporosis bone fractures are responsible for considerable pain, decreased quality of life, lost workdays, and disability.Some 20% of women with a hip fracture will die in the subsequent year as an indirect result of the fracture.In addition, once a person has experienced a spine fracture due to osteoporosis, he or she is at very high risk of suffering another such fracture in the near future (next few years).
8 Effect on Independence At six months after a hip fracture, only 15 percent of hip fracture patients can walk across a room unaided.Up to 30% of patients suffering a hip fracture will require long-term nursing-home care.
9 SymptomsPeople cannot feel their bones getting weaker. They may not know that they have osteoporosis until they break a bone. A person with osteoporosis can fracture a bone from a minor fall, or in serious cases, from a simple action such as a sneeze or even spontaneously.Women can lose up to 20 percent of their bone mass in the five to seven years after menopause, making them more susceptible to osteoporosis.
10 Peak Bone MassPeak bone mass is obtained at around age 20 healthy diet. Building strong bones in childhood helps to decrease fracture risk later in life.
11 Vertebral FracturesVertebral (spinal) fractures may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture. In many cases, a vertebral fracture can even occur with no pain.
13 Who Should be Screened NOF Screen > 65. Less then 65 based on risk factors 1) , 100 lbs 2) FH of fracture 3) incidence of previous fracture
14 Risk Factors Age Female Sex Race Low weight or BMI Previous Fracture Parental history of hip fractureSteroid useCurrent smokingAlcohol > 3 drinks a dayRheumatoid ArthritisInflammatory Bowel diseaseProlonged ImmobilizationType 1 DiabetesThyroid Disorder
15 Fractures1 in 2 women after age 50 will have a osteoporotic fracture in their lifetime while for men this 1 in 4.Fractures due to osteoporosis lower an individuals quality of life25% of individuals die within 1 year of an osteoporotic fracture1 in 6 individuals previously independent individuals require long term care following a fracture
16 DiagnosisA specialized machine called a bone mineral density test can be used to measure the extent of osteoporosis at various sitesBMD is safe and painlessBone density testing helps to monitor response to treatment as well as predict the chance of future fracturesMedicare reimburses for BMD testing every 2 years
17 How to make sense of BMD testing BMD compares your BMD to a healthy 30 year old this is the T score which stands for standard deviationsLower score is worse-1 to 1 is a normal bone density test-1 to -2.5 is termed osteopenia-2.5 or less is termed osteoporosisZ score is comparison to similar age adults and is less helpful then the T score
18 When to Treat Individuals with T score less then -2.5 Individuals with T score from -1 to -2.5 with risk factors
19 FRAX scoreEasy to use program to give score for probability of hip fracture in 10 years timeRequires a DEXA scan
20 Preventative StepsRemove all obstacles like throw rugs and long phone cordsInstall handles next to toilets and showersDo not wear sandals or slippers without backsUse 100 watt light bulbs instead of low lightInstall night lights to help to see when getting up to go the bathroomReview all medications with the doctor which may cause dizziness
21 Treatment of Osteoporosis Fall preventionProper NutritionExercise and weight bearing activities regularlyMedication
22 Measures to Decrease Risk Stop excessive alcohol useStop smoking – ask for help if needed
23 ExercisesHold onto the back of a sturdy chair and stand on one foot for 1 minuteHold onto the back of a sturdy chair and rock onto your toes and your heels 10 timesPerform with 2 hands, then as you get stronger go to one hand, then one fingertip, then no hands and finally with your eyes closed.
24 Medication - Antiresportive Bisphosphonates orally (Actonel, Fosamax)Bisphosponates IV once a year (Zolendronic Acid or Reclast)Calcitonin (Miacalcin)Estrogen Therapy
25 MedicationCalcium 1200 mg to 1500 mg by mouth every day for postmenopausal womenVitamin D 800 mg by mouth every dayVitamin D3 has been shown to be equivalent to vitamin D2.
28 Patient Non adherenceGreater then 50% of patients stop taking within 1 year associated with cost, concern for to many medications, dosing regimen, side effects.
29 SummaryOsteoporosis is a disease where bone becomes more fragile with increase risk of fracturePeak bone mass develops in 20’s then dropsKey risk factors for osteoporosis include genetic factors, lack of exercise, lack of calcium and vitamin D, personal history of fracture as an adult, rheumatoid arthritis, cigarette smoking, excessive alcohol consumption, low body weight, and family history of osteoporosis.
30 SummaryPatients with osteoporosis have no symptoms until bone fractures occur.Diagnosis can be suggested by X-rays and confirmed by using tests to measure bone density.Treatments for osteoporosis, in addition to prescription osteoporosis medications, include stopping use of alcohol and cigarettes, and assuring adequate exercise, calcium, and vitamin D.
31 Miles InitiativesBeginning a new osteoporosis treatment protocol to increase treatment for osteoporosis and cut down on future fracturesIncrease screening for osteoporosis through reinforcement of education with health care providersEducate community and increase awareness about osteoporosis through talks, press releases