1. Understanding Osteoporosis
I.M. Doctor, M.D.
My Office
My City, State
Introduction

2. Understanding Osteoporosis -Outline
Orthopaedics and The Bone and Joint Decade
What is Osteoporosis
Osteoporosis myths
Osteoporosis facts
We will begin our discussion today with Orthopaedics and the Bone and Joint Decade before moving into Osteoporosis. Osteoporosis is a significant health concern for many of us. We will begin by explaining what Osteoporosis is, then dispel some myths about it and cover some key facts.

3. Understanding Osteoporosis - Outline
Osteoporosis symptoms and warning signs
Who is at risk?
Diagnosing Osteoporosis
Next, we will talk about Osteoporosis symptoms and warning signs, who is at risk, and diagnosing Osteoporosis.

4. Understanding Osteoporosis - Outline
Treatment options
Medication
Treatments
Steps You Can Take to Prevent Osteoporosis
After we discuss treatment options, including medications and other treatments, we will finish up by covering some important steps you can take to prevent Osteoporosis.

5. Who is an orthopaedic surgeon?
A Medical doctor with extensive training in helping you keep your bones, joints, ligaments, muscles, tendons, cartilage and spine in good working order.
An orthopaedic surgeon is a medical doctor with extensive training in helping you keep your bones, joints, ligaments, muscles, tendons, cartilage and spine in good working order. Together, all of these parts of our bodies make up our musculoskeletal system.

6. Educating an Orthopaedic Surgeon
College
Medical School
Internship
Orthopaedic Resident
Fellowship (optional)
2 Years Practice
Total 4 1
(1) 2
16 years!
Discuss education of orthopaedist

7. Who is an orthopaedic surgeon?
Greatest knowledge of wide range of conditions and treatment options available
Greatest experience in treating musculoskeletal health
Orthopaedic surgeons have the greatest knowledge of and experience with the wide range of conditions and treatment options available in musculoskeletal care, many of which do not involve surgery.

8. What do orthopaedic surgeons do?
Use most effective & efficient diagnostic tools
Determine best course of treatment
Using the most effective and efficient diagnostic tools and our experience in musculoskeletal treatment to determine the best course of treatment for our patients is what we do.

9. The Bone and Joint Decade is an international initiative to focus attention on musculoskeletal conditions throughout the world.

10. Why Musculoskeletal Problems?
Musculoskeletal conditions affect hundreds of millions of people
$230 billion per year spent
Why have musculoskeletal problems been selected as the focus for the Decade?
Musculoskeletal conditions affect hundreds of millions of people, costing an estimated $230 billion dollars each year in the United States alone.

11. Why Musculoskeletal Problems?
Most common causes of severe long-term pain and physical disability
Research is at a critical point
As the most common causes of severe long-term pain and physical disability worldwide, it is hoped that heightened focus on musculoskeletal conditions will speed progress toward advancements in research. Ultimately, these advances will lead to further improvements in patient care and prevention of these disorders on a global scale.

12. The American Academy of Orthopaedic Surgeons is committed to working with its sister organizations throughout the United States to raise awareness of the Bone and Joint Decade.

13. Understanding Osteoporosis
Your Orthopaedic Surgeon
Getting You Back Into The Game
While the Bone and Joint Decade is about all musculoskeletal health, today we are focusing in on Osteoporosis and what can be done about it to get you back into the game.

14. Osteoporosis
Osteoporosis, or porous bone, is a devastating disease that robs its victims of bone mass.
What is Osteoporosis?
Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural deterioration of bone tissue. This disease can weaken your bones so much that even simple everyday activities can cause bones to break. Osteoporosis strikes both men and women, although women are afflicted in much greater numbers. While the effects of Osteoporosis are devastating, there are things you can do now to prevent and treat it.

15. Osteoporosis Normal Bone Osteoporotic Bone
On the left is an illustration of normal, healthy bone, and on the right, osteoporotic bone. You can see the difference in bone density clearly.
Normal Bone
Osteoporotic Bone

16. “Osteoporosis is not serious enough for me to worry about”
It is a progressive disease and irreversibly weakens bones
Any movement or bump can cause debilitating fracture
Chronic pain and disability are the potential outcomes
Hip fractures can cause death
There are Four Myths About Osteoporosis
Myth #1 is: “Osteoporosis is not serious enough for me to worry about.”
In fact, the opposite is true. The reality is that it is a progressive disease and irreversibly weakens bones.
Any movement or bump can cause debilitating fracture.
Chronic pain and disability are the potential outcomes.

17. “I’m a healthy person. I do the right things so I am not at risk.”
Osteoporosis Myths
Myth #2 is: “I’m a healthy person. I do the right things so I am not at risk.”
Osteoporosis is a “silent thief”-- you can’t feel how strong your bones are.
In addition, one out of two women and one out of five men have a lifetime of risk.
“I’m a healthy person. I do the right things so I am not at risk.”

18. “I’m too young to worry about Osteoporosis now.”
Osteoporosis Myths
“I’m too young to worry about Osteoporosis now.”
It is never too early to prevent Osteoporosis
Osteoporosis can strike at any age
Bone is a living, growing tissue that constantly rebuilds
Myth #3 is: “I’m too young to worry about Osteoporosis now.”
In fact, it is never too early to prevent Osteoporosis by getting enough calcium and weight bearing exercise to ensure that your bones are as strong as they can be.

19. “It’s too late for me to do anything
Osteoporosis Myths
“It’s too late for me to do anything
about Osteoporosis.”
The last prevalent myth is: “It’s too late for me to do anything about Osteoporosis.”
To the contrary, bone loss is irreversible but you can slow or stop its further progress.
The time to do something is now before you have experienced so much bone loss that you are at high risk for fractures.

20. More than 28 million Americans suffer from Osteoporosis
Prevalence
More than 28 million Americans suffer from Osteoporosis
80% are women
1 in 2 women & 1 in 8 men over 50 years old
The prevalence of Osteoporosis makes it a tremendous health risk.
Osteoporosis is a major public health threat causing almost 5 million physician visits each year.
While 80% of those who will be effected by Osteoporosis are women, men are also at significant risk:
Nearly 3 out of 4 women and 1 out of 6 men over 50 years old will be diagnosed with Osteoporosis.

21. 1.5 Million Fractures Annually
Vertebral Fractures:
700,000+
Wrist Fractures:
200,000+
Osteoporosis is a contributing factor in 1.5 million fractures treated each year. The approximate number of types of fractures related to Osteoporosis are:
Approximately 300,000 hip fractures.
Approximately 700,000 vertebral fractures.
Approximately 250,000 wrist fractures.
Approximately 300,000 fractures at other sites.
Hip Fractures:
300,000+
Other Fractures:
300,000+
Source: National Osteoporosis Foundation, 2000

22. $14 Billion Annually Burden of Disease Approximately $38 million daily
Congestive heart failure costs $8 billion annually
Asthma costs $9.8 billion annually
There are tremendous social and economic costs to society associated with Osteoporosis.
Osteoporosis costs the U.S. healthcare system nearly $14 billion annually.
This translates to approximately $38 million per day.
This is more than the cost of congestive heart failure or asthma (Congestive heart failure costs $8 billion annually, while Asthma costs $9.8 billion annually).

23. Burden of Disease
Osteoporotic fractures may cause disfigurement, disability, loss of mobility, prevent women from participating in daily activities and make them more dependent upon others.

24. Burden of Disease
1 out of 4 osteoporotic hip fractures result in long-term nursing home care
One half of these are unable to walk without assistance
24% greater risk of dying within one year
1 out of 4 osteoporotic hip fractures result in long-term nursing home care.
Half of those who suffer from osteoporotic hip fractures are unable to walk without assistance.
Those who experience the trauma of an osteoporotic hip fracture have a 24% increased risk of dying within one year following their fracture.

25. Osteoporosis Normal Spine Osteoporotic Spine
Osteoporosis fractures most often in the hip, wrist and spine. While vertebral fractures do heal, the bones do not go back to their original shape. Over time, multiple fractures of the spine can result in stooped posture, a loss of height and continual pain.
Source: National Osteoporosis Foundation, 2000

26. Symptoms and Warning Signs
Persistent, unexplained back pain
Shorter than you used to be
Spinal deformities
There are several symptoms and warning signs indicative of Osteoporosis to be on the lookout for:
Persistent, unexplained back pain,
Noticing that you are shorter than you used to be,
that you don’t stand up as straight as you used to,
or that your posture is becoming hunched over or stooped.

27. Symptoms and Warning Signs
Recurrent fractures
Fracture from minimal trauma
Experiencing chronic medical problems
Experiencing recurrent fractures,
Sustaining a fracture from minimal trauma, or
Experiencing chronic medical problems.
If you notice any of these warning signs, you should consult your doctor.

28. Risk Factors Female Thin or small frame Low body weight Smoker
In addition to warning signs, there are a significant number of risk factors to consider for Osteoporosis. However, it is important to be aware that you can have no risk factors and still have Osteoporosis.
The following risk factors have been identified:
Being female,
Having a thin or small frame and
Having a low body weight of 127 pounds or less.
In addition, being a smoker is a major risk factor as are

29. Risk Factors Advanced age History of fragility fracture
Family history- primary relative with Osteoporosis or fragility fracture
Reaching Advanced age, and
Having a history of fragility fracture or a primary relative with a history of fragility fracture or Osteoporosis.

30. Risk Factors Post Menopausal
Hormonal imbalances can result in rapid bone loss
Women can lose up to 20% of their bone mass in 5-7 years
In addition, post menopausal women are at great risk because the hormonal imbalances of menopause can result in rapid bone loss.
Women can lose up to 20% of their bone mass in the 5-7 years after the onset of menopause.

31. Amenorrhea, Anorexia & Bulimia Diet low in calcium Certain medications
Risk Factors
Amenorrhea, Anorexia & Bulimia
Diet low in calcium
Certain medications
Low testosterone in men
Eating disorders such as Anorexia and Bulimia,
A diet low in calcium,
Use of certain medications and
Low testosterone in men are all risk factors as well.

32. Excessive alcohol consumption
Risk Factors
Inactive lifestyle
Cigarette smoking
Finally, having an inactive lifestyle,
Cigarette smoking
And excessive alcohol consumption are risk factors that can be avoided.
Excessive alcohol consumption

33. Ethnicity & Osteoporosis
Hispanic Women at Highest Risk
13-16% with
Osteoporosis now
While significant risk has been reported in people of all ethnic backgrounds, and in both genders, Hispanic women are thought to be among those at highest risk.
13-16% have Osteoporosis now.
36-49% of Mexican-American women 50 years of age or older have experienced loss of bone density.
Hispanic women tend to consume less calcium than the RDA.
This risk is expected to increase as the estimated number of hip fractures worldwide is expected to rise sharply over the next ½ century.
36-49% of Mexican
American women 50+
have experienced
significant bone loss

34. Ethnicity & Osteoporosis
Caucasian & Asian-American Women Also High Risk
Caucasian and Asian-American women are also at high risk. This is due largely to differences in bone mass and density.
The average calcium intake among Asian-American women is about half that of their Caucasian counterparts.
While Asian-American women generally have lower incidence of hip fractures than Caucasian women, the prevalence of vertebral fractures is about equal between the two populations.

35. Ethnicity & Osteoporosis
Although African-American women generally have higher bone density and are at somewhat lower risk than their Asian-American and Caucasian counterparts, this should not be taken to mean that there is no cause for concern among this population.
10% of African-American women over 50 have Osteoporosis.
30% more have low bone density.
10% of African-American women 50+ have Osteoporosis
30% more have low bone density

36. Ethnicity & Osteoporosis
300,000 African-American women suffering from Osteoporosis today
80-95% of all fractures suffered by African-Americans 64+ are osteoporotic
African-American women more likely to die from hip fractures
300,000 African-American women are experiencing Osteoporosis today.
80-95% of all fractures suffered by African-American women over 64 are related to Osteoporosis.
African-American women are more likely than Caucasian women to die from hip fractures.

37. Ethnicity & Osteoporosis
Risk of hip fractures doubles approximately every 7 years
50% less calcium than RDA
As African-American women age, their risk for hip fracture doubles approximately every 7 years, bringing them to the same risk levels as Caucasian women.
Studies indicate that African-American women consume 50% less calcium than the RDA.

38. Inadequately researched
Men & Osteoporosis
Underdiagnosed
Unrecognized
Underreported
While Osteoporosis does strike women at higher rates, men are also at risk. Osteoporosis in men is underdiagnosed, unrecognized, and inadequately reported and researched. As with women, Caucasian men are at greater risk for Osteoporosis. Many of the same risk factors apply to men:
Lifestyle, age, heredity, prolonged exposure to certain medications. chronic disease and undiagnosed levels of testosterone all put men at increased risk for Osteoporosis.
Inadequately researched

39. Men & Osteoporosis 2 million American men suffer from Osteoporosis
3 million more are at risk
1/3 of male hip fractures related to Osteoporosis
1/3 of these men will not survive 1 year after fracture
2 million American men suffer from Osteoporosis.
Another 3 million are at risk.
1/3 of the hip fractures experienced by men are related to Osteoporosis.
1/3 of these men will not survive 1 year after their fracture.

40. Diagnosis
For all populations, the diagnosis of Osteoporosis is similar. Your doctor will utilize a combination of:
A complete history,
A Physical exam,
Skeletal X-rays,
Bone densitometry and
Specialized lab tests.

41. Diagnosis Before Your Appointment Prepare to describe your symptoms
Gather medical history
Make list of medications
Write down concerns and questions and bring them
Before you see your doctor, it’s a good idea to assemble your records and make written lists of medications you are taking, your medical history and your concerns about your condition.
Many of my patients also decide to bring a friend or family member along. It’s common to be nervous when you are seeing your doctor for a health problem. It’s often beneficial to have another person to help you understand and remember what went on during your visit.

42. During Your Appointment
Diagnosis
During Your Appointment
Expect what from treatment?
Treatment effect on daily activities?
How to prevent further disability?
We find that it is usually helpful when patients, or their companions, take notes. It’s very important to ask questions about anything you don’t understand. Three key questions are:
What should I expect from my treatment?
What effect will my treatment have on my daily activities?
And, what can I do to prevent further disability?
It’s usually helpful to ask your doctor for any handouts or brochures that may help you and your family understand your condition and treatment. Your doctor may also be able to refer you to an Internet web site for more information.

43. Bone Densitometry
Bone densitometry is a safe, painless x-ray technique that compares bone density to the peak bone density that someone of your same sex and ethnicity should have reached at about age when it is at its highest.
Bone densitometry allows your doctor to:
Detect a potential problem before fracture occurs,
Predict chances of future fractures and
Determine your rate of bone loss.
All of these factors can then be weighed to determine a course of treatment.

44. Anyone with a fragility fracture All women age 65 and older
Bone Densitometry
Anyone with a fragility fracture
All women age 65 and older
Postmenopausal younger than 65 with risk factors
Men over 50 with risk factors
Who should have bone densitometry testing?
Anyone with a fragility fracture.
All women age 65 and older.
Post-menopausal women younger than 65 who have other risk factors, and
Men over the age of 50 with risk factors.

45. Treatment
Bone lost as a result of Osteoporosis can not be replaced; therefore our treatments for Osteoporosis focus on prevention of further bone loss.
Treatment of Osteoporosis is often a team effort with your family physician or internist, orthopaedist, gynecologist and endocrinologist working together.

46. Estrogen Replacement Therapy Medications made from natural hormones
Bisphosphonates
Estrogen Replacement Therapy
Medications made from natural hormones
SERMs
There is no cure for Osteoporosis, but there are currently four different medications approved to either prevent and/or treat Osteoporosis.
Bisphosphonates are the number one treatment for Osteoporosis. They are used to prevent and manage Osteoporosis through increasing bone mass and helping to prevent spine and hip fractures.
ERT or estrogen replacement therapy is frequently used to both prevent and treat Osteoporosis in postmenopausal women.
Medications made from naturally occurring hormones may prevent spinal fractures and give some pain relief as well.
SERMs or antiestrogens are used in both prevention and treatment of Osteoporosis to increase bone mass while decreasing the risk of both spinal fractures and breast cancer.

47. Medication-Under Investigation
Vitamin D metabolites
Parathyroid hormone
Some other promising new treatments for Osteoporosis under investigation are:
Vitamin D metabolites,
Parathyroid hormone and
Other bisphosphonates and SERMs.
New bisphosphonates
New SERMs

48. Appropriate treatment of fragility fractures Hip nailing
Your orthopaedist will utilize a variety of methods of treatment based upon your particular needs.

49. Calcium and Vitamin D Intake
Prevention
Calcium and Vitamin D Intake
Units per day
Consult your doctor for dosage
The best treatment for Osteoporosis is still prevention. It is never too soon to start preventing Osteoporosis through healthy lifestyle choices. Two keys to prevention are adequate amounts of calcium and vitamin D in your diet.
The National Academy of Sciences recommends Units of Vitamin D and mg of Calcium in-take per day. Your age, gender and whether or not you are pregnant will determine the best dosage-- so consult your doctor.

50. Prevention Calcium rich foods include: Yogurt Cheese Milk
Sardines with bones and
Green leafy vegetables like broccoli and collard greens.
While a healthy diet should be your primary source of calcium, supplements are available. Before taking Calcium supplements you should consult your doctor.
Vitamin D helps the body absorb calcium; units is recommended daily. Vitamin D supplemented dairy products are also a good choice.
A note of caution here is important, because Vitamin D can be toxic, care should be taken, and your doctor consulted before you begin to take Vitamin D supplements.

51. Weight-Bearing Exercise
Regular exercise is one of the best things we can do to prevent Osteoporosis.
Bones, like muscles need exercise to stay strong.
Moderate exercise 3-4 times per week is recommended.
Weight bearing exercises like walking, jogging, tennis and low impact exercise classes are best for building and maintaining strong bones.
Consult your doctor first

52. Tai-chi helps reduce falls
The benefits of tai chi in particular have been documented. Osteoporotic bone is particularly susceptible to fractures from falls. Tai chi decreases falls among older individuals by 47%.
You should consult your doctor before beginning any exercise program.
Consult your doctor first

53. Prevention
10-20 Year Olds
Osteoporosis causes bones to thin and weaken. At each stage of life, there are things we can all do to help build and maintain healthy bones and fight Osteoporosis.
When you are years old is the time to make deposits in the “bone bank”.
A Calcium rich diet, including plenty of dairy products and green, leafy vegetables is one of the most important things we can do when we are very young.
Young women need to be concerned about maintaining regular menstrual cycles.

54. Prevention
20-35 Year Olds
When we are years old, our bones reach peak strength.
Maintaining a calcium rich diet and the habit of a regular, moderate exercise program are tremendous defenses against Osteoporosis.

55. Prevention
35-50 Year Olds
When we reach years old, individuals may already have started to lose bone mass. Continued emphasis on a
Calcium rich diet and regular, moderate exercise is a healthy strategy. In addition, during this time you might want to consider
bone density screening.

56. Prevention
Over 50
Over 50 years old, postmenopausal women may be losing bone mass at a rate of 1-6% per year.
Risk becomes greatest for men also.
As in our earlier years, by maintaining our commitment to a calcium rich diet and a healthy lifestyle which includes.
Exercise of at least 20 minutes at least 3 times per week we can diminish the effects of Osteoporosis.

57. Getting You Back In the Game
Name: Ruth C. Snyder
Age:Over 50
Ruth Snyder is an artist whose work depicts the forms and shapes of nature in space. Through her experiences with musculoskeletal health, she has developed an appreciation for the importance of healthy, strong bones and uses this as inspiration for many of her works.
Injuries/conditions: Fracture of dorsal lumbar spine, Osteoporosis,
hip fracture, and trigger finger

58. Video

59. Osteoporosis
While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other risk factors
Osteoporosis is a debilitating disease with tremendous social and economic costs attached to it. While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other risk factors. Encouragingly, we can diminish or eliminate many of the effects of Osteoporosis through awareness and healthy lifestyle choices.

60. Resources American Academy of Orthopaedic Surgeons
6300 North River Road
Rosemont, IL 60018
If you are concerned about Osteoporosis, contact your doctor to learn more and check out the AAOS and National Osteoporosis Foundation Web sites at and
National Osteoporosis Foundation
(202)

61. What are your questions and concerns?
Understanding Osteoporosis
What are your questions and concerns?
Do you have any questions or concerns that we have not yet addressed?

62. Understanding Osteoporosisc
Thank you for participating today
Remember, your orthopaedic surgeon can help get you back into the game
Thank you for participating today. I hope that you have each learned something helpful about dealing with Osteoporosis. If you or someone you love is suffering with Osteoporosis, your orthopaedic surgeon is your best resource to guide you on the road to recovery and get you back into the game.