1. OSTOEOPOROSIS: You CAN Do Something About It! Lisa Z. Killinger, DC

2. What do we know about OP? Now affects 25 million Americans Now affects 25 million Americans 1/3 of women > 75 are osteoporotic* 1/3 of women > 75 are osteoporotic* 94% of women > 75 have low bone mass 94% of women > 75 have low bone mass 1.5 million OP-related fractures/year 1.5 million OP-related fractures/year 700,000 vertebral fx/year *2.5 standard deviations below the mean of a young adult reference popul. 700,000 vertebral fx/year *2.5 standard deviations below the mean of a young adult reference popul.

3. So, what can WE do?

4. Primary Prevention : (Prevent OP from ever happening) Counsel pts about diet and physical activity at all ages, to maximize bone density in the third decade of life and slow the rate of bone loss after that. Counsel pts about diet and physical activity at all ages, to maximize bone density in the third decade of life and slow the rate of bone loss after that. –Most important factor = physical activity!!!! (National Osteoporosis Foundation and Clinician’s Handbook of Preventive Services recommendations)

5. Secondary Prevention: (Early detection) 1. Screen all patients: OP checklist 2. Identify preventable risks 3. Get baseline bone mineral density test (Dexa scan of the hip is the gold standard) 4. Design a prevention plan suited to patient’s risk factors

6. BMD testing: The DEXA Scan Recommended for: Recommended for: –Women with risk factors –Women whe have had a fracture (as an adult) –Those 65 and older –Those who are considering OP therapies –Those who have been on or are starting HRT

7. But, what does it all mean?!! Normal = BD within 1 Standard deviation of a young healthy adult Normal = BD within 1 Standard deviation of a young healthy adult Low Bone Mass = BD is 1-2.5 SD below mean Low Bone Mass = BD is 1-2.5 SD below mean Osteoporosis = BD is >2.5 SD below mean Osteoporosis = BD is >2.5 SD below mean Your Z score = compares your BD to people your size, age and gender (careful) Your Z score = compares your BD to people your size, age and gender (careful)

8. Tertiary Prevention: (Minimizing osteoporosis’ impact and disability/slowing progression) Employ safe chiropractic adjusting strategies Employ safe chiropractic adjusting strategies Keep patients physically active Keep patients physically active Monitor lifestyle and behaviors, encouraging healthy choices Monitor lifestyle and behaviors, encouraging healthy choices

9. So, what do we tell our patients? Physical activity-Weight bearing (axial loading) activities are best Physical activity-Weight bearing (axial loading) activities are best –Stair climbing –Walking –Step aerobics –Jazzercise –3 times a week for 15-20 minutes –Find a friend to be active with!

10. Pumping Iron Free weights work wonders! Free weights work wonders! Focus on lifting weights with muscles that tug against the spine (traps, rhomboids, lats, etc) Focus on lifting weights with muscles that tug against the spine (traps, rhomboids, lats, etc) Start small and work up to more weight Start small and work up to more weight Can be done while watching TV, etc. Can be done while watching TV, etc. Lower body? (Jette, Exercise-It’s never too late; AJPH) Lower body? (Jette, Exercise-It’s never too late; AJPH)

11. Later years: Fall prevention Strengthen lower body Strengthen lower body Proprioceptive training Proprioceptive training Balance/gait focus Balance/gait focus Home safety checklist Home safety checklist Modify unsafe surroundings Modify unsafe surroundings Assess and monitor meds Assess and monitor meds Regular chiropractic care-IMPORTANT! Regular chiropractic care-IMPORTANT!

12. Risks for hip fractures/falls older age older age history of fx history of fx low weight low weight caffeine intake (>2 cups coffee/day) caffeine intake (>2 cups coffee/day) alcohol use alcohol use lack of walking/exercise lack of walking/exercise vision impairment vision impairment meds that have dizziness or bone loss as a side effect (steroids, anticonvulsives, BP meds) meds that have dizziness or bone loss as a side effect (steroids, anticonvulsives, BP meds)

13. What about nutrition? Recommendation =1,200-1,500 mg/day of calcium (hard to get in diet) Recommendation =1,200-1,500 mg/day of calcium (hard to get in diet) Vitamin D=400 - 800 IU/day Vitamin D=400 - 800 IU/day Other bone helpers = magnesium, boron, Vit C (collagen), etc. Other bone helpers = magnesium, boron, Vit C (collagen), etc. Choosing where the calcium deposits… through physical activities Choosing where the calcium deposits… through physical activities Watch out for calcium thieves: phosphorus, caffeine, alcohol, smoking, oxalic acids, etc. Watch out for calcium thieves: phosphorus, caffeine, alcohol, smoking, oxalic acids, etc.

14. But what kind of Calcium? Calcium citrate-most easily digested (expensive) 22% usable Ca++/big pills Calcium citrate-most easily digested (expensive) 22% usable Ca++/big pills Calcium carbonate-needs acidic gastric envir (but cheaper!) 40% elemental or usable Ca++/smaller pills) Calcium carbonate-needs acidic gastric envir (but cheaper!) 40% elemental or usable Ca++/smaller pills) Dairy-yogurt and lowfat milk are the gold standard calcium sources (all other sources are viewed in comparison to these) Dairy-yogurt and lowfat milk are the gold standard calcium sources (all other sources are viewed in comparison to these)

15. The Acid Test Tablet should dissolve completely in a small glass of vinegar in 30 minutes or less Tablet should dissolve completely in a small glass of vinegar in 30 minutes or less Beware of coated, compressed supplements with a shelf life of a zillion years! Beware of coated, compressed supplements with a shelf life of a zillion years! Don’t take more than 500 mg at a time Don’t take more than 500 mg at a time

16. Foods for Calcium Yogurt/milk Yogurt/milk Ca++ fortified Juice Ca++ fortified Juice Fortified cereals Fortified cereals Acidophillus milk Acidophillus milk Fortified soy milk/cheese, etc Fortified soy milk/cheese, etc Canned sardines with bones Canned sardines with bones Legumes-soak the phylates out first! Legumes-soak the phylates out first!

17. Calcium Interference Oxalates and phylates Oxalates and phylates High protein diets (esp. meat-based) High protein diets (esp. meat-based) High sodium diets (causes kidneys to dump Ca++) High sodium diets (causes kidneys to dump Ca++) Wheat bran-phylate Wheat bran-phylate High iron intake High iron intake High phosphorus intake High phosphorus intake Alcohol, smoking, etc Alcohol, smoking, etc

18. Know the medical options... HRT, ERT, etc HRT, ERT, etc Alendronate (bisphosphonate)-”Fosomax”- decreases osteoclastic activity, arrests bone loss, may increase bone density, reduces fractures (EXPENSIVE) Alendronate (bisphosphonate)-”Fosomax”- decreases osteoclastic activity, arrests bone loss, may increase bone density, reduces fractures (EXPENSIVE) Calcitonin-oral or nasal spray (hormone): increases bone density in postmenopausal women Calcitonin-oral or nasal spray (hormone): increases bone density in postmenopausal women

19. Resources related to OP: Article: Management considerations for patients with OA and OP: A chiropractic perspective on what’s working. TICC 2002;9(1):48-60. Article: Management considerations for patients with OA and OP: A chiropractic perspective on what’s working. TICC 2002;9(1):48-60. National OP foundation: 1(800) 624-BONE or “www.nof.org” National OP foundation: 1(800) 624-BONE or “www.nof.org” –info on prevention, patient pamphlets (free!), bone density tests, research, causes, etc.

20. Take Home Messages... Counsel patients on diet/physical activity Counsel patients on diet/physical activity Screen patients for risks Screen patients for risks Assess bone density before designing intervention Assess bone density before designing intervention Develop prevention/health promotion strategies based on patient’s clinical scenario Develop prevention/health promotion strategies based on patient’s clinical scenario Offer good, sound, safe chiropractic care Offer good, sound, safe chiropractic care