2. Osteoporosis What you should know?

3. What is Osteoporosis? Osteo means bone, Porosis means porous (holes) Porous bones –Bones have lost calcium & other minerals –Bones are fragile –Spine, hip & wrist fractures are common

4. Osteoporosis: Definition A chronic, progressive condition associated with deterioration of bone tissue that results in low bone mass. As the condition progresses bone fragility increases leading to increased risk of fracture. Osteopenia is bone that is not as dense as normal bone & is a precursor to osteoporosis.

5. Osteoporosis Very common bone disease Bone weakness can lead to fractures from simple falls or even a sneeze or a cough!

6. “Silent Killer” The disease is “silent” because there are no symptoms when you have osteoporosis. You may not know that you have osteoporosis till your Bones Break

7. Osteoporosis - types Postmenopausal osteoporosis (type I) –Caused by lack of estrogen –Causes PTH to overstimulate osteoclasts –Excessive loss of trabecular bone Age-associated osteoporosis (type II) –Bone loss due to increased bone turnover –Malabsorption –Mineral & vitamin deficiency

8. Glimpse of Osteoporosis Fractures –One out of two women > age 50 –One out of eight men > age 50 –Nearly 1/2 million hospitalized with fractures each year One out of five dies within 1 year Half never live independently again

9. What causes osteoporosis? When you are young your body makes new bone faster than it breaks down old bones. As you get older, this process slows down & you start losing bone density. The risk for osteoporosis depends on how much bone mass you attained between ages 25-35 & how fast you lose it.

10. Pathophysiology of Osteoporosis Trauma Low bone mass/ impaired bone quality Inadequate peak bone mass Early menopausal bone loss Decrease in bone mass/bone quality Calcium/ vitamin D deficiency Other factors Fractures

11. Pathogenesis of Bone Loss Due to Calcium/Vitamin D Deficiency in Aged Secondary hyperparathyroidism BONE LOSS Decreased calcium absorption Low dietary Calcium intake Decreased sunlight exposure Decreased vitamin D synthesis Impaired renal function Estrogen deficiency

12. Osteoporosis & Fractures Fractures can affect most bones of the body, but they mostly involve the hips, vertebra, wrist, and arms. Fractures can be very painful and very debilitating

13. Risk Factors for Falls Risks for Fracture in a Fall Falling to the side Age Low bone mass Unfavorable bone geometry High bone turnover Muscle weakness Poor balance Poor eyesight Benzodiazepine use Poor overall health Most Osteoporotic Fractures Occur in a Fall

14. Risk Factors Certain people are more likely to develop this disease than others. Female Thin and/or small frame Advanced age Family history of osteoporosis Post menopause

15. Lifestyle Risk Factors Inactive lifestyle Diet low in calcium Little sun exposure and diet low in vitamin D Consume few fruits and vegetables Drink excess alcohol (>7 drinks/week) Current or former smoker Consume large amounts of caffeine

16. Prevention Lifestyle changes - best way of preventing osteoporosis: Consult your doctor. Get enough calcium (1000-1500 mg/day, depends on age) Get enough vitamin D (400-800 IU/day) Stop smoking Avoid excess alcohol intake Engage in weight-bearing exercises Treat underlying medical conditions that can cause osteoporosis Minimize/change medications that can cause osteoporosis; If at high risk for falls, consider using hip protectors which will prevent a hip fracture.

17. Avoid Harmful Habits Smoking Strict dieting Heavy drinking (alcohol) High caffeine consumption Diet low in calcium and vitamin D Inactive lifestyle

18. Maintain Bone Strength Take enough calcium (1000 mg/day before menopause & 1500 mg/day postmenopausal). –Consult your doctor Get adequate vitamin D intake, which is important for calcium absorption & to maintain muscle strength (400 IU/day until age 60, 600-800 IU/day after age 60). Get regular exercise, especially weight bearing exercise.

19. Exercise Exercising regularly during childhood and adolescence can ensure that you will reach peak bone density as you grow. Need to participate in weight bearing exercise. –For example, walking, dancing, jogging, stair climbing, racquet sports and hiking.

20. Fall Prevention: Extra Advice for Older Adults Fall prevention –Reduce household hazards Keep floors safe Improve lighting Install handrails Reorganize furniture Remove clutter –Improve balance & strength Exercises –Review medicines

21. Patient Education Educate your self more on Osteoporosis Educate your friends & family members Improve adherence to medications Establish baseline BMD measurement Follow up: measure BMD every 1-2 years Always consult your doctor

22. MODIFYING RISK FACTORS Encourage regular, weight-bearing exercise Encourage adequate calcium and vitamin D intake Encourage lower animal protein intake Quit smoking Use medications that may  osteoporosis risk with caution (e.g., anticonvulsants, cyclosporine, glucocorticoids, long-term heparin, methotrexate, thyroid hormone replacement) –Consult your doctor for more information

23. Osteoporosis (OP): Importance OP is a major health concern for 2 reasons: –Osteoporotic fractures, most commonly of the vertebrae, femur & wrist are associated with increased morbidity & mortality. –As the fraction of elderly individuals in the population increases, OP will become more prevalent. Everyone should try to educate themselves though their health care provider.

24. How is it diagnosed? A simple test that measures bone mineral density (BMD) at different parts of body, such as spine and hip, can help determine osteoporosis. BMD is measured by DEXA Scan.

25. Bone Mineral Density (BMD) Measure of QUALITY & STRENGTH of bone. BMD test measures the density of minerals (such as calcium) in bones using a special X-ray, CT scan, or ultrasound.

26. Calcium Is needed for heart muscles, and nerves to function properly. Inadequate amounts contribute to osteoporosis. Appropriate calcium intake falls between 1000 - 1300 mg a day.

27. Calcium Increase calcium intake: Consume calcium rich foods such as, low-fat milk, cheese, broccoli, and others. Calcium supplement, if dietary calcium consumption is inadequate. Consult your doctor

28. Vitamin D Is needed for your body to absorb calcium. Comes from 2 sources: The sun & fortified dairy products, egg yolks, saltwater fish & liver. Need 400-800 IU a day.

29. SUMMARY 1 Osteoporosis is prevalent among older adults & is associated with high personal & financial costs as well as mortality. It can be prevented though healthy lifestyle as suggested by your healthcare provider right from younger days. Osteopenia & osteoporosis can be diagnosed with BMD using dual-energy radiographic absorptiometry. Evaluation of patients with osteoporosis should include assessment for secondary causes of bone loss.

30. SUMMARY – 2 Osteoporosis prevention & treatment combines risk reduction, exercise, calcium & vitamin-D supplementation, hormones & other pharmacotherapies. Pain of osteoporotic vertebral fractures can be treated with NSAIDs, calcitonin & narcotics as well as physiotherapy. Do not ignore, understand that with the help of your doctor you can prevent it.

31. Always consult your doctor OSTEOPOROSIS LIT/31/PK/B-09440-5/FK/OCT-09