OSTEOPOROSIS

WHAT IS OSTEOPOROSIS?
 Osteoporosis is a disease that causes your bones to
become weak and brittle

 It is a common disease, and can result in fractures

from even simple trauma.

 In fact, it is estimated that a 50 year-old woman has a

40% chance of having an osteoporotic fracture during
her remaining lifetime

 Osteoporosis is important because of the problems

resulting from these fractures- disability, loss of
independence, and even death
WHAT IS OSTEOPOROSIS?
 Osteoporosis is silent because there are no
symptoms (what you feel).
 It may come to your attention only after you break a
bone.
 When you have this condition, a fracture can occur
even after a minor injury, such as a fall.
 Any kind of fracture may occur, but the most common
are fractures of the spine, hip, and wrist.
 Osteoporosis is not an inevitable part of aging, but is
a disease that can be prevented and treated, provided
it is detected early.
 The main goal of treating osteoporosis is to prevent
such fractures in the first place.
http://e-infopages.com/2012/the-silent-thief-osteoporosis/
WHAT CAUSES OSTEOPOROSIS?
 Osteoporosis results from a loss of bone mass
(measured as bone density) and from a change in
bone structure.
 Many factors will raise your risk of developing
osteoporosis and breaking a bone.
 Recognizing your risk factors is important so you can
take steps to prevent this condition or treat it before it
becomes worse.
COMMON RISK FACTORS FOR
OSTEOPOROSIS
 Female  Smoking

 Postmenopausal  Age (starting in the mid-30s but

more likely with advancing age)
 Family history of
osteoporosis  Rheumatoid arthritis,
hyperthyroidism,
hyperparathyroidism,
 Lack of exercise hypogonadism
 Small body frame  Medications – corticosteroids
(Prednisone), excess thyroid
 Low calcium intake hormone, some diuretics (Lasix),
and anticonvulsants (Dilantin,
Phenobarb, Tegretol)
 Vitamin D deficiency
DO YOU HAVE OSTEOPOROSIS?
 Osteoporosis only causes
symptoms when it is far
advanced.

 Symptoms include loss of

height, deformed spine
“dowager’s hump”),
unexplained back pain, and
fractures.

 It is best to detect problems

at an early stage, when
treatment is most effective.

 The best test for detecting

osteoporosis is bone
densitometry, done with a
technique called “Dual-
energy X-ray
Absorptiometry” or DXA.
BONE DENSITOMETRY
WHAT IS BONE DENSITY TESTING?
 This is a way of measuring the amount of calcium in a
certain amount of bone.

 This is important because the amount

of calcium in your bone determines how strong it is.

 If the bone density is very low, then you have

osteoporosis and a very high risk of fracturing your
bones.

 A standard X-ray is not a good way to measure bone

density, because you must lose about 30% of your bone
mass before it can be detected this way.

 The most advanced is called“Dual-energy X-ray

Absorptiometry” or DXA.
DEXA
DEXA
 Simple test that measures
bone mineral density.

 Often the measurements are

at your spine and your hip,
including a part of the hip
called the femoral neck, at
the top of the thighbone
(femur).

 The test is quick and painless.

 It is similar to an X-ray, but

uses much less radiation.

 Even so, pregnant women

should not have this test, to
avoid any risk of harming the
fetus.
DEXA
 DXA test results are scored compared
with the BMD of young, healthy people.
 This results in a measure called a T-score.

DXA T-score Bone mineral density (BMD)

Not lower than –1.0 Normal

Between –1.0 and –2.5 Osteopenia (mild BMD loss)

–2.5 or lower Osteoporosis

 The risk of fracture most often is lower in people with

osteopenia than those with osteoporosis.
 But, if bone loss continues, the risk of fracture
increases.
WHO NEEDS BONE DENSITOMETRY?
 Anyone who wants an accurate measurement
of bone density.

 However, because of cost concerns, the test

is most often done for those with high risk of
developing osteoporosis, or to monitor the
effectiveness of treatment for osteoporosis.

 Consult with your physician if you think you might

benefit from knowing your bone density.
THE CATEGORIES FOR WHICH BONE
DENSITOMETRY IS MOST OFTEN
DONE ARE:
 Estrogen deficient women undecided about taking
hormones.

 Those with spinal abnormalities or X-ray evidence of

bone loss.

 Anyone taking long-term corticosteroid treatment

(such as Prednisone).

 Primary hyperparathyroidism with no symptoms.

 Monitoring of therapy for osteoporosis.

HOW IS OSTEOPOROSIS
TREATED?
 If you have osteoporosis, your health care provider will
advise the following:
 Calcium
 Make sure you are getting enough calcium in your diet or
you might need to consider taking supplements.
 The recommended daily dose is 1,000 milligrams per day
for most adults and 1,200 mg per day for women over age
50 or men over age 70.
 Vitamin D
 Get adequate amounts of vitamin D, which is important to
help your body absorb calcium from foods you eat.

 The recommended daily dose is 400–800 International

Units (called IU) for adults younger than age 50, and 800–
1,000 IU for those age 50 and older.
 Physical activity
 Get exercise most days, especially weight-bearing
exercise, such as walking
HOW IS OSTEOPOROSIS
TREATED?
HOW IS OSTEOPOROSIS
TREATED?
 Some people also will need medication.

 A number of medications are available for the

prevention and/or treatment (“management”) of
osteoporosis.

 Bisphosphonates
 This class of drugs (often called “antiresorptive” drugs) helps
slow bone loss.
 Studies show they can decrease the risk of fractures.
 With all of these medications, you should make sure you are
taking enough calcium and vitamin D, and that the vitamin D
levels in your body are not low.
HOW IS OSTEOPOROSIS
TREATED?
Bisphosphonate Medications for Osteoporosis (OP)
Generic drug name Approved uses for OP Dosing and form

Alendronate Prevention and treatment Once-daily or once-weekly

of postmenopausal OP in pills
women

Treatment of OP due to use of

glucocorticoid medicines

Risedronate Prevention and treatment Once-daily, once-weekly or

of postmenopausal OP in once-monthly pills
women

Prevention and treatment

of OP due to use of
glucocorticoid medicines

Ibandronate Prevention and treatment Once-monthly pills, or every

of postmenopausal OP in three months by intravenous
women infusion (often called IV)
given through a vein
HOW IS OSTEOPOROSIS
TREATED?
 Calcitonin
 This medication, a hormone made from the thyroid
gland, is given most often as a nasal spray or as an
injection (shot) under the skin.
 Approved for the management of postmenopausal
osteoporosis and helps prevent vertebral (spine)
fractures.
 It also is helpful in controlling pain after an osteoporotic
vertebral fracture.
 Estrogen or hormone replacement therapy
 Estrogen treatment alone or combined with another
hormone, progestin, has been shown to decrease the
risk of osteoporosis and osteoporotic fractures in
women.
 Consult with your doctor about whether hormone
replacement therapy is right for you.
HOW IS OSTEOPOROSIS
TREATED?
 Selective estrogen receptor modulators
 These medications, often referred to as SERMs,
mimic estrogen’s good effects on bones without
some of the serious side effects such as breast
cancer.
 Teriparatide
 Teriparatide is a form of parathyroid hormone that
helps stimulate bone formation.
 It is approved for use in postmenopausal women
and men at high risk of osteoporotic fracture.
 It also is approved for treatment of glucocorticoid-
induced osteoporosis.
 It is given as a daily injection under the skin and
can be used for up to two years.
YOUNG WOMEN AND PREGNANCY
 Young women who have risk factors for
osteoporosis and fractures need to carefully
consider their medication options if they are
planning a pregnancy.

 None of the drugs for managing osteoporosis has

enough safety data available to recommend using
them in women who are pregnant or
breastfeeding.

 Bisphosphonates, even after you stop taking

them, can stay in your body a long time.

 Thus, women who want to become pregnant later

should weigh the expected benefits of
bisphosphonates against the possible risks.

 If a woman who has taken a bisphosphonate

becomes pregnant, she should have her blood
calcium levels checked, because they could
become low.
PREVENTION
 Lifestyle changes may be the best way of preventing
osteoporosis.
 Here are some tips:
 Make sure you get enough calcium in your diet or through
supplements (roughly 1,000–1,200 mg/day, but will depend
on your age).
 Get enough vitamin D (400–1,000 IU/day, depending on
your age and your blood level of vitamin D measured by
your doctor).
 Stop smoking.
 Avoid excess alcohol intake: no more than two or three
drinks a day.
 Engage in weight-bearing exercise. Aim for at least 2½
hours a week (30 minutes a day five times a week or 50
minutes a day three times a week), or as much as you can.
Exercises that can improve balance, such as yoga, may
help prevent falls.
PREVENTION
 You also should get treatment of any underlying
medical problem that can cause osteoporosis.

 If you are on a medication that can cause

osteoporosis, ask your doctor if you can lower the
dose or take another type of medicine.

 Never change the dose or stop taking any medicine

without speaking to your doctor first.
WHAT IS THE BROADER HEALTH
IMPACT OF OSTEOPOROSIS?
 The most serious health consequence of
osteoporosis is a fracture.

 Spine and hip fractures especially may lead

to chronic pain, long-term disability and even
death.

 The main goal of treating osteoporosis is to

prevent fractures.
LIVING WITH OSTEOPOROSIS
 If you have osteoporosis, it is important to help
prevent not just further bone loss but also a
fracture.
 Here are some ways to decrease your chance of
falls:
 Use a walking aid. If you are unsteady, use a cane
or walker.
 Remove hazards in the home. Remove throw rugs.
Also, remove or secure loose wires or cables that may
make you trip. Add nightlights in the hallways leading
to the bathroom. Install grab bars in the bathroom and
nonskid mats near sinks and the tub.
 Get help carrying or lifting heavy items. If you
are not careful, you could fall, or even suffer a spine
fracture without falling.
 Wear sturdy shoes. This is above all true in winter
or when it rains.
POINTS TO REMEMBER
 Make sure there is enough calcium and vitamin D
in your diet.

 Be physically active and do weight-bearing exercises,

like walking, most days each week.

 Change lifestyle choices that raise your risk of

osteoporosis.

 Implement strategies to help decrease your risk of

falling.