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Osteoporosis prevention and management
Osteoporosis is a prevalent skeletal disease primarily affecting women due to lower peak bone mass and hormonal changes post-menopause, increasing fracture risks, particularly in the hip. Diagnosing osteoporosis involves measuring bone mineral density using methods such as DEXA scans, while treatment focuses on lifestyle changes, medications like bisphosphonates, and exercise to strengthen bones and minimize fall risks. Recent advancements include FDA-approved treatments such as Reclast for easier medication intake, alongside additional options like hormone therapy and calcitonin for managing severe cases.
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Osteoporosis prevention and management
- 1. Osteoporosis Prevention andManagement Margarita Correa MD FAAPMR Physical Medicine and Rehabilitation Pain Medicine Physical Medicine Institute
- 2. Osteoporosis Osteoporosis is a systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility
- 3. Incidence Osteoporosis isthree times ( 3 X ) more common in women than in men, partly because women have a lower peak bone mass and partly because of the hormonal changes that occur at the menopause
- 4. Incidence In addition,women live longer than men and therefore have greater reductions in bone mass In osteoporosis, the morbidity of the disease arises from the associated fractures The pathogenesis of fractures depends on many factors other than osteoporosis
- 5. Causes of OsteoporosisLow calcium diet Lack of physical activity Family History : If someone in your family has or had osteoporosis, you're more at risk Gender : Women are simply more likely to develop osteoporosis Ethnicity : White and Asian people are more likely to be affected by osteoporosis
- 6. Causes of OsteoporosisGlucocorticoid medications (ex cortisone, prednisone) Hypogonadism (low testosterone levels) Excessive alcohol consumption Smoking Chronic obstructive pulmonary disease (COPD) and asthma Gastrointestinal disease – malabsorption, prolonged use of PPI’s
- 7. Causes of OsteoporosisHypercalciuria (loss of calcium by urine) Anticonvulsant medications (ex. Dilantin) Thyrotoxicosis (hyperthyroidism) Hyperparathyroidism (increased parathyroid hormone levels) Neoplastic disease – cancer (ex. multiple myeloma) Ankylosing spondylitis Rheumatoid arthritis
- 8. Osteoporosis Fracture Themost serious osteoporotic fracture is that of the hip Hip fractures typically result from falls, but some occur spontaneously Women are more often affected than men and the incidence rates rise exponentially with age
- 9. Osteoporosis Until recently,osteoporosis was an under-recognized disease and considered an inevitable consequence of ageing However, perceptions have changed, as epidemiological studies have highlighted the high burden of the disease and its costs to society and health care systems
- 10. Diagnosis – BoneMineral Density The cornerstone of diagnosis is the measurement of bone mineral density Diagnostic thresholds offered by the WHO have been widely accepted: Osteopenia = <2.5 SD T score Osteoporosis = ≥2.5 SD T score
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- 12. Osteoporosis Diagnosis: CTscan A special type of spine CT that can show loss of bone mineral density, quantitative computed tomography (QCT) may be used in rare cases
- 13. Osteoporosis Diagnosis: x-raysIn severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis
- 14. Goals of OsteoporosisTreatment Control pain from the disease Slow down or stop bone loss Prevent bone fractures with medicines that strengthen bone Minimize the risk of falls that might cause fractures
- 15. Treatment STOP UNHEALTHYHABITS Limit alcohol intake Too much alcohol can damage your bones, as well as put you at risk for falling and breaking a bone Quit smoking, if you smoke
- 16. Treatment PREVENT FALLSAvoid sedating medications Remove household hazards to reduce the risk of fractures Make sure your vision is good
- 17. Other ways toprevent falling include: Avoiding walking alone on icy days Using bars in the bathtub, when needed Wearing well-fitting shoes Prevent Falls
- 18. Treatment DIET Getat least 1,200 milligrams per day of calcium, and 800 - 1,000 international units of vitamin D3 Vitamin D helps your body absorb calcium
- 19. Treatment High-calcium foodsinclude: Cheese Ice cream Leafy green vegetables, such as spinach and collard greens Low-fat milk Salmon Sardines (with the bones) Tofu Yogurt
- 20. Treatment High-vitamin Dfoods: Fish oil, cod liver : Vitamin D 2217 IU Fish herring, Atlantic raw : Vit D 2061 IU Fish catfish, wild raw : Vit D 1053 IU Mollusks, oysters raw : Vit D 941 IU Fish salmon sockeye : Vit D 920 IU Fish salmon pink : Vit D 898 IU
- 21. Treatment EXERCISES Regularexercise can reduce the likelihood of bone fractures in people with osteoporosis. Some of the recommended exercises include: Weight-bearing exercises -- walking, jogging, playing tennis, dancing Resistance exercises -- free weights, weight machines, stretch bands
- 22. Treatment EXERCISES Balanceexercises -- tai chi, yoga Riding a stationary bicycle Using rowing machines
- 23. Treatment EXERCISES Posturalretraining Improve core muscle strength, extensor muscles (back) Spinomed® support
- 24. Treatment Medications areused to strengthen bones when: Osteoporosis has been diagnosed by a bone density study (DEXA) Osteopenia (thin bones, but not osteoporosis) has been diagnosed by a bone density study, if a bone fracture has occurred
- 25. Treatment BISPHOSPHONATES Bisphosphonatesare the primary drugs used to both prevent and treat osteoporosis in postmenopausal women Bisphosphonates taken by mouth include Alendronate ( Fosamax ), Ibandronate (Boniva), and Risedronate ( Actonel ) Most are taken by mouth, usually once a week or once a month
- 26. Treatment A novelapproach for the treatment of osteoporosis has just been approved by the FDA: Reclast ( Zoledronic acid) This IV medication is a once a year, 15 minute infusion, which will allow the easiest available intake of an osteoporosis medication, with excellent efficacy, and a good safety profile Serum creatinine (renal function) should be measured before each Reclast dose
- 27. Treatment CALCITONIN Calcitonin is a medicine that slows the rate of bone loss and relieves bone pain. It comes as a nasal spray or injection . The main side effects are nasal irritation from the spray form and nausea from the injectable form. Calcitonin appears to be less effective than bisphosphonates
- 28. Treatment HORMONE REPLACEMENTTHERAPY Estrogens or hormone replacement therapy (HRT) is rarely used anymore to prevent osteoporosis Many experts recommend that long-term estrogen replacement therapy only be considered for women with a significant risk for osteoporosis that outweighs the risks of taking HRT
- 29. Treatment PARATHYROID HORMONETeriparatide (Forteo) is approved for the treatment of postmenopausal women who have severe osteoporosis and are considered at high risk for fractures The medicine is given through daily shots underneath the skin. You can give yourself the shots at home
- 30. Treatment RALOXIFENE Raloxifene( Evista ) is used for the prevention and treatment of osteoporosis. Raloxifene is similar to the breast cancer drug tamoxifen Raloxifene can reduce the risk of spinal fractures by almost 50%. However, it does not appear to prevent other fractures, including those in the hip
- 31. Treatment RALOXIFENEIt may have protective effects against heart disease and breast cancer, though more studies are needed The most serious side effect of raloxifene is a very small risk of blood clots in the leg veins (deep venous thrombosis) or in the lungs (pulmonary embolus)
- 32. Monitoring Your responseto treatment can be monitored with a series of bone mineral density measurements taken every 1 - 2 years Women taking estrogen should have routine mammograms, pelvic exams, and Pap smears
- 33. Related Procedures Aprocedure called vertebroplasty can be used to treat any small fractures in your spinal column due to osteoporosis. It can also help prevent weak vertebra from becoming fractured by strengthening the bones in your spinal column.
- 34. Vertebroplasty The procedureinvolves injecting a fast-hardening glue (bone cement) into the areas that are fractured or weak
- 35. Related Procedures Kyphoplasty, is a similar procedure, the bone is drilled and a balloon, called a bone tamp, is inserted on each side These balloons are then inflated with contrast medium (to be seen using image guidance x-rays) until they expand to the desired height and removed.
- 36. Kyphoplasty The balloonSIMPLY CREATES A CAVITY FOR THE CEMENT AND ALSO HELPS EXPAND THE COMPRESSED BONE
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