Building Bone Density-Research Issues
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- Terence Jennings
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1 Building Bone Density-Research Issues
2 Helping to Regain Bone Density
3 QUESTION 1 What are the symptoms of Osteoporosis? Who is at risk?
4 Symptoms Bone Fractures Osteoporosis 1,500,000 fractures a year Kyphosis Loss of height stooped position 300,000 HIP Fractures
5 OVERVIEW Definition and Risks Disease Fragile Bones Osteoporosis Porous bone No symptoms Fracture Women 4 timed Men 24,000,000 women
6 OVERVIEW Bone Anatomy and Physiology Muscle support Protection of Organ Mineral Storage Cortical Bone Trabecular Bone Bone Remodeling
7 Question 2 What are the key age factors?
8 OVERVIEW Key Age Factors Teens to to 50 Older than 50 Post menopause
9 OVERVIEW Key Age Factors Teens to 30 Building 30 to 50 Slow loss Older than 50 Post menopause
10 OVERVIEW Key Age Factors Teens to 30 Weight bearing Exercise Calcium intake NO smoking
11 OVERVIEW Key Age Factors Adults Slow loss Exercise Non smoking Idiopathic Osteoporosis Osteoporosis Int Some blood chemical levels lower Women and men
12 Smoking
13 Smoking and fracture risk: a meta-analysis analysis Osteoporosis, Int,,
14 Smoking Study 59,232 men and women (74% w) Fracture 1.25 smokers to non-smokers Fracture 1.13 BMD considered Highest Risk Hip fracture (1.84) Higher risk for Men
15 Effect of age, weight & Lifestyle factors on calcaneal quantitative ultrasound in premenopausal women Calif. Tissue Int. (2004) 74(4)
16 Effect of age, weight & Lifestyle factors Bone Stiffness Positive Outdoor activity Bone Stiffness Negative # of pregnancies Chronic use of drugs Smoking Subjective Health Status
17 OVERVIEW Post menopause Bone density screening Exercise Medications
18 Factors that effect Osteoporosis Potential Uncontrollable Factors Family History Age Race Gender Controllable Factors Activity Diet Medication
19 Lifestyle Choices Exercise Weight bearing Body Weight Extreme weight loss at 50 (>10%) Smoking
20 Diet Calcium & Vitamin D 1500 mg/day 8-ounce milk 300 mg 5 15 minutes sunlight Soy Others Protein Sodium Coffee
21 Do medications help?
22 Drugs Choice?
23 MEDICATIONS Alendronate ( Fosamax) Raloxifene (Evista) Risedronate Sodium (Actinel( Actinel) Hormone Therapy
24 MEDICATION Alendronate ( Fosamax) Class of drugs bisphosphonates Action Bone cells Taking Fosamax First thing in morning Full glass of water upright position Minimum 1/2 hour preferably one hour Same time before first food, beverage, or medication of the day.
25 MEDICATION Side Effects Alendronate ( Fosamax) Side effects are uncommon Abdominal or musculoskeletal pain, Nausea, Heartburn, Irritation of the esophagus.
26 MEDICATION Raloxifene (Evista) Standard use
27 MEDICATION Risedronate Sodium (Actinel( Actinel) Taking Medication: First thing in morning Full glass of water ½ hour before food or beverage Remain upright
28 MEDICATION Hormone Therapy Higher Risk factors
29 DETECTION Individual Fractures BMD Duel energy x-ray x absorption DEXA Location Effects
30 Research Can detection be done effectively?
31 BMD: The Problem Osteoporosis Int : Considered the wrong measure 3-D D to a 2-D 2 D (average Bone mineral/area of bone shadow Bone Mineral Content (BMC) better Desire for STRENGTH
32 Research Can detection be cheaper?
33 Identifying postmenopausal women with osteoporosis by calcaneal ultrasound, metacarpal digital x-ray x radiogrammetry and phalangeal radiographic absorptiometry: : a comparative study
34 Osteoporosis Detection Quantitative Ultrasound (QUS) 67.5% sensitivity Digital X-ray X radiogrammetry 76.9% sensitivity Phalangeal Radiographic absorptimetry (RA) 82.9% sensitivity
35 How else may we work against Osteoporosis? (And get a kick out of it)
36 Exercise
37 EXERCISE I Effects when young Effects for Middle age Effects for post-menopausal
38 Recent Research Can exercise help children s bone density? Osteoporosis International (2005) 16:
39 Diet and exercise during growth have site-specific specific skeletal effects: a co-tiwn control study Effects on peri-pubertal pubertal and post-pubertal pubertal NOT pre-pubertal pubertal Hour/week differences in exercise 1.2% total body Bone Mineral Content (BMC) 1.4% leg BMC 0.5% spine BMC 0.1% cortical Thickness Protein intake (1 gram) 0.4% in arm BMC
40 Recent Research Can exercise help the bone density for premenopausal women?
41 Effects of high-impact impact exercise on bone mineral density: a randomized controlled trail in premenopausal women Osteoporosis, Inc. (2005)
42 Effects of Impact exercise Femoral neck and Trochanter No loss of BMD exercise -1.1% Control group MEAN trochanter BMC No loss of BMD exercise -7.7% control group Fall with fractures 6 Exercise Group 16 Control Group
43 Recent Research Can exercise help elderly woman?
44 Effects of impact exercise on bone mineral density in elderly women with low BMD: a population-based randomized controlled 30- month intervension Osterporosis Int :
45 Effects of high-impact impact exercise on bone mineral density Femoral neck BMD 1.1% versus -0.4% Intertrochanteric BMD 0.8% versus -0.2% Total femoral BMD 0.1% versus -0.3%
46 Effects of high-impact impact exercise on bone mineral density L1 vertebra 2.2% versus -0.4% Lumbar vertebra L2 L4 No exercise effects
47 Resent Research Can exercise help the spine of a postmenopausal women over a 3 year period? The bones are just not the same
48 Exercise maintains bone density at spine and hip EFOPSS: a 3-year 3 longitudinal study in early postmenopausal women Osteoporosis Int :
49 Spine
50 Exercise maintains bone density at spine and hip 38 months DXA lumbar spine 0.8% versus -3.3% QCT trabecular bone 1.1% versus -7.7% QCT cortical bone 5.3% versus -2.6%
51 Exercise maintains bone density at spine and hip 38 months DXA total hip -0.2% versus -1.9% DXA distal forearm -2.8% versus 3.8% QCT cortical bone 5.3% versus -2.6%
52 Exercise maintains bone density at spine and hip 38 months DXA lumbar spine between group 4.1% QCT trabecular bone between group 8.8% QCT cortical bone between group 7.9%
53 Exercise maintains bone density at spine and hip 38 months DXA total hip between group 2.1% DXA distal forearm between group 1%
54 Exercise maintains bone density at spine and hip 38 months Spine Pain frequency and intensity reduced
55 Resent Research Can we just exercise at home and solve our bone mass problems?
56 Predictors of compliance with a home-based exercise program added to usual medical care in preventing postmenopausal osteoporosis: an 18-month prospective study Osteoporosis Int. (2005) 16:
57 Hone-based exercise programs 18 month compliance rate 17.8% Factors Contraindication for hormone replacement General physical function
58 What happens when the problems are not solved?
59 Bone Problems Kyphosis Spinal Hump Wrist Fractures Spinal Fractures Hip Fractures
60 Don t fall No fractures
61 Fall Prevention Be careful! Time Surfaces Contact Surfaces Exercise
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