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2 2 Overview of the Presentation Osteoporosis: An Overview Bone Basics Diagnosis of Osteoporosis Drug Therapies Risk Reduction Living with Osteoporosis

3 3 What is Osteoporosis? Osteoporosis: An Overview A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of two main features: bone density and bone quality (US National Institutes of Health)

4 4 What is Osteoporosis? Osteoporosis: An Overview Porous Bone Normal Bone

5 5 Osteoporosis: An Overview Who Will Fracture from Osteoporosis? 1 in 3 women 1 in 5 men

6 6 Osteoporosis: An Overview Common Fracture Sites hip wrist spine

7 7 Impact of Osteoporosis Osteoporosis: An Overview 4 cm 8 cm 12 cm Height Loss 3 FB s 2 FB s

8 8 Osteoporosis: An Overview Projected Number of Hip Fractures in Canada Proportion of population at age % 25% 85+ 1% 4% Estimated # of 23,375 88,124 hip fractures

9 9 Osteoporosis: An Overview Impact of Osteoporosis Approximately 30,000 hip fractures each year in Canada (70% are osteoporosis related) 1 in 4 people with a hip fracture will die within a year, 1 will return to independent living and 2 will require assisted living

10 10 Osteoporosis: An Overview Economic Burden of Osteoporosis in Canada Healthcare costs are estimated at $2.3 billion as of 2010* Acute care costs $1.2 billion When outpatient care, prescription drugs and indirect costs are added, the yearly total comes to over $2.3 billion *J.E. Tarride et al, The burden of illness of osteoporosis in Canada, Osteoporosis International (2012)

11 11 Bone Basics What is Bone?

12 12 The Remodeling Process: How Bone Repairs Itself Bone Basics

13 13 Bone Basics Normal Growth and Development of Bone

14 14 Four Major Factors that Contribute to Bone Health Bone Basics Genetics Hormones Nutrition Physical Activity

15 15 Diagnosis of Osteoporosis Assessment for Osteoporosis and Fracture Risk Who should be assessed? Women and men over 50 to identify those at high risk Anyone over 50 who has experienced a fragility fracture

16 16 Diagnosis of Osteoporosis Assessment for Osteoporosis and Fracture Risk How is the Assessment Done? Detailed history to identify risk factors for low BMD, future fractures and falls: Prior fragility fracture Parental hip fracture Glucocorticoid use Current smoking High alcohol intake (3 or more drinks per day) Rheumatoid arthritis Inquire about falls in past 12 months Inquire about gait and balance

17 17 Assessment for Osteoporosis and Fracture Risk cont. Physical examination Measure weight Screening for vertebral fractures: Measure height annually Measure rib to pelvis distance Measure occiput-to-wall distance Spinal x-ray indicated if there is evidence of vertebral fracture Assess fall risk by using Get-Up-and-Go Test

18 18 Diagnosis of Osteoporosis Who Should Get a BMD Test? All women and men 65 years or older Postmenopausal women and men with risk factors for fracture Younger men or women (under 50) with a disease or condition associated with low bone mass or bone loss

19 19 Bone Densitometry Diagnosis of Osteoporosis

20 20 Diagnosis of Osteoporosis How is Osteoporosis Diagnosed?

21 21 Diagnosis of Osteoporosis 10-year Absolute Fracture Risk (CAROC) Other factors in addition to (hip) BMD results are used to determine 10-year fracture risk These factors are age, sex, fracture history and glucocorticoid use

22 22 FRAX In 2008, the World Health Organization (WHO) launched FRAX, a web-based fracture risk assessment tool. In 2010 Canadian data were added In addition to femoral neck (hip) BMD, age, sex, fracture history and steroid use, FRAX also takes into account other risk factors to calculate the absolute 10-year risk of a hip fracture or other major osteoporotic fracture (spine, forearm, upper arm)

23 23 Drug Therapies How do Drug Therapies Work? Slow bone erosion Bisphosphonates Denosumab Raloxifene HT Calcitonin Speed up bone building Parathyroid hormone (hpth 1-34)

24 24 Drug Therapies Bisphosphonates Etidronate: Taken cyclically with calcium supplements Alendronate: Taken in a continuous daily or once weekly dose Risedronate: Taken in a continuous daily, once weekly or monthly dose Zoledronic acid: Taken once yearly by IV infusion

25 25 Denosumab Denosumab (Prolia ) was approved in Canada in 2010 for the treatment of postmenopausal women with osteoporosis Administered twice yearly by a healthcare professional Dosage 60mg/ml solution for injection under the skin

26 26 SERMs (Selective Estrogen Receptor Modulators) Raloxifene (Evista ) Drug Therapies Taken in a continuous daily dose

27 27 Prevention of menopausal symptoms Prevention of vertebral, hip and non-vertebral fractures in the presence of menopausal symptoms Drug Therapies Hormone Therapy (HT) Estrogen and Progesterone

28 28 Hormone Therapy (HT) Benefits and Risks Drug Therapies Benefits Menopausal symptoms Bone loss and fracture Colon cancer Risks Cardiovascular disease (heart attack and stroke) Blood clots Breast cancer

29 29 Drug Therapies Calcitonin Salmon Calcitonin (Miacalcin and generic) Approved in Canada in 1999 for treatment of osteoporosis in women five years postmenopause Taken one spray each day in one nostril, alternating nostrils daily

30 30 Parathyroid Hormone (PTH) Teriparatide (FORTEO ) Drug Therapies Approved in Canada for treatment of severe osteoporosis in postmenopausal women and men at high risk of fracture or who have failed to respond to or are intolerant of bisphosphonates; also GIOP Self-injected each day for a period of 24 months maximum

31 31 Osteoporosis Risk Reduction Choosing a Bone Healthy Lifestyle

32 32 Osteoporosis Risk Reduction Calcium Must Always be Available to the Body Meeting your daily calcium requirement Body does not take calcium from bones Not meeting your daily calcium requirements Calcium taken from bones to be used in body

33 33 Osteoporosis Risk Reduction Calcium: OC s Daily Recommended Intake Age Children (4 8) Adolescents (9 18) Men & women (19 50) Men & women (50+) Pregnant or lactating women (> 18 years) Daily Intake 1000 mg 1300 mg 1000 mg 1200 mg 1000 mg

34 34 Osteoporosis Risk Reduction Vitamin D: OC s Daily Recommended Intake (IU) Age Daily Intake Men & women (19 50) Men & women (50+) Pregnant or lactating women (> 18 years)

35 35 Eat foods high in calcium Ensure proper calcium absorption Ensure adequate vitamin D Osteoporosis Risk Reduction Good Nutrition for Healthy Bones Eat a balanced diet with adequate protein, and fruits and vegetables

36 36 Osteoporosis Risk Reduction Calcium Supplements: Questions & Answers What are they made of? How do I choose one? What is the best way to take them? Which types are recommended?

37 37 Osteoporosis Risk Reduction The Benefits of Being Physically Active Better coordination and balance, falls prevention Improved muscle strength and flexibility Healthier bones - works with calcium and vitamin D to build strong bones Increased endurance for daily activities Improved posture

38 38 Osteoporosis Risk Reduction What Type of Exercise Helps Bone? Weight bearing Resistance

39 39 The Physical Impact of Osteoporosis Living with Osteoporosis

40 Living with Osteoporosis Some Movements Should be Avoided 40

41 41 Living with Osteoporosis The Psychological Impact of Osteoporosis

42 42 Living with Osteoporosis Advice for People Living with Osteoporosis Take charge of your health Find ways to cope with pain Learn how to manage difficult movements Consider your daily needs Get emotional support Seek out professionals who can help

43 43 Osteoporosis Canada Our Vision Canada without osteoporotic fractures

44 44 Osteoporosis Canada s mission is to work towards a future where all Canadians will Be knowledgeable about osteoporosis Be empowered to make informed choices about their bone health Have access to the best osteoporosis care and support Benefit from research into the prevention, diagnosis and treatment of osteoporosis

45 45 Get Involved Make a donation Become a member Add your name to COPN Go to an event Become a volunteer Participate in a Break Through program

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