Preventing and Managing Osteoporosis. Jessica Ewen, MS Exercise Physiologist Alaska Regional Hospital

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2 Preventing and Managing Osteoporosis Jessica Ewen, MS Exercise Physiologist Alaska Regional Hospital

3 What Is Osteoporosis? Osteoporosis is a disease of the bones that occurs when: You lose too much bone Make too little bone Both Causes bones to become weak leading to potential fractures Most common fractures occur in the hip, wrist or spine.

4 Osteoporosis Continued Osteoporosis means porous bone

5 How Common is Osteoporosis? About 54 million Americans have osteoporosis and low bone mass. Low bone mass Greater risk to develop osteoporosis in the future. After age 50, percentage of men and women estimated to break a bone due to osteoporosis 1:2 women 1:4 men

6 How does bone loss occur? Bone is living tissue. When we are young, body has ability to break down old bone and rebuild new bone. About age 30, bone mass stops increasing. Goal - Maintain bone mass Women - rate of bone loss increases for several years after menopause then slows down. Men bone loss slow progression Age most men and women lose bone at same rate.

7 Vertebral Compression Fracture Occur in nearly 700,000 patients each year Vertebrae weaken from osteoporosis progression Too much pressure is placed on weakened vertebrae and cracks

8 Silent Disease Without Symptoms Do not feel bones getting weaker Bone loss occurs without symptoms First Sings of Osteoporosis: -breaking a bone -getting shorter -upper back curving forward Potentially Resulting in: -trip to hospital -surgery -long-term disabling condition

9 How costly is Osteoporosis? Combination of all osteoporotic fractures cost the U.S. health care system about $19 billion/year. 2 million fractures Expected to increase to $25 billion/year in million fractures Diagnosed by clinical screening or having osteoporotic fracture. Emphasis on early prevention, detection and treatment.

10 Risk Factors Non-Modifiable Risk Factors Gender Age Ethnicity Family History History of Previous Fracture Modifiable Risk Factors Poor Diet Physical Inactivity Smoking Medications Low Body Weight

11 Diagnosis Bone Density Tests Measures how strong (dense) your bones are Compare your bones to bones of healthy adult Determine if you have Healthy bones Osteopenia Osteoporosis Helps physicians determine risk for future fractures Most important diagnostic test to predict fracture risk Who should get tested? Women age 65 + Men age 70+ Women 60 + at increase risk for osteoporosis-related fracture Physician deems it necessary Medicare usually covers cost of bone density test and followup test every 2 years for females and for males with risk factors for osteoporosis

12 Other Diagnostic tools Physical Examination Determine height loss / spine curvature X RAYS Can show breaks in spine Bone Scan/CT Scan/MRI Follow up to abnormal x-ray Laboratory Tests (Blood and urine) Blood-Calcium Levels 24-hour urine calcium measurement Thyroid function tests Parathyroid hormone levels Testosterone levels in men Vitamin D Biochemical markers

13 Prevention/Treatment/Management No cure for osteoporosis, but it can be PREVENTED and TREATED. Goal of Treatment To prevent Fractures (maintain bone health) Medication Nutrition Exercise Fall prevention

14 Medication (Treatment) Several medications are approved by the Food and Drug Administration for osteoporosis Talk to your doctor about which medication is right for you TYPES OF MEDICATIONS Bisphosphonates Estrogen Raloxifene Other Medications Calcitonin Teriparatide Denosumab

15 Bisphosphonates Alendronate, risedronate, ibandronate, zoledronic acid What they do Slow bone loss, reduce fracture risk, sometimes increase bone density. Decrease the activity of bone dissolving cells Side Effects Nausea, heartburn, stomach pain Muscle, bone, joint pain Flu-like symptoms Rare cases Deterioration of jawbone or unusual type of broken bone in femur FDA recommends periodic reevaluation

16 Estrogen Approved for treatment of menopausal symptoms and osteoporosis in women after menopause Should only be considered for women at significant risk for osteoporosis Side effects Breast cancer, stroke, blood clots, heart attack FDA recommends taking lowest effective dose for shortest periods possible Nonestrogen medication should be considered first

17 Raloxifene Approved in postmenopausal women Selective estrogen receptor modulator (SERMs) Nonhormonal drug with estrogen-like effects on skeleton Blocks estrogen effects on breast and uterus Slows bone loss and reduces the risk of fractures in spine No effect on hip fracture has been seen Side effects hot flashes and increased risk of blood clots in some women

18 Other Medications Calcitonin approved for treatment for osteoporosis in women who are at least 5 years post menopause Hormone produced by thyroid gland Slows bone loss and reduces the risk of spine fractures No serious side effects Teriparatide stimulates new bone formation. Daily injection up to 24 months Increases bone tissue and bone strength Reduce risk of spine and other fractures Approved for use in post menopausal women and men who are at high risk of fracture Side effects leg crams/dizziness

19 Other Medications Continued Denosumab Available as an injection every six months for men and postmenopausal women Side effects low calcium blood levels; infections; skin and jawbone problems; and pain in the muscles, back, arms, and legs

20 Nutrition Consume a diet that contains variety of: Calcium Vitamin D

21 Nutrition - Calcium Helps to build and keep bones strong 99% calcium is in our bones and teeth Lose calcium through nails, hair, sweat, urine and feces Body cannot produce calcium Need to get calcium from the food we eat Not enough calcium each day can lead to bone loss and low bone density, and possible broken bones

22 How much calcium do I need? Age 50 and Younger Age 51 and Older Women 1000 mg/day 1200 mg/day Age 70 and Younger Age 70 and Older Men 1000 mg/day 1200 mg/day

23 Where can I get my calcium? Low fat dairy products milk, yogurt, cheese Calcium fortified orange juice Dark green, leafy vegetables (broccoli, collard greens, bok choy) Sardines and canned salmon Almonds Foods fortified with calcium (tofu, cereals, orange juice) Supplements Aim to get recommended amount of calcium from food first No added benefit in taking more calcium than recommended

24 Vitamin D Also helps to protect your bones Needed to absorb calcium Adults need it to keep bones strong and healthy Not enough vitamin D each day can lead to bone loss, lower bone density, and possibly broken bones.

25 How much vitamin D do you need? Women and Men Under age of IU* daily Age 50 and older 800 IU* daily *IU international unit Some people need more vitamin D. Safe upper limit of vitamin D is 4,000 IU per day for most adults

26 Sources of Vitamin D Sunlight Skin makes vitamin D from UVB rays Cancer risk most people get vitamin D from other sources Food Fatty fish (wild caught mackerel, salmon, and tuna) Also added to milk and other dairy products, orange juice, soymilk and cereals Check food labels for % daily value of vitamin D (based on 400IU of vitamin D) Supplements Both vitamin D2 and vitamin D3 are good for bone health Check other supplements (multivitamins or medications) to see if they contain vitamin D

27 Exercise Goal of exercise during adulthood To gain bone strength and offset bone loss Exercise to preserve bone health during adulthood Weight-bearing exercises help build bone and keep them strong. Include activities that make you move against gravity while staying upright. high-impact dancing, high-impact aerobics, hiking, jogging/running, stair climbing, tennis Low impact elliptical training machines, low-impact aerobics, stair step machines, fast walking on a treadmill or outside

28 Exercise Muscle-Strengthening Exercises resistance exercises move body, a weight or other resistance against gravity Lifting weights elastic exercise bands Weight machines Lifting your own body weight Functional movements (standing and rising up on toes) *Yoga and pilates can improve strength, balance and flexibility Some exercises may not be safe for individuals with osteoporosis or those with increase risk of broken bones

29 Non-Impact Exercises Help to improve balance, posture and how well you move Help increase muscle strength and decrease the risk of falls and broken bones Balance exercises strengthen legs and test balance (Tai Chi) Posture exercises improve posture and reduce rounding or sloping shoulders can decrease chance of breaking a bone in the spine Functional exercises improve how well you move each day

30 How much exercise do you need? Weight-bearing exercises > 30 minutes on most days of the week. Muscle-strengthening exercises Balance, posture, and functional exercises Two to three days per week. Every day or as often as needed.

31 Fall Prevention Falls increase chances of fracturing bone in hip, wrist, spine or other part of the skeleton. Important to be aware of any physical changes that may affect balance or gait and discuss chances with health care provider. Impaired vision Impaired balance Chronic diseases that affect mental/physical functioning Changes in medications (sedatives and antidepressants)

32 Fall Prevention Tips to eliminate environmental factors that lead to falls: Outdoors Use a cane or walker for stability Wear rubber-soled shoes for traction Walk on grass when sidewalks are slippery In winter, carry salt or kitty litter to sprinkle on slippery sidewalks In winter, wear cleats on your shoes when walking on icy sidewalks and parking lots Be careful on highly polished floors that become slick and dangerous when wet Use plastic or carpet runners when possible

33 Tips to eliminate environmental factors that lead to falls: Indoors Keep rooms free of clutter, especially on floors Keep floor surfaces smooth but not slippery Wear supportive, low healed shoes, even at home Avoid walking in socks, stockings, or slippers Be sure carpets and area rugs have skid-proof backing or are tacked to the floor Be sure stairwells are well lit and that stairs have handrails on both sides Install grab bars on bathroom walls near tub, shower, and toilet Use a rubber bath mat in shower or tub Keep a flashlight with fresh batteries beside your bed Use a sturdy step stool with handrails and wide steps to get to hard to reach areas Add ceiling fixtures to rooms lit by lamps Consider purchasing a cordless phone and carrying it around with you to call for help if you do fall.

34 References National Osteoporosis Foundation National Institute of Arthritis and Musculoskeletal and Skin Diseases National Institute of Health Senior Health American College of Sport Medicine

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