Osteoporosis: Who, What, When, Why, and How

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1 Osteoporosis: Who, What, When, Why, and How Doris J. Uh, PharmD, AE-C Pharm 445 September 20, 2005 Objectives define osteoporosis (what) determine high risk groups (who, when) review modifiable, non-modifiable risk factors (why) review treatment, prevention measures (how) review current screening techniques and procedures Bone Facts 2 major types of bone: cortical vs.trabecular normal bone physiology: resorption/formation major bone loss begins 4 th -5 th decade of life trabecular bone loss > cortical bone loss females lose ~50% trabecular, ~35% cortical bone in their lifetime males lose ~30% trabecular, ~20% cortical bone in their lifetime 1

2 Peak bone mass occurs by age 20-30! Peak Bone Mass Peak Bone Mass Normal bone (left) is dense and strong whereas osteoporotic bone (right) is thin and brittle and can fracture easily. Images courtesy of the National Osteoporosis Foundation 2

3 So, what is osteoporosis? As defined by the NIH in the 2000 Osteoporosis Consensus Statement: Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. html.htm Simply put: Osteoporosis is a disease in which bones become fragile and more likely to break. 3

4 Prevalence of Osteoporosis ~10 million individuals in the U.S. are osteoporotic (80% are females) ~18 million individuals are osteopenic Result in 1.5 million fractures annually 1/5 women, 1/8 men >50 yrs have some risk of fractures (hip, vertebrae, wrist) Estimated fracture-related expenses: $13.8 billion per year $38 million per day Bone strength is determined by 2 characteristics: 1) bone density (peak bone mass/bone loss) 2) bone quality (structural make-up and composition of bone, damage accumulation, turn-over) Who is at risk of developing osteoporosis? 4

5 EVERYONE! Non-Modifiable Risk Factors women (80% in women) age 65 years post-menopausal Asian or Caucasian African-Americans and Latinos are at lower risk small, thin frame family history of osteoporosis history of fractures medical conditions that may predispose individuals to greater, more rapid bone loss Modifiable Risk Factors Diet elemental calcium (Ca ++ ), vitamin D alcohol anorexia nervosa, bulimia Lifestyle exercise (weight-bearing) smoking Medications Fall Prevention throw rugs hand rails 5

6 Treatment calcium supplementation/vitamin D mg Ca ++, IU Vit D daily bisphosphonates SERMs calcitonin Recommended Calcium Intakes* Ages Amount mg/day Birth - 6 months months - 1 year or older 1200 Pregnant & Lactating *Source: National Academy of Sciences (NAS) Comparison of Calcium Salts Carbonate: 40% Tri-phosphate: 38% Citrate: 21% Lactate: 13% % Elemental Calcium (Ca ++ ) Gluconate: 9% Calcium Carbonate Tricalcium Calcium Calcium Phosphate Citrate Lactate Various Calcium Salts Calcium Gluconate 6

7 Prevention calcium supplements/vitamin D bisphosphonates SERMs(HRT) weight-bearing exercise diet fall prevention measures Bone Density Screening measures bone mineral density (BMD) of trabecular bone BMD is measured in grams/cm 2, but most often interpreted using standard deviations (SD) SD readings described by T-score, Z- score What s a T-score? Z-score? T-score: # of SD above or below the average BMD value for young, healthy Caucasian women Z-score: # of SD above or below the average BMD for age- and gender-matched controls 7

8 quick review of bell curve, SD Interpreting Bone Mineral Density Scores Osteopenia: T-, Z-score < < 2.5 Osteoporosis: T-, Z-score < 2.5 Results should be calibrated to match age, gender, race (when possible) 8

9 3 different technologies currently being used: 1) Single X-Ray (SXA) e.g. OsteoAnalyzer Used for screening purposes only, not diagnostic Measures heel bone Wet (water bath) or dry Exam time: up to 4 minutes Radiation dose: 10x < than standard chest x-ray Caution: pregnant patients 3 different technologies currently being used: 2) Ultrasound (US) e.g. QUS -2 Used for screening purposes only, not diagnostic Measures heel (sometimes tibia, patella) Wet (gel or water, depending on device) Exam time: up to 2 minutes Portability! 3 different technologies currently being used: 3) Dual X-Ray (DEXA) e.g. PIXI Used for diagnosis Measures hip, spine Dry Exam time: 5 seconds Caution: pregnant patients 9

10 Example of screening event: welcome patient, obtain consent gather patient information (e.g. family history, past medical history, assessment of risk factors, etc.) screening discuss results of screening, assessment of risk factors pharmacologic, non-pharmacologic recommendations (if necessary) follow-up, referral (if necessary) Education is the key to preventing osteoporosis! With your help, $$BILLIONS$ of dollars can be saved every year! Resources

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