aging gracefully: bone health and diabetes
TRANSCRIPT
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Aging Gracefully
Christina Mitchell, MD
Penn Medicine Valley ForgeDivision of Endocrinology, Diabetes and MetabolismJune 8, 2016
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Learning Objectives• Learn what you can do to prevent
osteoporosis• Discover what treatment options are
available for you if osteoporosis is diagnosed
• Recognize the manifestations of diabetes• Identify ways to take control of your blood
sugar
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BONE HEALTH
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Why is bone health important?
• Osteoporosis is COMMON.
• Osteoporosis is SERIOUS.
• Osteoporosis is COSTLY.
• Osteoporosis can SNEAK UP ON YOU!
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Osteoporosis is COMMON• Osteoporosis is a condition
in which the bones become weak and can break more easily.
• 10 million Americans already have the disease.
• 34 million are at risk. • Estimates suggest that
about half of all women older than 50 will break a bone because of osteoporosis.
• Up to one in four men will too.
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Effects of Osteoporosis on Bone Health
Osteoporosis is decreased bone quantity and quality leading to weak bones
Normal Osteoporotic
NIAMS. Osteoporosis overview. 2009; NOF. Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2008; US Surgeon General’s Report. 2004.
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Osteoporosis is SERIOUS• Broken bones due to osteoporosis
are most likely to occur in the hip, spine and wrist, but other bones can break too.
• Broken bones can cause severe pain that may not go away.
• Some people lose height and become shorter.
• Osteoporosis may even keep you from getting around easily and doing the things you enjoy.
• 20% of seniors who break a hip die within one year from problems related to the broken bone itself or surgery to repair it. Many of those who survive need long-term nursing home care.
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Osteoporosis is COSTLY• In 2005, osteoporosis
was responsible for an estimated two million fractures and $19 billion in costs.
• By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs each year.
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Osteoporosis canSNEAK UP ON YOU!!!
• You can’t feel your bones becoming weaker.
• You could have osteoporosis now or be at risk for it without realizing it.
• Often, breaking a bone is the first clue that you have osteoporosis.
• A bone mineral density test can tell if you have osteoporosis before you have these symptoms.
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When should I be thinking about osteoporosis?
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In Your 30’s• No DXA yet• Exercise• Stop smoking• Restrict your alcohol
intake to fewer than 7 drinks/week
• Avoid excessive weight loss
• Calcium 1000 mg/day• Vitamin D 400 IU/day
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In Your 40’s
• Consider baseline DXA
• Exercise• Stop smoking• Restrict alcohol• Calcium 1000 mg/day• Vitamin D 400 IU/day
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In Your 50’s• Consider baseline DXA• DXA if you break a bone• If you have risk factors
– Family history– Low body weight– Cigarette smoking– Early menopause– Thyroid– Celiac disease– Depo-Provera– SSRI’s
• Calcium 1200 mg/day• Vitamin D 800-1000 IU/day
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In Your 60’s• DXA after age 65• Under age 65 with risk
factors• X-ray showing break or
bone loss• Height loss of ½ inch or
more in 1 year• Total height loss of 1.5
inches from your original height
• Calcium 1200 mg/day• Vitamin D 800-1000 IU/day
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In Your 70’s and Beyond
• DXA if you are a man older than 70
• Screening DXA for all women
• No data on when to stop DXA screening
• Calcium 1200 mg/day• Vitamin D 800-1000
IU/day
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Calcium and Vitamin D
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When a serving of milk
says it contains 30% calcium, how
do I know how much calcium
is in that serving?
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Treatment
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Factors to Consider When Choosing Treatment
• Your sex. • Your age. • If you have not reached menopause. • How severe your osteoporosis is. • Other health problems you may have.• Personal preference.
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Treatment Options
• Bisphosphonates– Alendronate
(Fosamax®)– Risedronate (Actonel®)– Zoledronate (Reclast®)– Ibandronate (Boniva®)
• Teriparatide (Forteo®)• Denosumab (Prolia®)
• Calcitonin nasal spray (Miacalcin®)
• Raloxifene (Evista®)• Estrogen
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DIABETES
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Diabetes is COMMON
• In 2012, 9.3% of the population had diabetes.
• Among Americans age 65 and older, the prevalence was 25.9%.
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Diabetes is SERIOUS
• 7th leading cause of death in the US
• Can lead to many complications
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Diabetes is COSTLY
• Total costs of diagnosed diabetes: $245 billon/year
• Medical expenditures are 2.3 times higher in people diagnosed with diabetes
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Early Diabetes is ASYMPTOMATIC
• Later symptoms include:– Fatigue– Increased thirst– Increased hunger– Increased urination– Blurry vision– Slow healing– Depression
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Risk Factors
• Gestational diabetes• Overweight• High blood pressure• Unhealthy cholesterol• Physical inactivity• Smoking• Unhealthy eating• Age, race, gender and family history
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Healthy Eating
• NOT ‘One size fits all’• Plate method:
Vegetables 50%!• Watch portions• Lean meats• Whole Grains• Start with a salad or soup• Water, Water, Water
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Physical Activity
• Aim for 30 minutes/day, 5 days/week– Activity tracker (10,000
steps/day)– Brisk walk– Dancing– Swimming or water aerobics– Indoor or outdoor bike– Light weights or resistance
bands
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Losing Weight
• Eat breakfast every day• Track your food intake (My Fitness Pal)• Weigh yourself regularly• Increase physical activity• Medication may be helpful
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Resources
• http://www.diabetes.org (ADA website)• http://www.shef.ac.uk/FRAX/• Bisphosphonates in the management of osteoporosis in postmenopausal
women. Uptodate.com.• National Institute of Arthritis and Musculoskeletal and Skin Diseases.
Osteoporosis overview. Reviewed May 2009. www.niams.nigh.gov/Health_Info/Bone/Osteoporosis/overview.pdf.
• National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation. 2008.
• US Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. October 14, 2004. Accessed July 6, 2009 at www.surgeongeneral.gov/library/bonehealth/.