osteoporosis dr.hazar ibrahim yacoub pharmacy college.ksu

Osteoporosis

Dr.Hazar Ibrahim Yacoub

Pharmacy College .KSU

FACTS

AND

FIGURES

NATIONAL STATISTICS

Osteoporosis affects more than 28 million Americans; 80% of them are women and 20% men

1 in 2 women and 1 in 8 men over the age of 50 will develop osteoporosis

Thin bones are the cause of 1.5 million fractures a year

FLORIDA STATISTICS

Over 2.1 million individuals have osteoporosis or low bone mass

1998 - 22,630 residents had hip fractures

1998 - Hospital charges for hip fractures were $477.8 million with 80% discharged to nursing homes

VERTEBRAL FRACTURES

Can lead to chronic back pain, loss of height, protruding stomach, stooped posture - back pain is the most common complaint

At age 50, a woman has a 50% chance of an osteoporosis-related fracture during her life

Loss of ability to do daily living activities (cooking, cleaning, getting dressed, etc.)

A woman’s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer

15-20% need long-term care facilities

There is a 20% increased risk of death during the first year following a hip fracture

HIP FRACTURES

MYTHS OR FACTS

Men do not get osteoporosis

Diet can provide all of the calcium a body needs

If your grandmother had osteoporosis, you will get it too

Dairy products are the only source of calcium

Activity – Myths or Facts About Osteoporosis

MYTHS OR FACTS

If you have osteoporosis, you can do nothing about it

Our bones stop growing when we reach full height (about age 20)

Susceptibility to fractures can indicate osteoporosis

Low calcium intake during adolescence can cause osteoporosis later

Exercise is dangerous for older people

MYTHS OR FACTS

MEN & OSTEOPOROSIS

Lifetime risk of getting osteoporosis is the same as a man’s lifetime risk for prostate cancer

Nationally, one in eight men over 50 will get osteoporosis

By age 75, one in three men will get osteoporosis

ALL

ABOUT

BONES

OSTEOPOROSIS: “The Silent Disease”

“Osteo” is Latin for “bone”

“Porosis” means “porous or full of holes”

“Osteoporosis” means “bones that are full of holes”

Osteoporosis can develop without symptoms

You may not know you have the disease until a bone fractures

TYPES OF BONE

(1) Cortical – is hard, compact, dense bone (example: mid-section of larger, long-bones of arms and legs)

(2) Trabecular – is spongy, porous and flexible bone (example: end of the wrist, hip and the spine)

Activity - Understanding Our Bones

HEALTHY BONE

Bone is living tissue, which is constantly being broken down and rebuilt, a process called remodeling

Bone is renewed like skin, hair and nails

OSTEOPOROTIC BONE

The loss of living bone tissue makes bones fragile and more likely to fracture

Note: arrow points to micro - fracture

BONE “REMODELING”

Resorption-removes old bone

Formation-replaces old bone with new bone

OSTEOCLASTS-PHASE 1

Cells called osteoclasts (think “C” for chiseler) seek out old bone or damaged bone tissue and destroy it, leaving small spaces (resorption)

OSTEOBLASTS – PHASE 2

Cells called osteoblasts (think “B” for builder) use minerals like calcium, phosphorus, and vitamin D to fill in the spaces with new bone (formation)

BUILD YOUR BONE BANK

You build bone until about age 30

Steps to building healthy bones include:

Calcium & vitamin D

Limit Caffeine & Alcohol

Exercise

Don’t Smoke

BONE BANK DEPOSITS

From birth through adolescence, new bone is built faster than old bone is removed

In mid-life, depending on lifestyle and other factors, bone removal can achieve a balance with bone formation

After menopause, bone removal may accelerate due to a decrease in estrogen

BONE LOSS & AGING

The first 5-15 years after menopause a woman can lose approximately 25 - 30 % of trabecular bone & approximately 10 – 15 % of cortical bone

Bone loss often occurs without symptoms or warning signs

CHANGES IN BONE MASS

After menopause, bone removal accelerates due to a decrease in estrogen

EARLY WARNING SIGNS

History of broken bones as an adult

Unexplained back pain – subsides after a couple of weeks

Loss of more than an inch in height

Posture has become stooped

OSTEOPOROSIS

Normal Posture Dowager’s Hump

CLARIFICATIONS

There is no relationship between osteoporosis and arthritis

Osteoporosis is a generalized bone disease that causes porous bones, usually not causing symptoms until a fracture occurs

Arthritis refers to a group of diseases and conditions that affect the joints and are usually painful

Osteoarthritis is a degenerative type of arthritis affecting the hip, knees and tips of the fingers—no relationship to osteoporosis

CLARIFICATIONS

Steroids are sometimes used to treat arthritis, and using steroids may put a person at risk for osteoporosis

There is no clear relationship between dental cavities and osteoporosis

Someone with osteoporosis may have weakened jawbones and be prone to losing teeth

CLARIFICATIONS

RISK

FACTORS

RISK FACTORS - CAN’T CONTROL

Gender: Females are usually diagnosed with osteoporosis at four times the rate of males. Bone mass in males is approximately 15-20% higher than females

Small Boned & Thin: may result in smaller bones with a lower bone density

Activity - Risk Factor Worksheet

RISK FACTORS - CAN’T CONTROL

Race/Ethnicity: Women, especially Caucasian and Asian women with thin frames are at greater risk

African American women have a higher peak bone mass (10%) than Caucasian women, but other factors such as nutrition, exercise, certain diseases, and medications may increase their risk of osteoporosis

RISK FACTORS - CAN’T CONTROL

Heredity: your family history may put you genetically at risk or may be a result of family members sharing the same environment, exercise, and nutritional habits

Menopause or several months without periods: bone loss begins to exceed bone formation, due to a decrease of estrogen

Age: In your 40’s you start to lose bone faster than you build new bone. The accumulated loss of bone puts an older person at higher risk

RISK FACTORS - CAN’T CONTROL

RISK FACTORS – CAN CONTROL

Calcium Rich Diet:

milk, cheese, yogurt

Weight Bearing Exercise:

walk, bike, run

Vitamin D:

sunshine, multivitamin, fortified food

RISK FACTORS – CAN CONTROL

Caffeine: Recommendation-No more than 2-3 cups of caffeine beverages per day

Cola, coffee and chocolate all contain caffeine

Alcohol: consuming more than one alcoholic drink per day is associated with risk of low bone mass

RISK FACTORS – CAN CONTROL

Eating Disorders: anorexia nervosa or bulimia can lead to malnutrition and bone loss

Smoking: causes lower bone density

Immobility: extreme lack of exercise can lead to bone loss

RISK FACTORS – CAN CONTROL

OTHER RISK FACTORS

Steroids - cause increased bone breakdown and decreased bone replacement

Prolonged hyperthyroidism – can cause increased risk of bone loss

Thyroid hormone - (in excess) – acts on bone cells to increase resorption

Diuretics – some types of diuretics may increase excretion of calcium in the urine

Kidney failure – affects the metabolism of calcium, phosphorous and vitamin D

Chronic hepatitis – chronic liver disease may cause bone loss in several different ways

Intestinal disease – some can affect the absorption of vitamin D & calcium

OTHER RISK FACTORS

DRUGS-MAY CAUSE BONE LOSS

Cortisone Isoniazid

Seizure drugs Lithium

Cyclosporine Heparin

Methotrexate

Some Hormones Lupron®

Zoledex® Ask your healthcare provider

PREVENTION

CALCIUM’S FUNCTION

Blood clotting (control bleeding)

Regulates heart beat

Muscle function

Nerve transmission

Bone formation

Age

1-3 years

4-8 years

9-18 years

19-50 years

over 50 years

Milligrams (mg)

500

800

1,300

1,000

1,200- 1,500

DAILY CALCIUM REQUIREMENTS

National Academy of Science

CALCIUM NEEDS

Adolescents-may lack calcium due to high fat snacks with empty calories, soda and dieting

Eating Disorders-anorexic or bulimic teens lack calcium and may develop osteoporosis at an early age

Older Adults-may have increased calcium need due to poor absorption

SERVING SIZE

1 ½ cup (12 oz) of liquid is the size of soda-pop can

1 cup (8 oz) of food is the size of large handful

½ cup (4 oz) of food is about half a large handful

3 (oz) of cooked meat, fish, poultry is about the size of a deck of cards

A serving size is the amount of the food after it is cooked

Fat: Sparingly

Dairy: 2-3

Protein 2-3

Vegetable: 3-5

Fruit: 2-4

Grains: 6-11

SERVINGS-INCLUDE CALCIUM

Activity - Calcium Worksheet or Calcium Card Game

Food Serving

1 oz cream cheese: 20 mg

1 hard boiled egg: 30 mg

½ cup cooked broccoli: 40 mg

½ cup cottage cheese: 80 mg

1 oz cheddar cheese: 205 mg

6 oz calcium-fortified OJ: 250 mg

1 cup milk: 300 mg

1 cup fruit yogurt: 345 mg

3 oz sardines with bones: 370 mg

8 oz vegetable lasagna: 450 mg Activity - Results to Calcium Card Game

CALCIUM IN FOODS

Serving size & numberof servings

FOOD LABELS

Calories, Total & Saturated fat in grams, Cholesterol & Sodium, Fiber, Sugars, & Protein in grams

% Daily Value (DV)

Daily Amount

READING FOOD LABELS

Calcium content may vary greatly between different brands of food

The percentage of calcium in a food is based on 1000 milligrams. A food containing 20% calcium = 200 mg

A food containing 10-19% of calcium is a good source; 20% of calcium or higher is a very good source

Activity – Nutrition Facts

% DAILY VALUE OF CALCIUM

FOOD %DV

Fruit yogurt 35%

Oatmeal 10%

Turnip Greens 20%

Total % DV = 65%

Add % DV by reading food labels to ensure you get the recommended daily calcium

Activity - Foods and Calcium

LACTOSE-INTOLERANCE

Individuals who have difficulty digesting the sugar found in milk, called lactose

Start with small portions of food such as milk--gradually Increase portions

Eat dairy foods in combination with other foods

Many hard cheeses have less lactose than milk

Commercial lactase preparations aid digestion

CALCIUM SUPPLEMENTS

Read Labels--several different types of calcium supplements available

Avoid -“natural” calcium such as bone meal or dolomite-some contain toxic lead or mercury

“Elemental calcium” - is the type of calcium the body absorbs

ELEMENTAL CALCIUM

Kinds of Calcium % Elemental Calcium

Calcium carbonate 40%

Calcium phosphate (tribasic) 39%

Calcium phosphate (dibasic) 30%

Calcium citrate 21%

Calcium lactate 13%

Calcium gluconate 9%

Example, a 500 mg calcium tablet may only contain 45-200 mg of elemental calcium

CALCIUM TIPS

Do not take more than 500 mg of calcium at a time or 2000 mg total per day

Your body can absorb only about 500 to 600 mg at a time

Example: take one tablet at breakfast and another at dinner

CARBONATE CITRATE

Needs acid to dissolve and for absorption

Less stomach acid as we age

Take “at” or “after” meals when more stomach acid

Doesn’t require stomach acid for absorption

May be taken between meals

May cost more

TEST YOUR CALCIUM TABLET

Put a calcium tablet in a cup of half water and half vinegar. Stir every 5 minutes. If it doesn’t dissolve in 30 minutes, it probably won’t dissolve in your stomach

VITAMIN D

CALCIUM

VITAMIN

•Vitamin D is necessary for calcium to be absorbed

•Multivitamin or calcium tablets may contain 400 IU daily (don’t exceed 800)

•Vitamin D is in milk (100 IU in 1 cup)

EXERCISE!

Walking

Dancing

Gardening

Tennis

Jump Rope

Volleyball

SkatingActivity – Exercise Guide

ENVIRONMENTAL SAFETY

PREVENT

PAINFUL

FALLS

Activity – Environmental Safety

Cartoon

BONE

DENSITY

TESTING

WHO NEEDS TESTING?If you have major risk factors for osteoporosis

If you have a family history of osteoporosis

If you have a personal history of fractures after age 45

If you are on prolonged use of steroids

If you are postmenopausal, and not on estrogen replacement therapy

Consult your healthcare provider

SCREENING TESTS

Portable scanners:

SXA - (Single Energy X-ray Absorptiometry), measures wrist or heel

pDXA - (Peripheral Dual Energy X-ray), measures wrist or heel

RA - (Radiographic Absorptiometry), x-ray of hand that is compared to a small metal wedge

QCT - (Quantitative Computed Tomography), measures the spine

Ultrasound - sound waves to measure the heel, shin, and kneecap

SCREENING TESTS

DXA-BONE DENSITY TESTING

WHAT IS A DXA?

DXA (Dual Energy X-ray Absorptiometry) is the “gold standard”

Measures bone density in the hip, spine, and forearm

Painless, non-invasive, requires no injections

Takes 10 - 20 minutes

WHAT IS A T-SCORE?

World Health Organization T-score is comparing the average bone density to that of healthy young Caucasian women

T-Score Diagnosis

0 to –1 “Normal”

-1 to –2.5 “Osteopenic”- low bone mass

-2.5 or lower “Osteoporotic”

MEDICATION

MEDICATIONS

Estrogen - “ERT”

Fosamax® - Alendronate

Actonel® - Risedronate

Evista® - Raloxifene

Miacalcin® - Calcitonin

ESTROGEN

Most cost-effective prevention for osteoporosis

Slows bone loss and may slightly increase bone mass

Estimated to reduce hip fracture by 30-50%

EVISTA (Raloxifene)

SERMS-Selective Estrogen Receptor Modulators-designer drugs

SERMS act like estrogen but doesn’t stimulate breast or uterine tissue

Evista is the first and only SERM approved for the prevention and treatment of osteoporosis

BISPHOSPHONATES

Fosamax and Actonel

Specifically designed to affect the skeleton, increase bone density & reduce number of fractures

Must be taken correctly - on an empty stomach, first thing in the morning with glass of plain water, fasting, & remain upright for 30 minutes

FOSAMAX ® (Alendronate)

Approved for prevention and treatment

Approved for treatment of steroid- induced osteoporosis in men and women

Prevention – 5 mg daily

Treatment – 10 mg daily or 70 mg once weekly (for men and postmenopausal women)

ACTONEL ® (Risedronate)

Weekly 35 mg is approved for prevention and treatment of osteoporosis in postmenopausal women, and for women who have osteopenia, but are not yet postmenopausal

Daily 5 mg dose is approved for prevention and treatment of glucocorticoid-induced osteoporosis in women

Actonel may be given to males at the discretion of the Health Care Provider

MIACALCIN (Calcitonin)

Is a naturally occurring hormone involved in calcium regulation and bone metabolism

Available by injection or nasal spray

PUTTING

IT ALL

TOGETHER

SUMMARY

Calcium Rich Diet

Vitamin D

Prevent Falls

Weight-Bearing Exercise

Don’t Smoke

Minimize Caffeine & Alcohol

Testing & Medication if Needed

SUMMARY

HEALTHCARE PROVIDERS

Healthcare providers are the best source of information about osteoporosis and medical options

Please complete evaluation form-thank you!

Activity – Affirming a Positive Change