heather eatson peterborough & area manager ontario osteoporosis strategy osteoporosis canada
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Heather Eatson Peterborough & Area Manager Ontario Osteoporosis Strategy Osteoporosis Canada. Ontario Osteoporosis Strategy. GOAL: To reduce fractures, morbidity, mortality and costs from osteoporosis… - PowerPoint PPT PresentationTRANSCRIPT
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Heather EatsonPeterborough & Area
ManagerOntario Osteoporosis
Strategy
Osteoporosis Canada
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Ontario Osteoporosis Strategy
GOAL:
To reduce fractures, morbidity, mortality and costs from osteoporosis…
through an integrated and comprehensive approach aimed at health promotion and disease management.
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Background
October 2000: “A Framework and Strategy for the Prevention and Management of Osteoporosis”
May 2002:“Osteoporosis Action Plan: An Osteoporosis Strategy for Ontario”
February 22nd, 2005: MOHLTC announced the launch of Ontario’s first Osteoporosis Strategy
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Identification of service gaps
Low public awareness
Inappropriate diagnostic testing
Lack of adequate management
Lack of clinically useful information
Lack of integrated post-fracture care protocols
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Osteoporosis Strategy: 5 Components
Health Promotion
1. Education programs for seniors and children:
– Increase seniors knowledge of osteoporosis and improving bone health
– Increase bone health education in schools
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Disease Management
2. Improve the use, and accuracy of bone mineral diagnostic testing (BMD) to increase early diagnosis of osteoporosis
3. Integration of fracture care, rehabilitation and osteoporosis management
4. Improve evidence based practice by Health Professionals
5. Research and evaluation
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What Is Osteoporosis?
Normal Bone Osteoporosis- (Porous Bone)
“Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.”1
1. Consensus Development Conference, JAMA 2001; 285: 785-95.
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Osteoporosis is a…
potentially crippling disease characterized by low bone
mass (density) and deterioration of bone tissue, a
condition that can lead to increased bone fragility and
risk of fracture- most often at the spine, wrist or hip.
Common Fracture Sites
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Overview on Osteoporosis
• Bone loss occurs without symptoms- The Silent Thief
• Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence
• 1.4 million Canadians live with Osteoporosis• Healthcare costs are estimated to be $1.9 billion
each year in Canada
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Hip fractures Hip fractures related to osteoporosis are a serious problem in older people
Approx. 25,000 hip fractures each
year in Canada (70% are osteoporosis related)
Hip fractures result in death in up to 20% and disability in up to 50% of those who survive
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• Osteoporosis is a major public health issue in Canada
• Osteoporosis is diagnosed and treated by a variety of specialists and family physicians
• Osteoporotic fracture cases are treated almost exclusively by orthopaedic surgeons
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The Evidence
• The majority of individuals who sustain fragility fractures are not receiving adequate osteoporosis management
– Less than 32% of fracture patients are investigated for osteoporosis.
Elliot-Gibson et al, 2004
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Fragility Fractures…
“ a fracture caused by injury that would be insufficient to fracture normal bone: the result of reduced compressive and/ or torsional strength of bone ”
– Minimal trauma– From standing height, or less
WHO, 1998
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Post- Fracture Care
Osteoporosis Screening Coordinators
• Increase the rate of referral of fragility fracture patients for assessment and treatment of OP, in order to reduce the risk of re-fracture
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What does OP Screening Coordinator do?
• Identify all men and women 50+ who have suffered a fragility fracture
• Assess patient for OP risk factors
• Encourage patient to see family physician for further OP assessment
• Educate identified patient
• Follow up evaluation- 3/6 month
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Long-Term Outcome Goals
• To increase preventive health behaviours in patients who have sustained a fragility fracture.
• Lower rates of subsequent fracture in this high-risk patient population, particularly hip fractures.
• Lower fragility fracture-related health care costs for the hospital and provincial government.
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Other Initiatives
• Low Volume Fracture Screening
• Fracture Fighters – Rehab component
• Break Through – Adult Education
• Bone Fit – Osteoporosis Fitness Cert.
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1 in 4 women 1 in 8 men
Osteoporosis: An Overview
Who Gets Osteoporosis?
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How strong are your bones?
• Healthy strong bones are critical in preventing fractures.
• Bone is renewed through a process in which old bone is removed and replaced by new bone.
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The Remodeling Process: How Bone Repairs Itself
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Normal Growth and Development of Bone
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• Genetics• Hormones• Nutrition• Physical activity
Four Major Factors that Contribute to Bone Health
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Risk Factors
• Certain factors appear to play a role in the development of Osteoporosis
• These are called “risk factors”
• There are both minor and major risk factors
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• Age 65• Vertebral compression
fracture• Fragility fracture after age 40• Family history of
osteoporotic fracture• Systemic glucocorticoid use
> 3 months
• Malabsorption syndrome• Primary
Hyperparathyroidism• Propensity to fall• Osteopenia apparent on x-
ray• Hypogonadism• Early menopause (before
age 45)
Diagnosis of Osteoporosis
Assessing Your Risk Factors: Major Risk Factors
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Diagnosis of Osteoporosis
Assessing Your Risk Factors: Minor Risk Factors
• Rheumatoid Arthritis• History of clinical
hyperthyroidism• Chronic anticonvulsant
therapy• Low dietary calcium
intake• Smoker
• Excess alcohol• Excess caffeine • Low body weight (<57 kg
or 125 lbs)• Weight loss > 10% of
weight at age 25• Chronic heparin therapy
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• Everyone over the age of 50 should assess their risk factors with their physician.
• Those individuals with at least one major or two minor risk factors should have a bone mineral density (BMD) test.
• Everyone age 65 and over should have a bone mineral density (BMD) test.
Review Your Risk Factors with Your Physician
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Diagnosis of Osteoporosis
Bone Densitometry
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Determining Your 10-year Absolute Fracture Risk
• Factors that influence this are:• BMD results• Age• Gender• Fracture history• Family history• Glucocorticoid (steroid) use
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Goals of Osteoporosis Management
• bone loss
• Maintain and/or increase bone density
• Reduce the risk of fracture(s)
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Slow bone erosion
Bisphosphonates include: Etidronate (Didrocal ) Alendronate (Fosamax,
Fosavance ) Risedronate(Actonel ) Zoledronic Acid (Aclasta)
SERMs-Raloxifene( Evista)Calcitonin (Miacalcin)
Speed up bone building
Parathyroid hormone (PTH ) Teriparatide (Forteo) a daily
subcutaneous injection for 18 months
Drug Therapies
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Age Daily Intake
Children (4 – 8) 800 mg
Adolescents (9 – 18) 1300 mg
Men & women (19 – 49) 1000 mg
Men & women (50+) 1500 mg
Pregnant or lactating women (> 18 years) 1000 mg
Calcium: OC’s Daily Recommended Intake
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Eat foods high in Calcium
• Dairy sources- whole and skim milk products, cheese, yogurt
• Fortified beverages• Fish bones-salmon,
sardines• Vegs- broccoli, bok
choy, kale
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Calcium Content of Some Foods
Milk – all 1cup 300mg
Yogurt ¾ cup 295mg
Cheese-hard 245mg
Ice cream ½ cup 80mg
Salmon/bones ½ can 240mg
Beans,baked ½ cup 75mg
Broccoli,cooked ¾ cup 50mg
Orange 1 med 50mg
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What are they made of?How do I choose one?What is the best way to take them?Which types are recommended?
Osteoporosis Prevention
Calcium Supplements: Questions & Answers
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Age Daily Intake
Men & women (19 – 50) 400 IU
Men & women (50+) 800 IU
Pregnant or lactating women (> 18 years)
400 IU
Osteoporosis Prevention
Vitamin D: OSC’s Daily Recommended Intake
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Where to find Vitamin D?
• Foods that are a natural source of Vit D – fish oils, eggs, chicken livers, salmon and sardines
• Foods fortified with Vit D - milk, margarine, some yogurts, some soy
beverages (check labels)• Vit D supplement, Multi vitamin, calcium
supplement with Vit D
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Physical Activity
• Regular weight bearing activity
• Resistance exercise
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Weight Bearing Exercise
Some examples of weight-bearing physical activities are…
• Walking, running, stair climbing, dancing
• Games and sports such as badminton, tennis, basketball, volleyball etc
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Resistance Exercises
These involve moving objects or your own weight to create resistance
• Common forms of resistance exercise include:• Weight – training with barbells, dumbbells,
household objects or wrist weights• Strength training with equipment in a gym or
health club
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Exercise with Caution
Check with a physician before starting any exercise program
• Don’t do exercise that causes pain• Warm up before exercise and stretch well after
exercising• Choose a facility, leader or trainer who knows the
exercise restrictions associated with osteoporosis• Choose an activity or program that is enjoyable
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Living with Osteoporosis
Some
Movements
Should be
Avoided
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Healthier bones - works with calcium & vitamin D to build strong bones
Better coordination and balanceImproved muscle strength and flexibilityIncreased endurance for daily activitiesImproved posture
Osteoporosis Prevention
The Benefits of Being Physically Active
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Balance & Falls Prevention
• 1 in 3 seniors 65+ falls each year• 1 in 2 seniors 80+ falls each year• The fall-related injury is 9x greater in seniors than
among those under 65• Vitamin D has been shown to reduce falls• Exercise has been shown to decrease falls as well
as the risk of falls if exercise includes activities aimed at improving balance.
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Personal costs after a Fall
• Pain and suffering
• Loss of independence
• Increased risk of falling- fall cycle
• Falls cause 90% of all hip fractures in seniors
• Almost half of all falls occur in/around home
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• Knowing/Assessing your risks• Bone Mineral Density Testing• Medication• Diet – Calcium and Vitamin D• Exercise – Wt Bearing and Resistance Training• Falls and Safety Prevention
The Key Messages for Osteoporosis
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Osteoporosis Canada
• 1-800-463-6842 (English)
• 1-800-977-1778 (French)
• www.osteoporosis.ca
• COPN (Canadian Osteoporosis Patient Network)