OTHER CHRONIC OTHER CHRONIC DISEASES DISEASES

& & CONDITIONSCONDITIONS

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“Our health always seems much more

valuable after we lose it.”

- Author Unknown -

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DIMENSIONS OF DIMENSIONS OF CHRONIC DISEASESCHRONIC DISEASES

EPIDEMIOLOGICAL OVERVIEWAffect women more often than they do men

Osteoarthritis, Rheumatoid Arthritis, Alzheimer Disease

1 in 2 women age 50+ will have an osteoporosis-related fracture in her lifetime

Diabetes affects 8.2% of all U.S. women

Lupus afflicts women 9X more often than men

Hypothyroidism is 50X more common in women

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ETHNIC & SOCIOECONOMIC DIMENSIONS

White and Asian women have osteoporosis more often than African American women

African American are more likely than white women to die following a hip fracture

Asian American women have lower rates of arthritis

African American women have highest prevalence rates of diabetes

African women have higher prevalence rate of lupus than white women

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ECONOMIC DIMENSIONSEstimated Annual Costs

CONDITION COSTHip Fractures $42 billion, worldwideArthritis $22 billion, U.S.Diabetes $50 billion, U.S.Alzheimer’s Disease $50 billion, U.S.

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OSTEOPOSROSISOSTEOPOSROSISHEALTHY BONE vs. OSTEOPOROTIC

BONE

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NON-MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS

Being female

Increased age/postmenopausal

Small frame and thin-boned

White or Asian

Family history of osteoporosis or fractures

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MODIFIABLE RISK FACTORS FOR OSTEOPOROSIS

Diet low in Calcium and Vitamin D

Sedentary lifestyle

Cigarette smoking

Excessive use of alcohol

Certain medications

Glucocorticoids, Anticonvulsants

Amenorrhea

Anorexia nervosa or bulimia

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SCREENING & DIAGNOSIS FOR OSTEOPOROSIS

All postmenopausal women younger than age 65 who have one or more additional risk factors for osteoporosis besides menopause

All women age 65 and older

Postmenopausal women with fractures

Women who are considering therapy for osteoporosis or who want to monitor the effectiveness of certain osteoporosis treatments

Women Who Should Be Tested:

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Bone Mineral Density Tests:

Dual-energy x-ray absorptiometry (DXA or DEXA)

Single-energy x-ray absorptiometry (SXA)

Peripheral dual-energy x-ray absorptiometry (pDXA)

Radiographic absorptiometry (RA)

Dual-photon absorptiometry (SPA)

Single-photon absorptiometry (SPA)

Quantitative computed tomography (QCT)

Ultrasound

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TREATMENT & PREVENTION FOR OSTEOPOROSIS

Adequate supply of calcium

Vitamin D

Participate in weight-bearing and muscle-strengthening exercises

Estrogen replacement therapy

Drugs: Raloxifene, Fosamax, Calcitonin

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ARTHRITISARTHRITISHEALTHY JOINT vs. OSTEOARTHRITIC

JOINT vs. RHEUMATOID ARTHRITIS

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RISK FACTORS FOR ARTHRITISGender: women are 2-3X greater risk than men

Obesity

Infectious Diseases: Lyme Disease

Occupations

Excessive physical activity: Repetitive joint use

Hormonal levels: Higher estrogen levels

Diet: coffee and tea

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DIAGNOSIS FOR ARTHRITISNo single test can diagnose arthritis

Family history and physical exam to check joints, reflexes, and muscle strength

Radiographs

Blood tests

Joint aspiration

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TREATMENT AND PREVENTION FOR ARTHRITIS

Maintaining weight

Avoid injuries during physical activity

Avoiding contact sports

Avoid repetitive joint motion, wear braces, pads, proper shoes

Prevent lyme disease = vaccine, insect repellent

Drugs = NSAIDs, Corticosteroids, Hyaluronic Acid, Immunosuppressants

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DIABETESDIABETESTYPES OF DIABETES

Type 1: Insulin-Dependent Diabetes Mellitus (IDDM)

Type 2: Non-Insulin Dependent Diabetes Mellitus (NIDDM)

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SYMPTOMS FOR DIABETESType 1:

Frequent urination

Unusual thirst

Extreme hunger

Unusual weight

Extreme fatigue

Irritability

Type 2:

Any Type 1 symptoms

Frequent infections

Blurred vision

Cuts/bruises that are hard to heal

Numbness of hands/feet

Recurring skin, bladder infections

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RISK FACTORS FOR DIABETES

Having a first-degree relative with diabetes

Being overweight

Having hypertension

Abnormal high-density lipoprotein (HDL)

Racial groups: African American, Hispanics, Native Americans

Women who had gestational diabetes or delivered a baby more than 9 pounds

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COMPARISON OF LIKELIHOOD OF DIABETES ACROSS RACIAL

GROUPS

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COMPLICATIONS OF DIABETESHeart disease

Stroke

High blood pressure

Retinopathy

End-stage renal disease

Damage of the nervous system

Lower-extremity amputations

Periodontal disease

Congenital malformations

Neonatal mortality

Macrosomia

Diabetic ketoacidosis

Susceptibility to infections and illness such as pneumonia

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DIAGNOSIS OF DIABETES

Routine Tests:Fasting plasma glucose test

Oral glucose tolerance test

Blood sugar level above 140 mg/dL on at least two occasions

Normal sugar level = 70-110 mg/DL

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TREATMENT & PREVENTION OF DIABETES

Daily insulin injections

Diet control

Physical activity

Home blood glucose testing several times a day

Oral medications

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AUTOIMMUNE AUTOIMMUNE DISEASESDISEASES

FEMALE-TO-MALE RATIO OF CERTAIN AUTOIMMUNE DISEASE

Multiple Sclerosis 1.5 : 1Type I Diabetes 2 : 1Rheumatoid Arthritis 3 :1Scleroderma 3 : 4.1Grave’s Disease 7 : 1Sjogren’s Syndrome 9 : 1Hashimoto’s Disease 50 : 1

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CHARACTERISTICS OF LUPUSImmune system forms antibodies that target healthy tissues and organs

Primarily a disease of young women of childbearing age

Affects women 9X more often than men

Affects American women 3X more often than white women

Types

Cutaneous Lupus

Systemic Lupus

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SYMPTOMS OF LUPUSPainful, swollen joints

Skin rash

Butterfly-shaped across face

Triggered by sun exposure

Arthritis

Seizures

Psychosis

Raynaud’s phenomenon

Extreme fatigue

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RISK FACTORS OF LUPUSExact cause is unknown

Genetic factors

Occurs within families

Environmental factors

Infections

Exposure to sunlight

Stress

Certain medications

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DIAGNOSIS OF LUPUS

Take note of symptoms

Skin rash, joint pain, chest pain, seizures, photosensitivity, review of history of medications

Blood count

Antinuclear antibody test (ANA)

Urinalysis

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TREATMENT AND PREVENTION OF LUPUS

Avoid sun exposure and use sunscreen

Exercise

Non-steroidal anti-inflammatory drugs (NSAIDs)

Corticosteroids

Antimalarial agents

Immunosuppressant drugs

Steroids

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THRYOID DISEASESymptoms of Hashimoto’s Disease and

Graves’ DiseaseHASHIMOTO’S DISEASE (Hypo) GRAVES’ DISEASE (Hyper)

• Weight gain • Weight loss

• Mental and physical slowing • Nervousness and irritability

• Dry skin • Increased energy expenditure

• Sensitivity to cold • Heat intolerance

• Constipation • Diarrhea

• Goiter • Bulging of the eyes

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RISK FACTORS OF THYROID DISEASE

Inherited

Family history of a family member with thyroid disease

Hashimoto’s occurs with greater frequency in people older than 60 years of age

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DIAGNOSIS OF THYROID DISEASE

Baseline testing to monitor thyroid function

Thyroid-stimulating hormone (TSH) test

Blood tests measuring levels of thyroxine (T4) can confirm presence of disease

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TREATMENT AND PREVENTION OF THYROID

DISEASE

Annual check-ups

Thyroxine for Hashimoto’s Disease

Antithyroid drugs for Graves’ Disease

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ALZEIMER’S DISEASEA Women’s Risk Doubles Every Five Years

Beyond Age 65

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RISK FACTORS FOR ALZEIMER’S DISEASE

Age

Genetic background

Lifestyle

Severe or repeated head injuries

Lower education levels

Environmental agents

Familial Alzheimer’s Disease (FAD)

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SYMPTOMS OF ALZEIMER’S DISEASE

Memory loss

Decline in ability to perform simple tasks

Think less clearly

Affected language and reasoning skills

Lack of ability to make judgments

Personality changes

Emotional outbursts

Wandering and agitation

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TREATMENT AND PREVENTION OF ALZEIMER’S

DISEASEControlling symptoms with drugs

Haloperidol (aggressive behavior)

Sertraline (depression)

Zolpidem, Diphenhydramine (insomnia)

Alzheimer’s Drugs

Cogrex, Aricept, Exelon

Antioxidants: Vitamin E (reduce nerve cell damage)

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SUMMARY Of MEDICATIONS USED TO TREAT CHRONIC CONDITIONS

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INFORMED INFORMED DECISION MAKINGDECISION MAKING

SECONDARY PREVENTION FOR SENIORS

Annual blood pressure screening

Cholesterol screening

Height:Weight Measurements

Clinical breast examinations annually

Cognitive function tests

Behavioral Assessment

Routine Mammography screening

Annual fecal occult blood test

Sigmoidoscopy every 5 years

Annual pap smear

Evaluation for hearing loss

Evaluation for visual acuity

Thyroid-stimulating thyroid test

Bone mineral density test