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Osteoporosis

Osteoporosis

§ Literally means �porous bone�§ A silent disease in which the density and

quality of the bone is reduced. § Can lead to bone weakness and increase in

fracture risk§ In the U.S., about 8 million women and 2

million men are affected

Osteoporosis

§ Affects 200 million women worldwide– 1/3 of women aged 60-70– 2/3 of women aged >80

§ About 30% of women over the age of 50 have one or more vertebral fracture

§ About 1 out of 5 men over the age of 50 will have an osteoporosis related fracture

BONE

§ Living tissue– Constantly being

• made (bone formation) • removed (bone resorption)

§ Peak bone mass mid 20�s– Lifestyle, hormones, genetics, nutrition

§ By the mid 30�s • Bone removed > bone made

Osteoporosis

§ No early warning symptoms– Loss of height– Forward curvature of the spine– Paraspinal muscle pain

Osteoporosis

§ The first presentation may be only after you break a bone

§ Most common fractures– Spine– Wrist– Hip

Osteoporosis

§ Spine• Back pain, loss of height, deformity, breathing problems

§ Hip• Unable to perform at least one independent activity of daily

living, walk independently, permanent disability

Risk Factors for Osteoporosis

§ Advanced age§ Female§ Non-Hispanic and Asian ethnic background§ Small bone structure or low body mass§ Family history of osteoporosis

– Osteoporosis-related fracture in parent or sibling

Risk Factors for Osteoporosis

§ Previous fracture <50yr§ Sex hormone deficiency§ Anorexia or malnutrition§ Cigarette smoking§ Excessive alcohol use

Risk Factors For Osteoporosis

§ Low dietary intake of calcium and vitamin D§ Sedentary lifestyle or immobility§ Medications

– Steroids (30-50% occur)– Excessive thyroid replacement– Anti-seizure medications– Heparin– Chemotherapy

Risk Factors for Osteoporosis

§ Certain Diseases– Endocrine disorders (hyperparathyroidism, hyperthyroidism,

Cushing�s Disease, hypogonadism, type I diabetes)– GI disorders - Celiac disease and other causes of malabsorption– Liver or kidney disease– Genetic Disorders – Systemic inflammatory disease (RA)– Cancers (Multiple myeloma)

Osteoporosis in Men

§ Primary Osteoporosis (50%)– Unknown cause

§ Secondary Osteoporosis (50%)– Steroid use– Low testosterone– Alcohol– High calcium– Smoking– GI disorders– Immobilization– Others…

Who should have bone mass measured?§ X-ray evidence, loss of height, history of

fracture, risk factors,§ National Osteoporosis Foundation 2003

– All women age 65 and older and all men 70 and older– Postmenopausal women under age 65 with a risk

factor– Men 50-70 with > 1 risk factor– Postmenopausal women or men >50 who present with

fractures– Postmenopausal women who have stopped hormone

replacement

How do you diagnosis Osteoporosis?

§ X-ray– May note signs of decrease bone mass

• 25-50% bone loss has already occurred§ Dual-energy x-ray absorptiometry (DEXA)

– X-ray with very low radiation exposure, precise, safe

Osteoporosis Treatment

§ Stop smoking§ Avoid excess alcohol intake§ Fall prevention§ Treat underlying medical conditions§ Limit medications that cause osteoporosis

Osteoporosis

§ Exercise

– Strengthening

– Weight bearing aerobic

– Flexibility

Osteoporosis Treatment

§ Calcium– Premenopausal women require 1000mg/day– Postmenopausal women 1200mg/day– Different types

• Calcium carbonate • Calcium citrate

§ Vitamin D– <60 years 400IU/day– >60 years 800IU/day– D2 vs D3

Osteoporosis Treatment

§ Calcitonin– Hormone made by the thyroid gland that inhibits bone

breakdown– Nasal spray or subcutaneous injection

§ Estrogen or Hormone Replacement Therapy– Decreases bone breakdown – Increase risk for breast cancer, strokes, heart attacks, and

clots

Osteoporosis Treatment

§ Selective Estrogen Receptor Modulators - Raloxifene (Evista)– Mimic estrogen without the side effect of breast cancer– Decreases bone breakdown

§ Teriparatide (Forteo)– A form of parathyroid hormone– Stimulates cells to build bone– Daily injection for up to 2 years

Osteoporosis Treatment

§ Bisphosphonates (Oral and IV)– Decreases bone breakdown– Oral

• Must be taken on an empty stomach with water• Remain upright for at least one hour after taking because of

potential for irritating the espophagus• Common side effects à GI symptoms, musculoskeletal pain

Bisphosphonates

§ Alendronate (Fosamax)– Once a week

§ Risedronate (Actonel) – Once a week– 2 days every month

§ Ibandronate (Boniva)– Once a month– IV every 3 months

§ Zoledronic acid (Reclast)– IV once a year