Osteoporosis

What is Osteoporosis?
 Osteoporosis is a disease that causes your bones to
become weak and brittle

 It is a common disease, and can result in fractures from even simple

trauma.

 In fact, it is estimated that a 50 year-old woman has a 40% chance

of having an osteoporotic fracture during her remaining lifetime

 Osteoporosis is important because of the problems resulting from

these fractures- disability, loss of independence, and even death
What is Osteoporosis?
 Osteoporosis is silent because there are no
symptoms (what you feel).
 It may come to your attention only after you break a bone.
 When you have this condition, a fracture can occur even after a
minor injury, such as a fall.
 Any kind of fracture may occur, but the most common are fractures
of the spine, hip, and wrist.
 Osteoporosis is not an inevitable part of aging, but is a disease that
can be prevented and treated, provided it is detected early.
 The main goal of treating osteoporosis is to prevent such fractures in
the first place.
http://e-infopages.com/2012/the-silent-thief-osteoporosis/
What causes osteoporosis?
 Osteoporosis results from a loss of bone mass (measured as bone
density) and from a change in bone structure.
 Many factors will raise your risk of developing osteoporosis and
breaking a bone.
 Recognizing your risk factors is important so you can take steps to
prevent this condition or treat it before it becomes worse.
Common risk factors for osteoporosis
 Female  Smoking

 Postmenopausal  Age (starting in the mid-30s but more

likely with advancing age)
 Family history of osteoporosis
 Rheumatoid arthritis, hyperthyroidism,
hyperparathyroidism, hypogonadism
 Lack of exercise
 Medications – corticosteroids
 Small body frame (Prednisone), excess thyroid hormone,
some diuretics (Lasix), and
 Low calcium intake anticonvulsants (Dilantin, Phenobarb,
Tegretol)
 Vitamin D deficiency
Do you have osteoporosis?
 Osteoporosis only causes symptoms
when it is far advanced.

 Symptoms include loss of height,

deformed spine
“dowager’s hump”), unexplained
back pain, and fractures.

 It is best to detect problems at an

early stage, when treatment is most
effective.

 The best test for detecting

osteoporosis is bone densitometry,
done with a technique called “Dual-
energy X-ray Absorptiometry” or
DXA.
Bone Densitometry
What is Bone Density Testing?
 This is a way of measuring the amount of calcium in a certain
amount of bone.

 This is important because the amount

of calcium in your bone determines how strong it is.

 If the bone density is very low, then you have osteoporosis and a
very high risk of fracturing your bones.

 A standard X-ray is not a good way to measure bone density,

because you must lose about 30% of your bone mass before it can
be detected this way.

 The most advanced is called“Dual-energy X-ray Absorptiometry”

or DXA.
DEXA
DEXA
 Simple test that measures bone
mineral density.

 Often the measurements are at your

spine and your hip, including a part
of the hip called the femoral neck, at
the top of the thighbone (femur).

 The test is quick and painless.

 It is similar to an X-ray, but uses

much less radiation.

 Even so, pregnant women should

not have this test, to avoid any risk
of harming the fetus.
DEXA
 DXA test results are scored compared
with the BMD of young, healthy people.
 This results in a measure called a T-score.

DXA T-score Bone mineral density (BMD)

Not lower than –1.0 Normal

Between –1.0 and –2.5 Osteopenia (mild BMD loss)

–2.5 or lower Osteoporosis

 The risk of fracture most often is lower in people with osteopenia

than those with osteoporosis.
 But, if bone loss continues, the risk of fracture increases.
Who needs bone densitometry?
 Anyone who wants an accurate measurement
of bone density.

 However, because of cost concerns, the test

is most often done for those with high risk of developing
osteoporosis, or to monitor the effectiveness of treatment for
osteoporosis.

 Consult with your physician if you think you might benefit from
knowing your bone density.
The categories for which bone densitometry is
most often done are:
 Estrogen deficient women undecided about taking hormones.

 Those with spinal abnormalities or X-ray evidence of bone loss.

 Anyone taking long-term corticosteroid treatment (such as

Prednisone).

 Primary hyperparathyroidism with no symptoms.

 Monitoring of therapy for osteoporosis.

How is osteoporosis treated?
 If you have osteoporosis, your health care provider will advise the
following:
 Calcium
 Make sure you are getting enough calcium in your diet or you might
need to consider taking supplements.
 The recommended daily dose is 1,000 milligrams per day for most adults
and 1,200 mg per day for women over age 50 or men over age 70.
 Vitamin D
 Get adequate amounts of vitamin D, which is important to help your
body absorb calcium from foods you eat.
 The recommended daily dose is 400–800 International Units (called IU)
for adults younger than age 50, and 800–1,000 IU for those age 50 and
older.
 Physical activity
 Get exercise most days, especially weight-bearing exercise, such as
walking
How is osteoporosis treated?
How is osteoporosis treated?
 Some people also will need medication.

 A number of medications are available for the prevention and/or

treatment (“management”) of osteoporosis.

 Bisphosphonates
 This class of drugs (often called “antiresorptive” drugs) helps slow bone
loss.
 Studies show they can decrease the risk of fractures.
 With all of these medications, you should make sure you are taking enough
calcium and vitamin D, and that the vitamin D levels in your body are not
low.
How is osteoporosis treated?
Bisphosphonate Medications for Osteoporosis (OP)

Generic drug name Approved uses for OP Dosing and form

Alendronate Prevention and treatment of Once-daily or once-weekly pills

postmenopausal OP in women

Treatment of OP due to use of

glucocorticoid medicines

Risedronate Prevention and treatment of Once-daily, once-weekly or once-

postmenopausal OP in women monthly pills

Prevention and treatment of OP

due to use of glucocorticoid
medicines

Ibandronate Prevention and treatment of Once-monthly pills, or every three

postmenopausal OP in women months by intravenous infusion
(often called IV) given through a vein

Zoledronic acid Same as for risedronate Once a year by IV

How is osteoporosis treated?
 Calcitonin
 This medication, a hormone made from the thyroid gland, is given
most often as a nasal spray or as an injection (shot) under the skin.
 Approved for the management of postmenopausal osteoporosis and
helps prevent vertebral (spine) fractures.
 It also is helpful in controlling pain after an osteoporotic vertebral
fracture.
 Estrogen or hormone replacement therapy
 Estrogen treatment alone or combined with another hormone,
progestin, has been shown to decrease the risk of osteoporosis and
osteoporotic fractures in women.
 Consult with your doctor about whether hormone replacement
therapy is right for you.
How is osteoporosis treated?
 Selective estrogen receptor modulators
 These medications, often referred to as SERMs, mimic
estrogen’s good effects on bones without some of the serious
side effects such as breast cancer.
 Teriparatide
 Teriparatide is a form of parathyroid hormone that helps
stimulate bone formation.
 It is approved for use in postmenopausal women and men at
high risk of osteoporotic fracture.
 It also is approved for treatment of glucocorticoid-induced
osteoporosis.
 It is given as a daily injection under the skin and can be used
for up to two years.
Young women and pregnancy
 Young women who have risk factors for osteoporosis and
fractures need to carefully consider their medication options
if they are planning a pregnancy.

 None of the drugs for managing osteoporosis has enough

safety data available to recommend using them in women
who are pregnant or breastfeeding.

 Bisphosphonates, even after you stop taking them, can stay in

your body a long time.

 Thus, women who want to become pregnant later should

weigh the expected benefits of bisphosphonates against the
possible risks.

 If a woman who has taken a bisphosphonate becomes

pregnant, she should have her blood calcium levels checked,
because they could become low.
Prevention
 Lifestyle changes may be the best way of preventing osteoporosis.
 Here are some tips:
 Make sure you get enough calcium in your diet or through supplements
(roughly 1,000–1,200 mg/day, but will depend on your age).
 Get enough vitamin D (400–1,000 IU/day, depending on your age and
your blood level of vitamin D measured by your doctor).
 Stop smoking.
 Avoid excess alcohol intake: no more than two or three drinks a day.
 Engage in weight-bearing exercise. Aim for at least 2½ hours a week
(30 minutes a day five times a week or 50 minutes a day three times a
week), or as much as you can. Exercises that can improve balance, such
as yoga, may help prevent falls.
Prevention
 You also should get treatment of any underlying medical problem
that can cause osteoporosis.

 If you are on a medication that can cause osteoporosis, ask your

doctor if you can lower the dose or take another type of medicine.

 Never change the dose or stop taking any medicine without

speaking to your doctor first.
What is the broader health impact of
osteoporosis?
 The most serious health consequence of osteoporosis is a
fracture.

 Spine and hip fractures especially may lead to chronic

pain, long-term disability and even death.

 The main goal of treating osteoporosis is to prevent

fractures.
Living with osteoporosis
 If you have osteoporosis, it is important to help prevent not
just further bone loss but also a fracture.
 Here are some ways to decrease your chance of falls:
 Use a walking aid. If you are unsteady, use a cane or walker.
 Remove hazards in the home. Remove throw rugs. Also, remove
or secure loose wires or cables that may make you trip. Add
nightlights in the hallways leading to the bathroom. Install grab bars
in the bathroom and nonskid mats near sinks and the tub.
 Get help carrying or lifting heavy items. If you are not careful,
you could fall, or even suffer a spine fracture without falling.
 Wear sturdy shoes. This is above all true in winter or when it rains.
Points to remember
 Make sure there is enough calcium and vitamin D
in your diet.

 Be physically active and do weight-bearing exercises, like walking,

most days each week.

 Change lifestyle choices that raise your risk of osteoporosis.

 Implement strategies to help decrease your risk of falling.