osteoporosis by jody vulk pa-c northwest iowa bone, joint & sports surgeons
TRANSCRIPT
![Page 1: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/1.jpg)
OsteoporosisBy Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons
![Page 2: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/2.jpg)
Osteoporosis
“Porous bone“
Bones lose protein & mineral content
![Page 3: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/3.jpg)
Clinical Definitions of OP
Vertebral height loss of > 25% of the vertebral body
2 compression fractures
2 or more fragility fractures
![Page 4: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/4.jpg)
A fracture from forces that would not ordinarily cause fracture in a healthy young adult.
Quantified as forces equivalent to a fall from a standing height or less.
FRAGILITY FRACTURES
![Page 5: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/5.jpg)
Types of Fragility Fractures Compression Fractures of the Vertebra
Proximal Humerus
Distal Radius Fractures
Hip Fractures
![Page 6: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/6.jpg)
True or False
#1 Spine
#2 Wrist
#3 Hip
Most Common Fragility Fractures are:
![Page 7: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/7.jpg)
True Spine 27%
Wrist 19%
Hip 14%
![Page 8: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/8.jpg)
Bone Cells
![Page 9: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/9.jpg)
Osteoclasts
■ Remove or retire old bone.
■ Active throughout lifetime.
Osteoblasts
■ Create new bone
■ Best before age 35 & before menopause
![Page 10: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/10.jpg)
OsteoclastsRemove Old Bone
(Classic)
Osteoblasts Create new bone (having a Blast!)
![Page 11: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/11.jpg)
In Osteoporosis
More of these working… than these.
![Page 12: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/12.jpg)
Osteoclasts
■ Remove or retire old bone.
■ Active throughout lifetime.
Osteoblasts
■ Create new bone
■ Best before age 35 & before menopause
![Page 13: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/13.jpg)
Dual Energy X-ray Absorptiometry
![Page 14: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/14.jpg)
BMD Levels
Normal = 0 to -0.9 T-Score
Osteopenia = -1 to -2.4 T-
Score
Osteoporosis = -2.5 T-
Score
![Page 15: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/15.jpg)
Who needs a BMD? A woman nearing menopause (for baseline)
Men over the age of 70
Women 65 or older (& have never had one)
Those with risk factors for osteoporosis
![Page 16: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/16.jpg)
How often to Test Normal BMD=15 years
Osteopenia=5 years
Severe Osteopenia=1 year
85 or older=3 years
![Page 17: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/17.jpg)
Bone Minerals
![Page 18: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/18.jpg)
True or False
To avoid Osteoporosis--
just is drink more milk.
![Page 19: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/19.jpg)
False
Calcium + Vitamin D + Magnesium+ Phosphorus + Alkaline Phosphatase =
Good Quality Bones
![Page 20: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/20.jpg)
Foods for Healthy Bones
![Page 21: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/21.jpg)
Calculate Need
1000-1500m
gDaily
![Page 22: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/22.jpg)
Calcium supplements
Calcium Citrate
Take with or without food
21% Calcium
More frequently causes gas, bloating, constipation
Calcium Carbonate
Requires stomach acid, take with food
40% Calcium
Fewer side effects
Inexpensive
![Page 23: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/23.jpg)
Calcium Zappers
![Page 24: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/24.jpg)
Osteoporosis & Vitamin D Deficiency
1 Billion worldwide
1/3 of OP patients also Vitamin D deficient
Vitamin D deficiency is not age dependent.
![Page 25: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/25.jpg)
Vitamin D is created through the skin by exposure to sunlight
![Page 26: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/26.jpg)
Vitamin D and Sunlight
You must live near the equator to rely on its benefits.
![Page 27: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/27.jpg)
True or False
Caucasians are more prone to Vitamin D deficiencies than those with darker skin.
![Page 28: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/28.jpg)
False
Darker skin does not absorb
Vitamin D as well.
![Page 29: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/29.jpg)
Vitamin D Rich foodsFatty fish *Cod Liver oil(1360 IU)Swordfish(566 IU) Salmon(sockeye)(447 IU) Tuna(154 IU)
*avoid Cod liver oil
Fortified foods:
Milk (115 IU) Orange juice (137 IU)
Egg yolks (41 IU).
![Page 30: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/30.jpg)
Vitamin D SupplementsErgocalciferol (Vitamin D2)
Fungal derivative
Vegan supplement
Cholecalciferol (Vitamin D3)
Synthesized in the skin
Wool oil
Preferred supplement
![Page 31: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/31.jpg)
New GuidelinesAge DosageAdults < 50 *400 to 800 IU daily
Adults > 50 *800 to 1,000 IU daily
Normal Vitamin D level, do not exceed 4,000IU daily.
*Do not commit these to long term memory, follow-up research pending.
![Page 32: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/32.jpg)
Vitamin D Deficiency Risk Factors
![Page 33: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/33.jpg)
Risk Factors of Vitamin D deficiency
Northern Latitudes
<15 minutes of sun
African American, or dark skinned
Elderly
Obesity
![Page 34: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/34.jpg)
Vitamin D Vitamin D is fat soluble, stored in fat
Testing is on blood Loose weight, boost Vitamin D
![Page 35: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/35.jpg)
Who is at risk?
![Page 36: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/36.jpg)
True or False
Men do not need to be tested for Osteoporosis.
![Page 37: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/37.jpg)
False 2 million men have
OP
Men are more likely to die in the first year
after hip fracture.
Men who fracture are less likely to be
tested.
![Page 38: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/38.jpg)
Early Signs of Osteoporosis
![Page 39: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/39.jpg)
Joan Surber Age 68
Pelvic Fracture 1/28/2012
T-Score of -2.5 in her Lumbar Spine, -1.8 in the Right hip and a -2.2 in the Left hip.
Vitamin D=12ng/mL
![Page 40: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/40.jpg)
Severe Osteoporosis
T-score –2.5 or less
&
a fragility fracture has occurred.
![Page 41: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/41.jpg)
Leg braces as a child
Menopause at age 34
Calcaneus Fracture at age 42
20+ year history of GERD with medication
use
Severe Secondary Osteoporosis with
Vitamin D Deficiency
![Page 42: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/42.jpg)
Risks factors & Prevention Don’t have it in your genes
Hormone replacement (at the guidance of your PCP)
Not recommending to avoid this one.
Avoid long-term use of bone depleting medications
Heredity/Ethnicity
Hormonal Changes (Estrogen & Testosterone)
Aging
Pharmaceuticals
![Page 43: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/43.jpg)
(Cont.) Risk Factors & Prevention
Low BMI
History of Fracture
EAT! -a diet rich in colors and eat real foods!Bubble wrap
![Page 44: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/44.jpg)
(Cont.) Risk Factors & PreventionMalabsorption
Poor Diet
Smoking
Alcohol in excess
Lack of Exercise
Avoid Gastric Bypass, Celiac Sprue, Anorexia… Eat FOODs rich in Vitamins and minerals
Don’t do that!
Limit alcohol to no more than 2 beverages dailyWeight bearing exercises such as walking, tia chi, & weight lifting/resistance exercises
![Page 45: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/45.jpg)
Types of OsteoporosisPrimary
Relatively unknown cause other than advancing age and postmenopausal
Secondary
Has a known cause or reason for having developed (i.e.=oral corticosteroid use, other medications, diseases or conditions)
![Page 46: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/46.jpg)
True or FalseKyphosis of the spine is “normal for aging.”
![Page 47: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/47.jpg)
False
Decreasing height and humped back are not normal. They are indications of compression fractures.
![Page 48: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/48.jpg)
NWIA Bone Approach
![Page 49: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/49.jpg)
But orthopedists fix bones, Right?
![Page 50: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/50.jpg)
Anyone over 50 with a fractured bone from ground height.
We Evaluate
![Page 51: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/51.jpg)
![Page 52: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/52.jpg)
Own The Bone Nutrition Counseling
• Calcium• Vitamin D
Physical Activity Counseling• Weight-bearing and muscle-strengthening exercise• Fall prevention education
Lifestyle Counseling• Smoking Cessation• Limiting excessive alcohol intake
Pharmacology• For the treatment of osteoporosis
Testing• Dual Energy X-Ray Absorptiometry (DXA)
Communication• Physician referral letter• Follow-up note and educational material to patie
![Page 53: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/53.jpg)
Step-wise Approach
Remove Bisphosphonates Fracture immobilization/ fixation Draw Labs/BMD Vitamin D Correction Heal the Fracture
Initially After a Fracture
![Page 54: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/54.jpg)
Step-wise Approach
Check Vitamin D Increase bone mass if warranted Fracture Risk Assessment Educate patients on calcium,
Vitamin D, exercises Resume Bisphosphonates
Through the OP Clinic
![Page 55: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/55.jpg)
Medications
![Page 56: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/56.jpg)
National Osteoporosis Foundation
Recommends treatment:
T-score is less than -2.0Or
Less than -1.5 with a risk factor
(after the fracture has healed )
![Page 57: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/57.jpg)
Medication Route and Frequency Use
Alendronate Oral; Daily or Weekly Prevent/Manage avoid in Hyperparathyroidism or Renal Dysfunction
Calcitonin Intranasal; Daily Management
Ibandronate Oral or IV; Daily/Monthly/q 3 mo.
Prevent/Manage avoid in Hyperparathyroidism or Renal Dysfunction
Raloxifene Oral; Daily Prevent/Manage +Breast CA prevention
Risedronate Oral; Daily or Weekly Prevent/Manage avoid in Hyperparathyroidism or Renal Dysfunction
Teriparatide Injection; Daily Management
Denosumab SubQ; q 6 mo. Management +Breast CA prevention
Zoledronic acid Injection; yearly Management
![Page 58: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/58.jpg)
Exercises
![Page 59: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/59.jpg)
True or FalseSwimming is a great exercise to prevent osteoporosis.
![Page 60: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/60.jpg)
FalseSwimming does not prevent osteoporosis. Only weight bearing exercises prevent osteoporosis.
![Page 61: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/61.jpg)
Balance Training & Good Posture
![Page 62: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/62.jpg)
Resistance Training & Stretching
![Page 63: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/63.jpg)
Weight Bearing Exercise
![Page 64: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/64.jpg)
ReviewCalcium + Vitamin D + Magnesium+ Phosphorus + Alkaline Phosphatase =
Good Quality BonesVitamin D3
Calcium Carbonate
![Page 65: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/65.jpg)
Game Time
![Page 66: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/66.jpg)
![Page 67: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/67.jpg)
What are the top three types of compression fractures?
#1
![Page 68: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/68.jpg)
#1) Spine 27%
#2) Wrist 19%
#3)Hip 14%
![Page 69: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/69.jpg)
What are the top three definitions of clinical osteoporosis?
#2
![Page 70: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/70.jpg)
Clinical Definitions of OP
#1) Vertebral height loss of > 25% of the vertebral body
#2) 2 compression fractures
#3) 2 or more fragility fractures
![Page 71: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/71.jpg)
What are the top objective (laboratory/radiological) definitions of good bone health?
(I have 6 answers)
#3
![Page 72: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/72.jpg)
Good Bone Health BMD with T-score from 0- 0.9. Vitamin D > 30ng/mL Calcium (within local lab normal limits) Magnesium (within local lab normal limits) Alkaline Phosphatase (within local lab normal
limits)
Phosphorus (within local lab normal limits)
![Page 73: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/73.jpg)
List the top sources of Vitamin D.
(7 were listed)
#4
![Page 74: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/74.jpg)
Vitamin D sources1. Sunlight2. Cod liver oil3. Swordfish4. Salmon5. Tuna6. Fortified Milk7. Fortified Orange Juice(Eggs also pictured)
![Page 75: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/75.jpg)
What are some great exercises for preventing bone loss?
(I have listed 6)
#5
![Page 76: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/76.jpg)
Exercises to prevent bone loss Walking Yoga Tai Chi Weight or Strength/Resistance training Balance training Good Posture
![Page 77: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/77.jpg)
What are the top risk factors for developing OP?
( I discussed 11)
#6
![Page 78: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/78.jpg)
OP Risk Factors1. Hereditary/ Ethnic background2. Hormonal changes3. Age4. Medications5. Low BMI6. Previous Fractures7. Malabsorption8. Poor diet9. Smoking10. Alcohol11.Lack of exercise
![Page 79: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/79.jpg)
References
Adi Cohen, MD, MHS Columbia University, May 18-21,2011 Osteoporosis in Premenopausal Women: diagnosis and Treatment Issues, ISO9 course, Las Vegas Nevada.
Bone Health. "Make Every Bite Bone-Friendly." Health monitor 2012: 26-27. Web. 07 May 2012. "Clinical Practice Comparison of Clinical Efficacy and Safety between Denosumab and Alendronate in
Postmenopausal Women with Osteoporosis: a Metaanalysis." Docguide.com. Docguide.com, n.d. Web. 20 Mar. 2012.
Conde Nast Digital. "Foods Highest in Vitamin D." Nutritiondata.self.com. Conde Nast Digital, 01 Aug. 2011. Web. 03 Aug. 2011.
Dr. Norman. "High Blood Calcium (too Much Calcium in the Blood)." Parathyroid.com/high-calcium.htm. Norman Parathyroid Center, 23 Feb. 2012. Web. 20 Mar. 2012.
Ehrlich, Steven D. "University of Maryland Medical Center | Home." University of Maryland Medical Center. VeriMed Healthcare Network, 17 June 2011. Web. 08 May 2012. <http://www.umm.edu/>.
Epocrates. "Epocrates Home | Epocrates." Epocrates Home | Epocrates. Epocrates, 2012. Web. 03 Feb. 2012. <http://www.epocrates.com/>.
Google. "Google Images." Google Images. N.p., n.d. Web. 20 Apr. 2012. <http://images.google.com/>. Gronholz, DO, M. J. "JAOA: Journal of the American Osteopathic Association." JAOA: Journal of the American
Osteopathic Association. JAOA, 1 Oct. 2008. Web. 03 Mar. 2012. <http://www.jaoa.org/>. "Higher Magnesium Intake Linked to Higher Bone Density Effect Seen in Older White, But Not Black, Adults."
Health in Aging. The AGS Foundation for Health in Aging, n.d. Web. 03 Feb. 2012. <http://www.healthinaging.org/>.
![Page 80: Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons](https://reader037.vdocuments.net/reader037/viewer/2022110205/56649c775503460f9492c327/html5/thumbnails/80.jpg)
References (Continued) "International Osteoporosis Foundation | Bone Health." International Osteoporosis Foundation | Bone
Health. International Osteoporosis Foundation, Jan. 2011. Web. 03 Mar. 2012. <http://www.iofbonehealth.org/>.
Calcium rich foods Livestrong. "What Foods Raise Alkaline Phosphatase Levels." Livestrong.com. N.p., n.d. Web. 20 Mar.
2012. Mason, Moya K. "Calcium." Moyak.com. N.p., 2012. Web. 20 Mar. 2012. Mosner, RD,CDN, Michelle. "NYSOPEP." Community Education. Proc. of International Symposium of
Osteoporosis, Las Vegas. N.p.: n.p., n.d. N. pag. Print. NIH Consensus Development Panel. "Osteoporosis Prevention, Diagnosis, and Therapy." NIH Consensus
Development Program. U.S. Department of Health and Human Services, 27 Mar. 2000. Web. 22 Mar. 2012. <http://consensus.nih.gov/>.
NIH. "Dietary Supplement Fact Sheet: Magnesium." Ods.od.nih.gov/factsheets/magnesium. National Institute of Health, n.d. Web. 20 Mar. 2012.
NIH. "Vitamin D Factsheet." Nih.gov. N.p., n.d. Web. 22 Mar. 2012. NOF. "About Osteoporosis | National Osteoporosis Foundation." About Osteoporosis | National
Osteoporosis Foundation. N.p., n.d. Web. 30 Apr. 2012. <http://www.nof.org/aboutosteoporosis>. NOF. "Why Bone Health Is Important | National Osteoporosis Foundation." Why Bone Health Is Important
| National Osteoporosis Foundation. N.p., n.d. Web. 30 Apr. 2012. <http://www.nof.org/aboutosteoporosis/bonebasics/whybonehealth>.
Watts, Dr. Nelson ,MD Bone Health and OP Center University of Cincinnati, May 18-21, 2011 International Symposium of Osteoporosis, Las Vegas, Nevada (IOF course)