osteoporosis dr.hazar ibrahim yacoub pharmacy college.ksu
TRANSCRIPT
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Osteoporosis
Dr.Hazar Ibrahim Yacoub
Pharmacy College .KSU
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FACTS
AND
FIGURES
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NATIONAL STATISTICS
Osteoporosis affects more than 28 million Americans; 80% of them are women and 20% men
1 in 2 women and 1 in 8 men over the age of 50 will develop osteoporosis
Thin bones are the cause of 1.5 million fractures a year
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FLORIDA STATISTICS
Over 2.1 million individuals have osteoporosis or low bone mass
1998 - 22,630 residents had hip fractures
1998 - Hospital charges for hip fractures were $477.8 million with 80% discharged to nursing homes
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VERTEBRAL FRACTURES
Can lead to chronic back pain, loss of height, protruding stomach, stooped posture - back pain is the most common complaint
At age 50, a woman has a 50% chance of an osteoporosis-related fracture during her life
Loss of ability to do daily living activities (cooking, cleaning, getting dressed, etc.)
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A woman’s hip fracture risk equals her combined risk of breast, uterine and ovarian cancer
15-20% need long-term care facilities
There is a 20% increased risk of death during the first year following a hip fracture
HIP FRACTURES
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MYTHS OR FACTS
Men do not get osteoporosis
Diet can provide all of the calcium a body needs
If your grandmother had osteoporosis, you will get it too
Dairy products are the only source of calcium
Activity – Myths or Facts About Osteoporosis
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MYTHS OR FACTS
If you have osteoporosis, you can do nothing about it
Our bones stop growing when we reach full height (about age 20)
Susceptibility to fractures can indicate osteoporosis
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Low calcium intake during adolescence can cause osteoporosis later
Exercise is dangerous for older people
MYTHS OR FACTS
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MEN & OSTEOPOROSIS
Lifetime risk of getting osteoporosis is the same as a man’s lifetime risk for prostate cancer
Nationally, one in eight men over 50 will get osteoporosis
By age 75, one in three men will get osteoporosis
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ALL
ABOUT
BONES
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OSTEOPOROSIS: “The Silent Disease”
“Osteo” is Latin for “bone”
“Porosis” means “porous or full of holes”
“Osteoporosis” means “bones that are full of holes”
Osteoporosis can develop without symptoms
You may not know you have the disease until a bone fractures
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TYPES OF BONE
(1) Cortical – is hard, compact, dense bone (example: mid-section of larger, long-bones of arms and legs)
(2) Trabecular – is spongy, porous and flexible bone (example: end of the wrist, hip and the spine)
Activity - Understanding Our Bones
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HEALTHY BONE
Bone is living tissue, which is constantly being broken down and rebuilt, a process called remodeling
Bone is renewed like skin, hair and nails
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OSTEOPOROTIC BONE
The loss of living bone tissue makes bones fragile and more likely to fracture
Note: arrow points to micro - fracture
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BONE “REMODELING”
Resorption-removes old bone
Formation-replaces old bone with new bone
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OSTEOCLASTS-PHASE 1
Cells called osteoclasts (think “C” for chiseler) seek out old bone or damaged bone tissue and destroy it, leaving small spaces (resorption)
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OSTEOBLASTS – PHASE 2
Cells called osteoblasts (think “B” for builder) use minerals like calcium, phosphorus, and vitamin D to fill in the spaces with new bone (formation)
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BUILD YOUR BONE BANK
You build bone until about age 30
Steps to building healthy bones include:
Calcium & vitamin D
Limit Caffeine & Alcohol
Exercise
Don’t Smoke
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BONE BANK DEPOSITS
From birth through adolescence, new bone is built faster than old bone is removed
In mid-life, depending on lifestyle and other factors, bone removal can achieve a balance with bone formation
After menopause, bone removal may accelerate due to a decrease in estrogen
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BONE LOSS & AGING
The first 5-15 years after menopause a woman can lose approximately 25 - 30 % of trabecular bone & approximately 10 – 15 % of cortical bone
Bone loss often occurs without symptoms or warning signs
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CHANGES IN BONE MASS
After menopause, bone removal accelerates due to a decrease in estrogen
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EARLY WARNING SIGNS
History of broken bones as an adult
Unexplained back pain – subsides after a couple of weeks
Loss of more than an inch in height
Posture has become stooped
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OSTEOPOROSIS
Normal Posture Dowager’s Hump
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CLARIFICATIONS
There is no relationship between osteoporosis and arthritis
Osteoporosis is a generalized bone disease that causes porous bones, usually not causing symptoms until a fracture occurs
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Arthritis refers to a group of diseases and conditions that affect the joints and are usually painful
Osteoarthritis is a degenerative type of arthritis affecting the hip, knees and tips of the fingers—no relationship to osteoporosis
CLARIFICATIONS
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Steroids are sometimes used to treat arthritis, and using steroids may put a person at risk for osteoporosis
There is no clear relationship between dental cavities and osteoporosis
Someone with osteoporosis may have weakened jawbones and be prone to losing teeth
CLARIFICATIONS
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RISK
FACTORS
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RISK FACTORS - CAN’T CONTROL
Gender: Females are usually diagnosed with osteoporosis at four times the rate of males. Bone mass in males is approximately 15-20% higher than females
Small Boned & Thin: may result in smaller bones with a lower bone density
Activity - Risk Factor Worksheet
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RISK FACTORS - CAN’T CONTROL
Race/Ethnicity: Women, especially Caucasian and Asian women with thin frames are at greater risk
African American women have a higher peak bone mass (10%) than Caucasian women, but other factors such as nutrition, exercise, certain diseases, and medications may increase their risk of osteoporosis
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RISK FACTORS - CAN’T CONTROL
Heredity: your family history may put you genetically at risk or may be a result of family members sharing the same environment, exercise, and nutritional habits
Menopause or several months without periods: bone loss begins to exceed bone formation, due to a decrease of estrogen
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Age: In your 40’s you start to lose bone faster than you build new bone. The accumulated loss of bone puts an older person at higher risk
RISK FACTORS - CAN’T CONTROL
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RISK FACTORS – CAN CONTROL
Calcium Rich Diet:
milk, cheese, yogurt
Weight Bearing Exercise:
walk, bike, run
Vitamin D:
sunshine, multivitamin, fortified food
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RISK FACTORS – CAN CONTROL
Caffeine: Recommendation-No more than 2-3 cups of caffeine beverages per day
Cola, coffee and chocolate all contain caffeine
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Alcohol: consuming more than one alcoholic drink per day is associated with risk of low bone mass
RISK FACTORS – CAN CONTROL
Eating Disorders: anorexia nervosa or bulimia can lead to malnutrition and bone loss
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Smoking: causes lower bone density
Immobility: extreme lack of exercise can lead to bone loss
RISK FACTORS – CAN CONTROL
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OTHER RISK FACTORS
Steroids - cause increased bone breakdown and decreased bone replacement
Prolonged hyperthyroidism – can cause increased risk of bone loss
Thyroid hormone - (in excess) – acts on bone cells to increase resorption
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Diuretics – some types of diuretics may increase excretion of calcium in the urine
Kidney failure – affects the metabolism of calcium, phosphorous and vitamin D
Chronic hepatitis – chronic liver disease may cause bone loss in several different ways
Intestinal disease – some can affect the absorption of vitamin D & calcium
OTHER RISK FACTORS
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DRUGS-MAY CAUSE BONE LOSS
Cortisone Isoniazid
Seizure drugs Lithium
Cyclosporine Heparin
Methotrexate
Some Hormones Lupron®
Zoledex® Ask your healthcare provider
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PREVENTION
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CALCIUM’S FUNCTION
Blood clotting (control bleeding)
Regulates heart beat
Muscle function
Nerve transmission
Bone formation
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Age
1-3 years
4-8 years
9-18 years
19-50 years
over 50 years
Milligrams (mg)
500
800
1,300
1,000
1,200- 1,500
DAILY CALCIUM REQUIREMENTS
National Academy of Science
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CALCIUM NEEDS
Adolescents-may lack calcium due to high fat snacks with empty calories, soda and dieting
Eating Disorders-anorexic or bulimic teens lack calcium and may develop osteoporosis at an early age
Older Adults-may have increased calcium need due to poor absorption
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SERVING SIZE
1 ½ cup (12 oz) of liquid is the size of soda-pop can
1 cup (8 oz) of food is the size of large handful
½ cup (4 oz) of food is about half a large handful
3 (oz) of cooked meat, fish, poultry is about the size of a deck of cards
A serving size is the amount of the food after it is cooked
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Fat: Sparingly
Dairy: 2-3
Protein 2-3
Vegetable: 3-5
Fruit: 2-4
Grains: 6-11
SERVINGS-INCLUDE CALCIUM
Activity - Calcium Worksheet or Calcium Card Game
Food Serving
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1 oz cream cheese: 20 mg
1 hard boiled egg: 30 mg
½ cup cooked broccoli: 40 mg
½ cup cottage cheese: 80 mg
1 oz cheddar cheese: 205 mg
6 oz calcium-fortified OJ: 250 mg
1 cup milk: 300 mg
1 cup fruit yogurt: 345 mg
3 oz sardines with bones: 370 mg
8 oz vegetable lasagna: 450 mg Activity - Results to Calcium Card Game
CALCIUM IN FOODS
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Serving size & numberof servings
FOOD LABELS
Calories, Total & Saturated fat in grams, Cholesterol & Sodium, Fiber, Sugars, & Protein in grams
% Daily Value (DV)
Daily Amount
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READING FOOD LABELS
Calcium content may vary greatly between different brands of food
The percentage of calcium in a food is based on 1000 milligrams. A food containing 20% calcium = 200 mg
A food containing 10-19% of calcium is a good source; 20% of calcium or higher is a very good source
Activity – Nutrition Facts
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% DAILY VALUE OF CALCIUM
FOOD %DV
Fruit yogurt 35%
Oatmeal 10%
Turnip Greens 20%
Total % DV = 65%
Add % DV by reading food labels to ensure you get the recommended daily calcium
Activity - Foods and Calcium
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LACTOSE-INTOLERANCE
Individuals who have difficulty digesting the sugar found in milk, called lactose
Start with small portions of food such as milk--gradually Increase portions
Eat dairy foods in combination with other foods
Many hard cheeses have less lactose than milk
Commercial lactase preparations aid digestion
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CALCIUM SUPPLEMENTS
Read Labels--several different types of calcium supplements available
Avoid -“natural” calcium such as bone meal or dolomite-some contain toxic lead or mercury
“Elemental calcium” - is the type of calcium the body absorbs
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ELEMENTAL CALCIUM
Kinds of Calcium % Elemental Calcium
Calcium carbonate 40%
Calcium phosphate (tribasic) 39%
Calcium phosphate (dibasic) 30%
Calcium citrate 21%
Calcium lactate 13%
Calcium gluconate 9%
Example, a 500 mg calcium tablet may only contain 45-200 mg of elemental calcium
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CALCIUM TIPS
Do not take more than 500 mg of calcium at a time or 2000 mg total per day
Your body can absorb only about 500 to 600 mg at a time
Example: take one tablet at breakfast and another at dinner
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CARBONATE CITRATE
Needs acid to dissolve and for absorption
Less stomach acid as we age
Take “at” or “after” meals when more stomach acid
Doesn’t require stomach acid for absorption
May be taken between meals
May cost more
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TEST YOUR CALCIUM TABLET
Put a calcium tablet in a cup of half water and half vinegar. Stir every 5 minutes. If it doesn’t dissolve in 30 minutes, it probably won’t dissolve in your stomach
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VITAMIN D
CALCIUM
VITAMIN
•Vitamin D is necessary for calcium to be absorbed
•Multivitamin or calcium tablets may contain 400 IU daily (don’t exceed 800)
•Vitamin D is in milk (100 IU in 1 cup)
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EXERCISE!
Walking
Dancing
Gardening
Tennis
Jump Rope
Volleyball
SkatingActivity – Exercise Guide
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ENVIRONMENTAL SAFETY
PREVENT
PAINFUL
FALLS
Activity – Environmental Safety
Cartoon
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BONE
DENSITY
TESTING
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WHO NEEDS TESTING?If you have major risk factors for osteoporosis
If you have a family history of osteoporosis
If you have a personal history of fractures after age 45
If you are on prolonged use of steroids
If you are postmenopausal, and not on estrogen replacement therapy
Consult your healthcare provider
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SCREENING TESTS
Portable scanners:
SXA - (Single Energy X-ray Absorptiometry), measures wrist or heel
pDXA - (Peripheral Dual Energy X-ray), measures wrist or heel
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RA - (Radiographic Absorptiometry), x-ray of hand that is compared to a small metal wedge
QCT - (Quantitative Computed Tomography), measures the spine
Ultrasound - sound waves to measure the heel, shin, and kneecap
SCREENING TESTS
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DXA-BONE DENSITY TESTING
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WHAT IS A DXA?
DXA (Dual Energy X-ray Absorptiometry) is the “gold standard”
Measures bone density in the hip, spine, and forearm
Painless, non-invasive, requires no injections
Takes 10 - 20 minutes
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WHAT IS A T-SCORE?
World Health Organization T-score is comparing the average bone density to that of healthy young Caucasian women
T-Score Diagnosis
0 to –1 “Normal”
-1 to –2.5 “Osteopenic”- low bone mass
-2.5 or lower “Osteoporotic”
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MEDICATION
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MEDICATIONS
Estrogen - “ERT”
Fosamax® - Alendronate
Actonel® - Risedronate
Evista® - Raloxifene
Miacalcin® - Calcitonin
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ESTROGEN
Most cost-effective prevention for osteoporosis
Slows bone loss and may slightly increase bone mass
Estimated to reduce hip fracture by 30-50%
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EVISTA (Raloxifene)
SERMS-Selective Estrogen Receptor Modulators-designer drugs
SERMS act like estrogen but doesn’t stimulate breast or uterine tissue
Evista is the first and only SERM approved for the prevention and treatment of osteoporosis
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BISPHOSPHONATES
Fosamax and Actonel
Specifically designed to affect the skeleton, increase bone density & reduce number of fractures
Must be taken correctly - on an empty stomach, first thing in the morning with glass of plain water, fasting, & remain upright for 30 minutes
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FOSAMAX ® (Alendronate)
Approved for prevention and treatment
Approved for treatment of steroid- induced osteoporosis in men and women
Prevention – 5 mg daily
Treatment – 10 mg daily or 70 mg once weekly (for men and postmenopausal women)
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ACTONEL ® (Risedronate)
Weekly 35 mg is approved for prevention and treatment of osteoporosis in postmenopausal women, and for women who have osteopenia, but are not yet postmenopausal
Daily 5 mg dose is approved for prevention and treatment of glucocorticoid-induced osteoporosis in women
Actonel may be given to males at the discretion of the Health Care Provider
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MIACALCIN (Calcitonin)
Is a naturally occurring hormone involved in calcium regulation and bone metabolism
Available by injection or nasal spray
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PUTTING
IT ALL
TOGETHER
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SUMMARY
Calcium Rich Diet
Vitamin D
Prevent Falls
Weight-Bearing Exercise
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Don’t Smoke
Minimize Caffeine & Alcohol
Testing & Medication if Needed
SUMMARY
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HEALTHCARE PROVIDERS
Healthcare providers are the best source of information about osteoporosis and medical options
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Activity – Affirming a Positive Change