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What is it? What are results of having it? What can be done about it?
Mary J. Aigner, RN, MSN, FNPC

What is it?

Osteoporosis means “porous bone” Bones that used to be strong gradually grow weak and thin This puts bones at risk for fractures
– Most commonly: spine, hip, and wrist

Osteopenia may be found first

Abnormally decreased bone density
– Indicates weakening bones

May progress into osteoporosis

Who is affected?

10 million Americans 80% are women


A woman in her upper 80’s with Advanced osteoporosis.

Why mostly women?
Bones lighter and less dense already  Hormonal changes (post-menopause, or post-ovary removal) increase risk

Uncommon in men until after 70  Most commonly before age 70, men get it secondary to other problems

Comparison by Race and Gender
NonHispWhite or Asian >50 Women NonHispBlack >50 Women Hispanic >50 Women NonHispwhite or Asian >50 Men NonHispBlack >50 Men Hispanic >50 Men



20% 5% 10% 7% 4% 3%

52% 35% 49% 35% 19% 23%

Bone loss progression
Bone loss in women occurs most rapidly during first 57 years after menopause, then slows again.

This is related to the sharp drop in estrogen levels … estrogen seems to help keep calcium in the bones.

Other risk factors
Amenorrhea  Personal hx fx >50yrs  Anorexia nervosa  Liver disease  Chronic renal failure  Malabsorption syndromes

Some at higher risk
Thin or small framed women  Smoking, drinking (excessively), or living a sedentary lifestyle  Family history  Ovaries removed before age 40  White and Asian women  Current concern about today’s children with low dairy intakes (low calcium)

What about men?

2 million men over 65 yrs. in U.S. (w/osteop) 3.5 million at risk By age 90, 1 in 6 men will have a hip fracture
– 1/3 less than women

Common causes for men
    

Delayed puberty Smoking Alcohol (excess) Calcium intake Physical activity and strength Genetic factors

Male hormones

Decreasing testosterone can lead to osteoporosis
– May occur with aging – May occur with some medications

Increased estogen production

Secondary Osteoporosis

Another illness or a medication Causes osteoporosis Equals same results as primary o.

Some disorders that can lead to 2nd osteop.
Endocrine Disorders Autoimmune Diseases Chronic Illnesses Bone marrow or malignant disorders
 

– Corticosteroids – Anticonvulsants – thyroid

Nutritional deficiencies Lifestyle factors

What can happen?

Fractures possibe

Vertebral fractures
– 2004 – estimated 700,000 occurred

Hip/femoral neck fractures
– 2000 – estimated 340,000 annually

Both have higher mortality rates in the 1-5 years after fracture

Vertebral fractures

Pain Loss of height Stooped/curved posture

Curved spine compresses organs

– Hard to breathe – Can’t take as deep of breaths – Higher risk pneumonia/infections

Compression affects digestive system

Unable to eat as much (at one time)
– Decreases sense of hunger – Weight loss results

Slower movement in colon
– Possibly narrowed – Constipation results

Skin problems

A stooped posture can lead to folds of skin around the abdomen Rashes and other skin irritation can occur Pressure Areas

Other problems from a bent posture

Back pain Poor balance
– Which then decreases mobility

Fatigue and muscle weakness Loss of Height

Hip fractures also common

Hip fracture problems

Hip fractures:
– Delirium/confusion may occur – Decreased mobility may result – Hardware problems can occur

Making the diagnosis

Biochemical markers can help make the diagnosis in conjunction with BMD results
– Some are markers of bone resorption – Others are markers of bone formation – All are lab tests – None are diagnostic by themselves

Special Test: BMD
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   

Specialized tests called bone mineral density (BMD) tests can measure bone density in various sites of the body. A BMD test can: Detect osteoporosis before a fracture occurs Predict chances of fracturing in the future Determine rate of bone loss and/or monitor the effects of treatment if a DXA BMD test is conducted at intervals of one year or more Medicare reimburses for BMD testing every two years. An increase in BMD testing and osteoporosis treatment was associated with a decrease in hip fracture incidence. Bone density is an important determinant of fracture risk even in nursing home patients. There has been a five-fold increase in office visits for osteoporosis (from 1.3 to 6.3 million) in the past 10 years.


Treatments once diagnosed

– – – – – Fosamax, Actonel Estrogen Evista Pain meds Calcium with Vitamin D

Osteoporosis Medications
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Bisphosphonates Alendronate and alendronate plus vitamin D (brand name Fosamax® and Fosamax® plus D) Ibandronate (brand name Boniva®) Risedronate and risedronate with calcium (brand name Actonel® and Actonel® with Calcium) Calcitonin (brand name Miacalcin®)

What about Estrogen??

Estrogen loss results in an increase in osteoclast activity (bone loss) after menopause Replacement therapy controversial

      

Estrogen/Hormone Therapy Estrogens (brand names, such as Climara®, Estrace®, Estraderm®, Estratab®, Ogen®, Ortho-Est®, Premarin®, Vivelle® and others) Estrogens and Progestins (brand names, such as Activella™, FemHrt®, Premphase®, Prempro® and others) Parathyroid Hormone – Teriparatide (PTH (1-34) (brand name Fortéo®) Selective Estrogen Receptor Modulators (SERMs) Raloxifene (brand name Evista®) Alendronate is approved as a treatment for osteoporosis in men and is approved for treatment of glucocorticoid (steroid)-induced osteoporosis in men and women. Risedronate is approved for prevention and treatment of glucocorticoid-induced osteoporosis in men and women.Parathyroid hormone is approved for the treatment of osteoporosis in men who are at high risk of fracture.Treatments under investigation include sodium fluoride, vitamin D metabolites, and other bisphosphonates and selective estrogen receptor

Surgery or Radiology may intervene


– Vertebroplasty – Kyphoplasty

–Hip Fractures:
–Surgical Repair –Type depends on severity

Better than Treatment!

Treatments? Prevention Best
Most bone growth before age 20
Encourage children be active consume Calcium Don’t start smoking Don’t drink excessive alcohol

Avoid Falls

Use handrails on stairs Remove clutter
– Clear walkways Avoid throw rugs – use nonskid mats

Avoid floppy shoes or slippers

Preventing Osteoporosis
 

Don’t smoke! Don’t drink too much alcohol Both smoking and alcohol intake (excessive) have been found to decrease bone strength

Exercise, exercise

Weight bearing exercise will strengthen bones Dance the night away! Walking good too!

Exercise Benefits

Decreases fall risk Increases muscle and bone mass

Improves cognitive function (brain)

What foods are good to build and keep strong bones?

Calcium rich foods

Low-fat or non-fat dairy products Green leafy veggies
– Also high in iron!

TIPS: • Use low-fat yogurt to make salad dressings • Add extra dry milk when baking

Saltwater fish

Lactose intolerant? Try lactose-free milk now available.

Calcium Intake

1500 mg/day for men and women over 65 years Calcium can cause: Divided doses are absorbed better Constipation – divide doses, Add milk & yogurt to diet Calcium Citrate absorbs better than Gas, Bloating – carbonate Try Tums Usually need Vitamin D as well

Vitamin D

Sunlight Found in
– Milk – Egg yolks – Fish

Usually 400 iu/day

What if I have had kidney stones?

1000 mg Ca Citrate
– Ask your doc/NP

Urine Calcium will need to be measured May need HCTZ
– A water pill

Avoid Vitamin D supplements

Lower YOUR Risk
 

Increase daily Calcium intake Exercise – weight bearing type

Talk to you health care provider about your risk factors

Remember . . .

Prevention needs to start YOUNG!