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Osteoporosis Moji Saberin-Williams, M.D. Paoli Hospital Obstetrician/Gynecologist Osteoporosis The Most Common Bone Disease • Characterized by low bone mass and deterioration of bone structure • Not a natural part of aging • Increased risk for women, post-menopausal, over age 65 • All races, sexes, and ages are susceptible • Preventable and treatable! Annual incidence of common diseases Frequency of Common Medical Events in Women 2,000,000 1,500,000 1,500,000 1,000,000 250,000 hip 250,000 forearm 250,000 other sites 513,000 ** 500,000 ** † ‡ 228,000† 750,000 vertebral ‡ 184,300 0 Osteoporotic Fractures * * annual incidence all ages annual estimate women 29+ annual estimate women 30+ 1996 new cases, women all ages Heart Attack Stroke Breast Cancer 1. Riggs, B.L., and Melton, L.J. III, Bone 17(5)(Suppl.):505S-511S, 1995 2. Heart and Stroke Facts: 1996 Statistical Supplement, American Heart Association 3. Cancer Facts & Figures—1996, American Cancer Society Osteoporosis: Definition A condition of skeletal fragility characterized by compromised bone strength predisposing to an increased risk of fracture Normal Bone Osteoporosis NIH Consensus Development Conference Statement, on Osteoporosis Prevention, Diagnosis, and Therapy, 2000. Source: Dempster DW, et al. J Bone Miner Res. 1986:1:15-21; Reprinted with permission from the American Society of Bone and Mineral Research Entire Skeleton Is at Risk for Fractures Vertebral 46% (700,000) Hip 19% (300,000) Wrist 16% (250,000) Other 19% (300,000) NIH/ORBD National Resource Center. October 2000. 250,000 Hip Fractures Each Year • • • • Up to 24% excess mortality within 1 year Nearly 65,000 American women die from complications of hip fracture each year 50% of hip fracture survivors are permanently incapacitated3 20% of hip fracture survivors require longterm nursing home care4 1. Ray NF et al. J Bone Miner Res 1997;12:24-35 2. Col NF et al. JAMA 1997;227:1140-1147 3. Consensus Development Conference. Am J Med, 1993;94 646-650 4. Chrischilles EA et al. Arch Intern Med 1991;151 EPIDEMIOLOGY •Major Health threat in an estimated 44 Million people ages 50 and older •1 in 2 women and 1 in 6 men over 50 will have an osteoporosis-related fracture •1 out of 3 women age 90 have had a hip fracture Hip Fracture Incidence in 1997 35 30 25 20 15 10 5 0 70-74 * 75-79 80-84 85+ Fracture rate per 1000 patient-years for 5-year intervals of age, from U.S. National Inpatient Sample database composed of >13 million white women, age 70- Osteoporosis Risk Factors Non-modifiable – Previous fragility fracture – History of fracture in a first degree relative – Increased age – Female gender – Caucasian or Asian – Premature graying of hair NOF guidelines – 2000 Modifiable - Estrogen deficiency - Propensity to fall - Impaired vision - Calcium deficiency - Vitamin D deficiency - Low body weight - Physical inactivity - Excessive Alcohol consumption How do I know if I have osteoporosis? Bone Mineral Density Test (BMD Test) • Measures bone density at various sites • Helps determine risk for fractures What kinds of BMD tests are there? • DEXA (dual energy x-ray absorptiometry) – Gold standard – Measures hip, and spine – Compares bone density to that of a young adult (T-score) • Peripheral measures (ankle, hand, finger) – A screening tool – Indicate possible risk of future fracture Who Should Get a Baseline Bone Density Test? National Osteoporosis Foundation Recommendation: • All women 65 years old or older • All women with a history of fragility fractures • All postmenopausal women with at least one risk factor • Adults with a disease or medication history associated with bone loss World Health Organization (WHO) Osteoporosis Guidelines T-Score WHO, Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis, 1998. Management of low Bone Mass • • • • • • • Vitamin D and Calcium Exercise Hormone Treatment Fosamax / Actonel / Boniva Evista / Tibolone Calcitonin PTH (Parathyroid hormone) Vitamin D Supplementation • • • • • In conjunction with Calcium Attenuation of Bone Loss Reduction of fall risk Main sources for Vitamin D: skin and milk Slows progression of Osteoarthritis Calcium Supplementation • • • • Calcium Citrate Calcium Carbonate (Shells) Divided doses Calcium Supplementation • With Vitamin D fracture risk reduction tooth loss reduction • Without Vitamin D ? • Reduces the rate of bone loss • Premenopausal women: 1000 mg/day • Postmenopausal women: 1500 mg/day Role of dietary Calcium • # servings of dairy X 300 = mg of Calcium • One serving: 8 oz milk (240 cc) 8 oz Yogurt 16 oz cottage cheese 1 oz hard cheese Physical activity • Aerobic exercise • Weight bearing exercise • Resistance training Bone mineral density improvement ? Fracture risk reduction CONCLUSION • Osteoporosis is the most common bone disorder • It is treatable • It is preventable