Transcript Ontario Osteoporosis Strategy

Heather Eatson
Peterborough & Area Manager
Ontario Osteoporosis Strategy
Osteoporosis Canada
Ontario Osteoporosis Strategy
GOAL:
To reduce fractures, morbidity, mortality and costs
from osteoporosis…
through an integrated and comprehensive
approach aimed at health promotion and disease
management.
Background
October 2000:
“A Framework and Strategy for the Prevention and
Management of Osteoporosis”
May 2002:
“Osteoporosis Action Plan: An Osteoporosis Strategy
for Ontario”
February 22nd, 2005:
MOHLTC announced the launch of Ontario’s first
Osteoporosis Strategy
Identification of service gaps
Low public awareness
Inappropriate diagnostic testing
Lack of adequate management
Lack of clinically useful information
Lack of integrated post-fracture care protocols
Osteoporosis Strategy:
5 Components
Health Promotion
1. Education programs for seniors and children:
– Increase seniors knowledge of osteoporosis and improving
bone health
– Increase bone health education in schools
Disease Management
2. Improve the use, and accuracy of bone mineral diagnostic
testing (BMD) to increase early diagnosis of osteoporosis
3. Integration of fracture care, rehabilitation and osteoporosis
management
4. Improve evidence based practice by Health Professionals
5. Research and evaluation
What Is Osteoporosis?
“Osteoporosis is a skeletal disorder characterized
by compromised bone strength predisposing a
person to an increased risk of fracture.”1
Osteoporosis- (Porous
Bone)
1. Consensus Development Conference, JAMA 2001; 285: 785-95.
Normal Bone
Osteoporosis is a…
potentially crippling disease characterized by low bone
mass (density) and deterioration of bone tissue, a
condition that can lead to increased bone fragility and
risk of fracture- most often at the spine, wrist or hip.
Common Fracture Sites
Overview on Osteoporosis
• Bone loss occurs without symptoms- The Silent
Thief
• Osteoporosis can result in disfigurement, lowered
self-esteem, reduction or loss of mobility, and
decreased independence
• 1.4 million Canadians live with Osteoporosis
• Healthcare costs are estimated to be $1.9 billion
each year in Canada
Hip fractures
Hip fractures related to osteoporosis are a serious problem in
older people
Approx. 25,000
hip fractures each
year in Canada
(70% are
osteoporosis
related)
Hip fractures result in death in up to 20% and disability in up
to 50% of those who survive
• Osteoporosis is a major public health issue in Canada
• Osteoporosis is diagnosed and treated by a variety of
specialists and family physicians
• Osteoporotic fracture cases are treated almost
exclusively by orthopaedic surgeons
The Evidence
• The majority of individuals who sustain
fragility fractures are not receiving adequate
osteoporosis management
– Less than 32% of fracture patients are
investigated for osteoporosis.
Elliot-Gibson et al, 2004
Fragility Fractures…
“ a fracture caused by injury that would be
insufficient to fracture normal bone: the result of
reduced compressive and/ or torsional strength of
bone ”
– Minimal trauma
– From standing height, or less
WHO, 1998
Post- Fracture Care
Osteoporosis Screening Coordinators
• Increase the rate of referral of fragility
fracture patients for assessment and
treatment of OP, in order to reduce the risk
of re-fracture
What does OP Screening Coordinator do?
• Identify all men and women 50+ who have
suffered a fragility fracture
• Assess patient for OP risk factors
• Encourage patient to see family physician
for further OP assessment
• Educate identified patient
• Follow up evaluation- 3/6 month
Long-Term Outcome Goals
• To increase preventive health behaviours in patients who
have sustained a fragility fracture.
• Lower rates of subsequent fracture in this high-risk patient
population, particularly hip fractures.
• Lower fragility fracture-related health care costs for the
hospital and provincial government.
Other Initiatives
• Low Volume Fracture Screening
• Fracture Fighters – Rehab component
• Break Through – Adult Education
• Bone Fit – Osteoporosis Fitness Cert.
Osteoporosis: An Overview
Who Gets Osteoporosis?
1 in 4 women
1 in 8 men
How strong are your bones?
• Healthy strong bones are critical in
preventing fractures.
• Bone is renewed through a process in which
old bone is removed and replaced by new
bone.
The Remodeling Process:
How Bone Repairs Itself
Normal Growth and
Development of Bone
Four Major Factors that
Contribute to Bone Health
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Genetics
Hormones
Nutrition
Physical activity
Risk Factors
• Certain factors appear to play a role in the
development of Osteoporosis
• These are called “risk factors”
• There are both minor and major risk factors
Diagnosis of Osteoporosis
Assessing Your Risk Factors:
Major Risk Factors
• Age  65
• Vertebral compression
fracture
• Fragility fracture after
age 40
• Family history of
osteoporotic fracture
• Systemic glucocorticoid
use > 3 months
• Malabsorption syndrome
• Primary
Hyperparathyroidism
• Propensity to fall
• Osteopenia apparent on
x-ray
• Hypogonadism
• Early menopause (before
age 45)
Diagnosis of Osteoporosis
Assessing Your Risk Factors:
Minor Risk Factors
• Rheumatoid Arthritis
• History of clinical
hyperthyroidism
• Chronic anticonvulsant
therapy
• Low dietary calcium
intake
• Smoker
• Excess alcohol
• Excess caffeine
• Low body weight (<57 kg
or 125 lbs)
• Weight loss > 10% of
weight at age 25
• Chronic heparin therapy
Review Your Risk Factors with Your
Physician
• Everyone over the age of 50 should assess their
risk factors with their physician.
• Those individuals with at least one major or two
minor risk factors should have a bone mineral
density (BMD) test.
• Everyone age 65 and over should have a bone
mineral density (BMD) test.
Diagnosis of Osteoporosis
Bone Densitometry
Determining Your 10-year Absolute Fracture
Risk
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Factors that influence this are:
BMD results
Age
Gender
Fracture history
Family history
Glucocorticoid (steroid) use
Goals of Osteoporosis Management
•
bone loss
• Maintain and/or increase bone
density
• Reduce the risk of fracture(s)
Drug Therapies
Slow bone erosion
Bisphosphonates include:
Etidronate (Didrocal )
Alendronate (Fosamax,
Fosavance )
Risedronate(Actonel )
Zoledronic Acid (Aclasta)
SERMs-Raloxifene( Evista)
Calcitonin (Miacalcin)
Speed up bone building
Parathyroid hormone (PTH )
Teriparatide (Forteo) a daily
subcutaneous injection for 18 months
Calcium: OC’s Daily
Recommended Intake
Age
Daily Intake
Children (4 – 8)
800 mg
Adolescents (9 – 18)
Men & women (19 – 49)
Men & women (50+)
1300 mg
1000 mg
1500 mg
Pregnant or lactating women (> 18 years)
1000 mg
Eat foods high in Calcium
• Dairy sources- whole
and skim milk products,
cheese, yogurt
• Fortified beverages
• Fish bones-salmon,
sardines
• Vegs- broccoli, bok
choy, kale
Calcium Content of Some Foods
Milk – all
1cup
Yogurt
¾ cup
Cheese-hard
Ice cream
½ cup
Salmon/bones
½ can
Beans,baked
½ cup
Broccoli,cooked ¾ cup
Orange
1 med
300mg
295mg
245mg
80mg
240mg
75mg
50mg
50mg
Osteoporosis Prevention
Calcium Supplements: Questions
& Answers
What are they made of?
How do I choose one?
What is the best way to take them?
Which types are recommended?
Osteoporosis Prevention
Vitamin D: OSC’s Daily
Recommended Intake
Age
Daily
Intake
Men & women (19 – 50)
Men & women (50+)
400 IU
800 IU
Pregnant or lactating women (> 18
years)
400 IU
Where to find Vitamin D?
• Foods that are a natural source of Vit D –
fish oils, eggs, chicken livers, salmon and
sardines
• Foods fortified with Vit D
- milk, margarine, some yogurts, some soy
beverages (check labels)
• Vit D supplement, Multi vitamin, calcium
supplement with Vit D
Physical Activity
• Regular weight bearing activity
• Resistance exercise
Weight Bearing Exercise
Some examples of weight-bearing physical
activities are…
• Walking, running, stair climbing, dancing
• Games and sports such as badminton,
tennis, basketball, volleyball etc
Resistance Exercises
These involve moving objects or your own weight to
create resistance
• Common forms of resistance exercise include:
• Weight – training with barbells, dumbbells,
household objects or wrist weights
• Strength training with equipment in a gym or
health club
Exercise with Caution
Check with a physician before starting any exercise
program
• Don’t do exercise that causes pain
• Warm up before exercise and stretch well after
exercising
• Choose a facility, leader or trainer who knows the
exercise restrictions associated with osteoporosis
• Choose an activity or program that is enjoyable
Living with Osteoporosis
Some
Movements
Should be
Avoided
Osteoporosis Prevention
The Benefits of Being
Physically Active
Healthier bones - works with calcium &
vitamin D to build strong bones
Better coordination and balance
Improved muscle strength and flexibility
Increased endurance for daily activities
Improved posture
Balance & Falls Prevention
• 1 in 3 seniors 65+ falls each year
• 1 in 2 seniors 80+ falls each year
• The fall-related injury is 9x greater in seniors than
among those under 65
• Vitamin D has been shown to reduce falls
• Exercise has been shown to decrease falls as well
as the risk of falls if exercise includes activities
aimed at improving balance.
Personal costs after a Fall
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Pain and suffering
Loss of independence
Increased risk of falling- fall cycle
Falls cause 90% of all hip fractures in
seniors
• Almost half of all falls occur in/around
home
The Key Messages for
Osteoporosis
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Knowing/Assessing your risks
Bone Mineral Density Testing
Medication
Diet – Calcium and Vitamin D
Exercise – Wt Bearing and Resistance Training
Falls and Safety Prevention
Osteoporosis Canada
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1-800-463-6842 (English)
1-800-977-1778 (French)
www.osteoporosis.ca
COPN (Canadian Osteoporosis Patient Network)