Osteoporosis

What you should know?

What is Osteoporosis?

• Osteo means bone,

• Porosis means porous (holes)
• Porous bones
– Bones have lost calcium & other minerals
– Bones are fragile
– Spine, hip & wrist fractures are common
Osteoporosis: Definition

• A chronic, progressive condition associated with

deterioration of bone tissue that results in low bone
mass.
• As the condition progresses bone fragility increases
leading to increased risk of fracture.
• Osteopenia is bone that is not as dense as normal bone
& is a precursor to osteoporosis.
Osteoporosis

• Very common bone disease

• Bone weakness can lead to fractures from simple falls or
even a sneeze or a cough!
“Silent Killer”

• The disease is “silent” because there are no symptoms

when you have osteoporosis.
• You may not know that you have osteoporosis till your
Bones Break
Osteoporosis - types

• Postmenopausal osteoporosis (type I)

– Caused by lack of estrogen
– Causes PTH to overstimulate osteoclasts
– Excessive loss of trabecular bone
• Age-associated osteoporosis (type II)
– Bone loss due to increased bone turnover
– Malabsorption
– Mineral & vitamin deficiency
Glimpse of Osteoporosis

• Fractures
– One out of two women > age 50
– One out of eight men > age 50
– Nearly 1/2 million hospitalized with fractures each year
• One out of five dies within 1 year
• Half never live independently again
What causes osteoporosis?

• When you are young your body makes new bone faster
than it breaks down old bones. As you get older, this
process slows down & you start losing bone density.
• The risk for osteoporosis depends on how much bone
mass you attained between ages 25-35 & how fast you lose
it.
Pathophysiology of Osteoporosis

Early Inadequate
menopausal peak bone Low bone
bone loss mass mass/
impaired
Decrease bone
Calcium/ quality Fractures
in bone
vitamin D
mass/bone
deficiency
quality

Other Trauma
factors
Pathogenesis of Bone Loss Due to
Calcium/Vitamin D Deficiency in Aged

Impaired renal Estrogen

function deficiency
Decreased calcium
absorption
Decreased Low dietary
vitamin D Calcium intake
synthesis
Secondary
hyperparathyroidism

Decreased sunlight
exposure
BONE LOSS
Osteoporosis & Fractures

• Fractures can affect most bones of the body, but they

mostly involve the hips, vertebra, wrist, and arms.
• Fractures can be very painful and very debilitating
Most Osteoporotic Fractures
Occur in a Fall
Risk Factors for Falls
• Muscle weakness
• Poor balance
• Poor eyesight
• Benzodiazepine use
• Poor overall health

Risks for Fracture in a Fall

• Falling to the side
• Age
• Low bone mass
• Unfavorable bone geometry
• High bone turnover
Risk Factors

Certain people are more likely to develop this disease

than others.
• Female
• Thin and/or small frame
• Advanced age
• Family history of osteoporosis
• Post menopause
Lifestyle Risk Factors

• Inactive lifestyle
• Diet low in calcium
• Little sun exposure and diet low in vitamin D
• Consume few fruits and vegetables
• Drink excess alcohol (>7 drinks/week)
• Current or former smoker
• Consume large amounts of caffeine
Prevention

• Lifestyle changes - best way of preventing osteoporosis:

• Consult your doctor.
• Get enough calcium (1000-1500 mg/day, depends on age)
• Get enough vitamin D (400-800 IU/day)
• Stop smoking
• Avoid excess alcohol intake
• Engage in weight-bearing exercises
• Treat underlying medical conditions that can cause osteoporosis
• Minimize/change medications that can cause osteoporosis;
• If at high risk for falls, consider using hip protectors which will
prevent a hip fracture.
Avoid Harmful Habits

• Smoking
• Strict dieting
• Heavy drinking (alcohol)
• High caffeine consumption
• Diet low in calcium and vitamin D
• Inactive lifestyle
Maintain Bone Strength

• Take enough calcium (1000 mg/day before menopause

& 1500 mg/day postmenopausal).
– Consult your doctor
• Get adequate vitamin D intake, which is important for
calcium absorption & to maintain muscle strength (400
IU/day until age 60, 600-800 IU/day after age 60).
• Get regular exercise, especially weight bearing exercise.
Exercise

• Exercising regularly during childhood and adolescence

can ensure that you will reach peak bone density as you
grow.
• Need to participate in weight bearing exercise.
– For example, walking, dancing, jogging, stair climbing, racquet
sports and hiking.
Fall Prevention:
Extra Advice for Older Adults

• Fall prevention
– Reduce household hazards
• Keep floors safe
• Improve lighting
• Install handrails
• Reorganize furniture
• Remove clutter
– Improve balance & strength
• Exercises
– Review medicines
Patient Education

• Educate your self more on Osteoporosis

• Educate your friends & family members
• Improve adherence to medications
• Establish baseline BMD measurement
• Follow up: measure BMD every 1-2 years
• Always consult your doctor
MODIFYING RISK FACTORS

• Encourage regular, weight-bearing exercise

• Encourage adequate calcium and vitamin D intake
• Encourage lower animal protein intake
• Quit smoking
• Use medications that may  osteoporosis risk with
caution (e.g., anticonvulsants, cyclosporine,
glucocorticoids, long-term heparin, methotrexate, thyroid
hormone replacement)
– Consult your doctor for more information
Osteoporosis (OP): Importance

• OP is a major health concern for 2 reasons:

– Osteoporotic fractures, most commonly of the vertebrae, femur &
wrist are associated with increased morbidity & mortality.
– As the fraction of elderly individuals in the population increases,
OP will become more prevalent.
• Everyone should try to educate themselves though their
health care provider.
How is it diagnosed?

• A simple test that measures bone mineral density (BMD)

at different parts of body, such as spine and hip, can help
determine osteoporosis.
• BMD is measured by DEXA Scan.
Bone Mineral Density (BMD)

• Measure of QUALITY & STRENGTH of bone.

• BMD test measures the density of minerals (such as
calcium) in bones using a special X-ray, CT scan, or
ultrasound.
Calcium

• Is needed for heart muscles, and nerves to function

properly.
• Inadequate amounts contribute to osteoporosis.
• Appropriate calcium intake falls between 1000 - 1300 mg
a day.
Calcium

Increase calcium intake:

• Consume calcium rich foods such as, low-fat milk,
cheese, broccoli, and others.
• Calcium supplement, if dietary calcium consumption is
inadequate.
• Consult your doctor
Vitamin D

• Is needed for your body to absorb calcium.

• Comes from 2 sources: The sun & fortified dairy
products, egg yolks, saltwater fish & liver.
• Need 400-800 IU a day.
SUMMARY 1

• Osteoporosis is prevalent among older adults & is

associated with high personal & financial costs as well
as mortality.
• It can be prevented though healthy lifestyle as suggested
by your healthcare provider right from younger days.
• Osteopenia & osteoporosis can be diagnosed with BMD
using dual-energy radiographic absorptiometry.
• Evaluation of patients with osteoporosis should include
assessment for secondary causes of bone loss.
SUMMARY – 2

• Osteoporosis prevention & treatment combines risk

reduction, exercise, calcium & vitamin-D
supplementation, hormones & other pharmacotherapies.
• Pain of osteoporotic vertebral fractures can be treated
with NSAIDs, calcitonin & narcotics as well as
physiotherapy.
• Do not ignore, understand that with the help of your
doctor you can prevent it.
Always consult your doctor

OSTEOPOROSIS LIT/31/PK/B-09440-5/FK/OCT-09