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OSTEOPOROSIS

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Physical activity-Weight bearing (axial loading) activities are best. Stair climbing ... bone loss, may increase bone density, reduces fractures (EXPENSIVE $20/pill) ... – PowerPoint PPT presentation

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Title: OSTEOPOROSIS


1
OSTEOPOROSIS OSTEOARTHRITIS You CAN Do
Something About It!
  • Lisa Z. Killinger, DC

2
REFERENCE FOR THIS PRESENTATIONGleberzon B,
Killinger LZ. Management considerations for
patients with OA and OP A chiropractic
perspective on whats working. TICC
20029(1)48-60.
3
What do we know about OP?
  • Now affects 25 million Americans
  • 1/3 of women gt 75 are osteoporotic
  • 94 of women gt 75 have low bone mass
  • 1.5 million OP-related fractures/year
  • 700,000 vertebral fx/year 2.5
    standard deviations below the mean of a young
    adult reference popul.

4
So, what can WE do?
5
Primary Prevention(Prevent OP from ever
happening)
  • Counsel pts about diet and physical activity at
    all ages, to maximize bone density in the third
    decade of life and slow the rate of bone loss
    after that.
  • Most important factor physical activity!!!!
    (National Osteoporosis Foundation and
    Clinicians Handbook of Preventive Services
    HP2010)

6
Secondary Prevention (Early detection)
  • 1. Screen all patients OP checklist
  • 2. Identify preventable risks
  • 3. Get baseline bone mineral density test (Dexa
    scan of the hip is the gold standard)
  • 4. Design a prevention plan suited to patients
    risk factors

7
BMD testing The DEXA Scan
  • Recommended for
  • Women with risk factors
  • Women who have had a fracture (as an adult)
  • Those 65 and older
  • Those who are considering OP therapies
  • Those who have been on or are starting HRT

8
But, what does it all mean?!!
  • Normal BD within 1 Standard deviation of a
    young healthy adult
  • Low Bone Mass BD is 1-2.5 SD below mean
  • Osteoporosis BD is gt2.5 SD below mean
  • Your Z score compares your BD to people your
    size, age and gender (careful)

9
Tertiary Prevention(Minimizing osteoporosis
impact and disability/slowing progression)
  • Employ safe chiro. adjusting strategies
  • Fall prevention (IMPORTANT!)
  • Keep patients physically active
  • Monitor lifestyle and behaviors,
  • Encouraging healthy dietary choices
  • Supplementation!!

10
So, what do we tell our patients?
  • Physical activity-Weight bearing (axial loading)
    activities are best
  • Stair climbing
  • Walking
  • Step aerobics
  • Jazzercise
  • 3 times a week for 15-20 minutes
  • Find a friend to be active with!

11
Pumping Iron
  • Free weights work wonders!
  • Focus on lifting weights with muscles that tug
    against the spine (traps, rhomboids, lats, etc)
  • Start small and work up to more weight
  • Can be done while watching TV, etc.
  • Lower body? (Jette, Exercise-Its never too
    late AJPH)

12
Later years Fall prevention
  • Strengthen lower body
  • Proprioceptive training
  • Balance/gait focus
  • Home safety checklist
  • Modify unsafe surroundings
  • Assess and monitor meds
  • Regular chiropractic care-IMPORTANT!

13
Risks for hip fractures/falls
  • older age
  • history of fx
  • low weight
  • caffeine intake (gt2 cups coffee/day)
  • alcohol use
  • lack of walking/exercise
  • vision impairment
  • meds that have dizziness or bone loss as a side
    effect (steroids, anticonvulsives, BP meds)

14
What about nutrition?
  • Recommendation 1,200-1,500 mg/day of calcium
    (hard to get in diet)
  • Vitamin D400 - 800 IU/day
  • Other bone helpers magnesium, boron, Vit C
    (collagen), etc.
  • Choosing where the calcium deposits through
    focused physical activities
  • Watch out for calcium thieves phosphorus,
    caffeine, alcohol, smoking, oxalic acids, etc.

15
But what kind of Calcium?
  • Calcium citrate-most easily digested (expensive)
    22 usable Ca/big pills
  • Calcium carbonate-needs acidic gastric envir (but
    cheaper!) 40 elemental or usable Ca/smaller
    pills)
  • Dairy-yogurt and lowfat milk are the gold
    standard calcium sources (all other sources are
    viewed in comparison to these)

16
The Acid Test
  • Calcium supplement tablet should dissolve
    completely in a small glass of vinegar in 30
    minutes or less
  • Beware of coated, compressed supplements with a
    shelf life of a zillion years!
  • Dont take more than 500 mg at a time

17
Foods for Calcium
  • Yogurt/milk
  • Ca fortified Juice
  • Fortified cereals
  • Acidophillus milk
  • Fortified soy milk/cheese, etc
  • Canned sardines with bones
  • Legumes-soak the phylates out first!

18
Calcium Interference
  • Oxalates and phylates
  • High protein diets (esp. meat-based)
  • High sodium diets (causes kidneys to dump Ca)
  • Wheat bran-phylate
  • High iron intake
  • High phosphorus intake
  • Alcohol, smoking, etc

19
Know the medical options...
  • HRT, ERT, etc
  • Alendronate (bisphosphonate)-Fosomax-decreases
    osteoclastic activity, arrests bone loss, may
    increase bone density, reduces fractures
    (EXPENSIVE 20/pill)
  • Calcitonin-oral or nasal spray (hormone)
    increases bone density in postmenopausal women

20
Resources related to OP
  • National OP foundation 1(800) 624-BONE or
    www.nof.org
  • info on prevention, patient pamphlets (free!),
    bone density tests, research, causes, etc.

21
Take Home Messages OP...
  • Counsel patients on diet/physical activity
  • Screen patients for risks
  • Assess bone density and risk factors before
    designing intervention
  • Develop prevention/health promotion strategies
    based on patients clinical scenario
  • Offer good, safe sound chiropractic care

22
Osteoarthritis
  • Affects about 50 of all people over 65
  • Costs 10,000,000 per year in US
  • Leading cause of disability in older adults

23
Whats working?(Summary of research on OA)
  • Physical activity Best strategy ()
  • Adjust Bones that are not aligned degenerate
    faster (animal models, human studies of the knee)
  • PT TENS 7 trials () Ultrasound (/-)
  • Acupuncture-7 clinical trials ()
  • Glucosamine-16 clinical trials (effective and
    safe). 1,500 mg/day in 3 doses ()
  • Ginger 1 clinical trial ()

24
Medical Interventions
  • NSIADS first line of therapy, but
  • 0.04 fatality rate
  • 2,600 -3,200 deaths annually in US
  • 20,000 hospitalizations annually
  • 2.74 rate of serious adverse events (GI)
  • COX-2 inhibitors interrupts bodys perception of
    pain Celebrex, Vioxx - Hypertension, Renal
    failure

25
Stay up on the literature!!This is a growing
area of investigation in an aging population.
Patients come in asking informed questions!
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