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Osteoporosis Dr.Hazar Ibrahim Yacoub Pharmacy College .KSU

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Title: Osteoporosis Dr.Hazar Ibrahim Yacoub Pharmacy College .KSU


1
Osteoporosis
  • Dr.Hazar Ibrahim Yacoub
  • Pharmacy College .KSU

2
FACTS AND FIGURES
3
NATIONAL STATISTICS
Osteoporosis affects more than 28 million
Americans 80 of them are women and 20 men 1 in
2 women and 1 in 8 men over the age of 50 will
develop osteoporosis Thin bones are the cause of
1.5 million fractures a year
4
FLORIDA STATISTICS
Over 2.1 million individuals have osteoporosis or
low bone mass 1998 - 22,630 residents had hip
fractures 1998 - Hospital charges for hip
fractures were 477.8 million with 80 discharged
to nursing homes
5
VERTEBRAL FRACTURES

Can lead to chronic back pain, loss of height,
protruding stomach, stooped posture - back pain
is the most common complaint At age 50, a woman
has a 50 chance of an osteoporosis-related
fracture during her life Loss of ability to do
daily living activities (cooking, cleaning,
getting dressed, etc.)
6
HIP FRACTURES
A womans hip fracture risk equals her combined
risk of breast, uterine and ovarian cancer 15-20
need long-term care facilities There is a 20
increased risk of death during the first year
following a hip fracture
7
MYTHS OR FACTS
Men do not get osteoporosis Diet can provide all
of the calcium a body needs If your grandmother
had osteoporosis, you will get it too Dairy
products are the only source of calcium
Activity Myths or Facts About Osteoporosis
8
MYTHS OR FACTS
If you have osteoporosis, you can do nothing
about it Our bones stop growing when we reach
full height (about age 20) Susceptibility to
fractures can indicate osteoporosis
9
MYTHS OR FACTS
Low calcium intake during adolescence can cause
osteoporosis later Exercise is dangerous for
older people
10
MEN OSTEOPOROSIS
Lifetime risk of getting osteoporosis is the
same as a mans lifetime risk for prostate
cancer Nationally, one in eight men over 50 will
get osteoporosis By age 75, one in three men will
get osteoporosis
11
ALL ABOUT BONES
12
OSTEOPOROSIS The Silent Disease
Osteo is Latin for bone Porosis means
porous or full of holes Osteoporosis means
bones that are full of holes
Osteoporosis can develop without symptoms You may
not know you have the disease until a bone
fractures
13
TYPES OF BONE
(1) Cortical is hard, compact, dense bone
(example mid-section of larger, long-bones of
arms and legs) (2) Trabecular is spongy, porous
and flexible bone (example end of the wrist, hip
and the spine)
Activity - Understanding Our Bones
14
HEALTHY BONE
Bone is living tissue, which is constantly being
broken down and rebuilt, a process called
remodeling Bone is renewed like skin, hair and
nails
15
OSTEOPOROTIC BONE

The loss of living bone tissue makes bones
fragile and more likely to fracture
Note arrow points to micro - fracture
16
BONE REMODELING
Resorption-removes old bone
Formation-replaces old bone with new bone
17
OSTEOCLASTS-PHASE 1
Cells called osteoclasts (think C for chiseler)
seek out old bone or damaged bone tissue and
destroy it, leaving small spaces (resorption)
18
OSTEOBLASTS PHASE 2

Cells called osteoblasts (think B for builder)
use minerals like calcium, phosphorus, and
vitamin D to fill in the spaces with new bone
(formation)
19
BUILD YOUR BONE BANK
You build bone until about age 30 Steps to
building healthy bones include Calcium
vitamin D Limit Caffeine Alcohol
Exercise Dont Smoke
20
BONE BANK DEPOSITS
From birth through adolescence, new bone is built
faster than old bone is removed In mid-life,
depending on lifestyle and other factors, bone
removal can achieve a balance with bone
formation After menopause, bone removal may
accelerate due to a decrease in estrogen
21
BONE LOSS AGING
The first 5-15 years after menopause a woman can
lose approximately 25 - 30 of trabecular
bone approximately 10 15 of cortical
bone Bone loss often occurs without symptoms
or warning signs
22
CHANGES IN BONE MASS
After menopause, bone removal accelerates due to
a decrease in estrogen
23
EARLY WARNING SIGNS
History of broken bones as an adult Unexplained
back pain subsides after a couple of weeks Loss
of more than an inch in height Posture has become
stooped
24
OSTEOPOROSIS
Normal Posture Dowagers Hump
25
CLARIFICATIONS
There is no relationship between osteoporosis and
arthritis Osteoporosis is a generalized bone
disease that causes porous bones, usually not
causing symptoms until a fracture occurs
26
CLARIFICATIONS
Arthritis refers to a group of diseases and
conditions that affect the joints and are usually
painful Osteoarthritis is a degenerative type of
arthritis affecting the hip, knees and tips of
the fingersno relationship to osteoporosis
27
CLARIFICATIONS
Steroids are sometimes used to treat arthritis,
and using steroids may put a person at risk for
osteoporosis There is no clear relationship
between dental cavities and osteoporosis Someone
with osteoporosis may have weakened jawbones and
be prone to losing teeth
28
RISK FACTORS
29
RISK FACTORS - CANT CONTROL
Gender Females are usually diagnosed with
osteoporosis at four times the rate of males.
Bone mass in males is approximately 15-20
higher than females Small Boned Thin may
result in smaller bones with a lower bone
density
Activity - Risk Factor Worksheet
30
RISK FACTORS - CANT CONTROL
  • Race/Ethnicity Women, especially Caucasian and
    Asian women with thin frames are at greater risk
  • African American women have a higher peak bone
    mass (10) than Caucasian women, but other
    factors such as nutrition, exercise, certain
    diseases, and medications may increase their risk
    of osteoporosis

31
RISK FACTORS - CANT CONTROL
Heredity your family history may put you
genetically at risk or may be a result of family
members sharing the same environment, exercise,
and nutritional habits Menopause or several
months without periods bone loss begins to
exceed bone formation, due to a decrease of
estrogen
32
RISK FACTORS - CANT CONTROL
Age In your 40s you start to lose bone faster
than you build new bone. The accumulated loss
of bone puts an older person at higher risk
33
RISK FACTORS CAN CONTROL
Calcium Rich Diet milk, cheese, yogurt Weight
Bearing Exercise walk, bike, run Vitamin D
sunshine, multivitamin, fortified food
34
RISK FACTORS CAN CONTROL
Caffeine Recommendation- No more than 2-3 cups
of caffeine beverages per day Cola, coffee and
chocolate all contain caffeine
35
RISK FACTORS CAN CONTROL
Alcohol consuming more than one alcoholic drink
per day is associated with risk of low bone mass
Eating Disorders anorexia nervosa or bulimia can
lead to malnutrition and bone loss
36
RISK FACTORS CAN CONTROL
Smoking causes lower bone
density Immobility extreme lack of exercise
can lead to bone loss
37
OTHER RISK FACTORS
Steroids - cause increased bone breakdown and
decreased bone replacement Prolonged
hyperthyroidism can cause increased risk of
bone loss Thyroid hormone - (in excess) acts on
bone cells to increase resorption
38
OTHER RISK FACTORS
Diuretics some types of diuretics may
increase excretion of calcium in the urine Kidney
failure affects the metabolism of calcium,
phosphorous and vitamin D Chronic hepatitis
chronic liver disease may cause bone loss in
several different ways Intestinal disease some
can affect the absorption of vitamin D calcium
39
DRUGS-MAY CAUSE BONE LOSS
Cortisone Isoniazid Seizure drugs
Lithium Cyclosporine Heparin Methotrexate
Some Hormones Lupron Zoledex
Ask your healthcare provider
40
PREVENTION
41
CALCIUMS FUNCTION
Blood clotting (control bleeding) Regulates heart
beat Muscle function Nerve transmission Bone
formation
42
DAILY CALCIUM REQUIREMENTS
Age 1-3 years 4-8 years 9-18 years 19-50
years over 50 years
  • Milligrams (mg)
  • 500
  • 800
  • 1,300
  • 1,000
  • 1,200- 1,500

National Academy of Science
43
CALCIUM NEEDS
Adolescents-may lack calcium due to high fat
snacks with empty calories, soda and
dieting Eating Disorders-anorexic or bulimic
teens lack calcium and may develop osteoporosis
at an early age Older Adults-may have increased
calcium need due to poor absorption
44
SERVING SIZE
1 ½ cup (12 oz) of liquid is the size of soda-pop
can 1 cup (8 oz) of food is the size of large
handful ½ cup (4 oz) of food is about half a
large handful 3 (oz) of cooked meat, fish,
poultry is about the size of a deck of cards A
serving size is the amount of the food after it
is cooked
45
SERVINGS-INCLUDE CALCIUM
Food Serving
Fat Sparingly Dairy 2-3
Protein 2-3 Vegetable 3-5 Fruit
2-4 Grains 6-11
Activity - Calcium Worksheet or Calcium Card Game
46
CALCIUM IN FOODS
1 oz cream cheese 20 mg 1 hard boiled
egg 30 mg ½ cup cooked broccoli
40 mg ½ cup cottage cheese 80 mg 1 oz
cheddar cheese 205 mg 6 oz
calcium-fortified OJ 250 mg 1 cup milk
300 mg 1 cup fruit yogurt 345 mg 3 oz
sardines with bones 370 mg 8 oz vegetable
lasagna 450 mg
Activity - Results to Calcium Card Game
47
FOOD LABELS
 
Serving size number of servings
Calories, Total Saturated fat in grams,
Cholesterol Sodium, Fiber, Sugars, Protein in
grams
Daily Value (DV)
Daily Amount
48
READING FOOD LABELS
Calcium content may vary greatly between
different brands of food The percentage of
calcium in a food is based on 1000 milligrams. A
food containing 20 calcium 200 mg A food
containing 10-19 of calcium is a good source
20 of calcium or higher is a very good source
Activity Nutrition Facts
49
DAILY VALUE OF CALCIUM
FOOD DV Fruit yogurt
35 Oatmeal
10 Turnip Greens 20
Total DV 65 Add DV by reading food
labels to ensure you get the recommended daily
calcium
Activity - Foods and Calcium
50
LACTOSE-INTOLERANCE
Individuals who have difficulty digesting the
sugar found in milk, called lactose Start with
small portions of food such as milk--gradually
Increase portions Eat dairy foods in combination
with other foods Many hard cheeses have less
lactose than milk Commercial lactase preparations
aid digestion
51
CALCIUM SUPPLEMENTS
Read Labels--several different types of calcium
supplements available Avoid -natural calcium
such as bone meal or dolomite-some contain toxic
lead or mercury Elemental calcium - is the type
of calcium the body absorbs
52
ELEMENTAL CALCIUM
Kinds of Calcium Elemental
Calcium Calcium carbonate 40 Calcium
phosphate (tribasic) 39 Calcium phosphate
(dibasic) 30 Calcium citrate
21 Calcium lactate 13 Calcium
gluconate 9 Example, a 500 mg calcium
tablet may only contain 45-200 mg of elemental
calcium
53
CALCIUM TIPS
Do not take more than 500 mg of calcium at a time
or 2000 mg total per day Your body can absorb
only about 500 to 600 mg at a time Example
take one tablet at breakfast and another at dinner
54
CARBONATE CITRATE
  • Needs acid to dissolve and for absorption
  • Less stomach acid as we age
  • Take at or after meals when more stomach acid
  • Doesnt require stomach acid for absorption
  • May be taken between meals
  • May cost more

55
TEST YOUR CALCIUM TABLET
Put a calcium tablet in a cup of half water and
half vinegar. Stir every 5 minutes. If it
doesnt dissolve in 30 minutes, it probably
wont dissolve in your stomach
56
VITAMIN D
  • Vitamin D is necessary for calcium to be absorbed
  • Multivitamin or calcium tablets may contain 400
    IU daily (dont exceed 800)
  • Vitamin D is in milk (100 IU in 1 cup)

57
EXERCISE!
Walking Dancing Gardening Tennis Jump
Rope Volleyball Skating
Activity Exercise Guide
58
ENVIRONMENTAL SAFETY
PREVENT PAINFUL FALLS
Activity Environmental Safety Cartoon
59
BONE DENSITY TESTING
60
WHO NEEDS TESTING?
If you have major risk factors for
osteoporosis If you have a family history of
osteoporosis If you have a personal history of
fractures after age 45 If you are on prolonged
use of steroids If you are postmenopausal, and
not on estrogen replacement therapy Consult your
healthcare provider
61
SCREENING TESTS
Portable scanners SXA - (Single Energy X-ray
Absorptiometry), measures wrist or heel pDXA -
(Peripheral Dual Energy X-ray), measures wrist or
heel
62
SCREENING TESTS
RA - (Radiographic Absorptiometry), x-ray of hand
that is compared to a small metal wedge QCT -
(Quantitative Computed Tomography), measures the
spine Ultrasound - sound waves to measure the
heel, shin, and kneecap
63
DXA-BONE DENSITY TESTING
64
WHAT IS A DXA?
DXA (Dual Energy X-ray Absorptiometry) is the
gold standard Measures bone density in the
hip, spine, and forearm Painless, non-invasive,
requires no injections Takes 10 - 20 minutes
65
WHAT IS A T-SCORE?
World Health Organization T-score is comparing
the average bone density to that of healthy young
Caucasian women T-Score Diagnosis 0 to
1 Normal -1 to 2.5 Osteopenic-
low bone mass -2.5 or lower
Osteoporotic
66
MEDICATION
67
MEDICATIONS
  • Estrogen - ERT
  • Fosamax - Alendronate
  • Actonel - Risedronate
  • Evista - Raloxifene
  • Miacalcin - Calcitonin

68
ESTROGEN
Most cost-effective prevention for
osteoporosis Slows bone loss and may slightly
increase bone mass Estimated to reduce hip
fracture by 30-50
69
EVISTA (Raloxifene)
SERMS-Selective Estrogen Receptor
Modulators-designer drugs SERMS act like estrogen
but doesnt stimulate breast or uterine
tissue Evista is the first and only SERM approved
for the prevention and treatment of osteoporosis
70
BISPHOSPHONATES
Fosamax and Actonel Specifically designed to
affect the skeleton, increase bone density
reduce number of fractures Must be taken
correctly - on an empty stomach, first thing in
the morning with glass of plain water, fasting,
remain upright for 30 minutes
71
FOSAMAX (Alendronate)
Approved for prevention and treatment Approved
for treatment of steroid- induced osteoporosis in
men and women Prevention 5 mg daily Treatment
10 mg daily or 70 mg once weekly (for men and
postmenopausal women)
72
ACTONEL (Risedronate)
Weekly 35 mg is approved for prevention and
treatment of osteoporosis in postmenopausal
women, and for women who have osteopenia, but are
not yet postmenopausal Daily 5 mg dose is
approved for prevention and treatment of
glucocorticoid-induced osteoporosis in women
Actonel may be given to males at the discretion
of the Health Care Provider
73
MIACALCIN (Calcitonin)
Is a naturally occurring hormone involved in
calcium regulation and bone metabolism Available
by injection or nasal spray
74
PUTTING IT ALL TOGETHER
75
SUMMARY
Calcium Rich Diet Vitamin D Prevent
Falls Weight-Bearing Exercise
76
SUMMARY
Dont Smoke Minimize Caffeine Alcohol Testing
Medication if Needed
77
HEALTHCARE PROVIDERS
Healthcare providers are the best source of
information about osteoporosis and medical options
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