Introducing the Pro Medical Osteoporosis Program

What is Osteoporosis?

Description

A skeletal disease characterized by severe bone loss, disruption of skeletal microarchitecture, and disturbed bone strength and bone quality sufficient to predispose to atraumatic fractures of the vertebral column, upper femur, distal radius, proximal humerus, pubic rami, and ribs.
Osteoporosis is not an inevitable part of the aging process. It occurs most severely when patients fail to achieve optimal skeletal mass at maturity or lose bone rapidly thereafter.
Osteoporosis is a preventable disease
Osteoporosis has multiple causes

Types/causes of osteoporosis:

• Primary
• Postmenopausal (type I): Most common in white and Asian women. Caused by acceleration of bone resorption following menopausal loss of estrogen secretion
• Involutional (type II): Occurs in both sexes >75 years. Caused by imbalance between rates of bone resorption and formation.
• Mixture of types I and II is common.
• Secondary:
• Caused by extrinsic factors such as Medical diseases and Iatrogenic
• Eating disorders, corticosteroid excess, rheumatoid arthritis,multiple sclerosis, chronic liver/kidney disease, malabsorption syndromes,systemic mastocytosis, hyperparathyroidism, hyperthyroidism, elite athletes/balletdancers with hypoestrogenism, a variety of hypogonadal states, idiopathic hypercalciuria, medroxyprogesterone acetate (Depo-Provera), chronic anticoagulant use, chronic antiseizure medication, chemotherapy and radiation treatment
• rare acute osteoporosis of pregnancy and juvenile
• Idiopathic: A rare form of primary osteoporosis occurring in premenopausal women and in men

What is my first step?

First step is Prevention

Osteoporosis is a preventable disease, Please call for an appt to be screen by us today. Our Physicians, Nurses, Dieticians, Physical therapists and Exercise specialist will be glad to assist you

Ways to prevent osteoporosis from occurring

• Exercise (weight bearing/aerobic and strength training)
• Calcium (500 mg t.i.d.) and Vitamin D (800 IU/d) Intake
• Smoking cessation
• Screening for and identification of osteopenia/osteoporosis.( offered On Site)
• Medication for Prevention of osteoporosis

What if I already have osteoporosis?
If you already have osteoporosis there are many things you can still do to help. Recent research tells us there are now several options to significantly improve your skeletal health
The treatment goals are

• to stop additional bone loss
• rebuild bones as able
• Prevent complications from occurring

Treatment of Osteoporosis

• Diet

• Diet to maintain normal body weight
• Calcium intake of 1,000-1,500 mg per day from all sources, depending on age, if
• no hypercalciuric and no history of calcium stones
• Avoidance of excess phosphoric acid-containing beverages and excess protein intake
• Intake of 800 IU vitamin D daily from all sources, depending on patient age

Good nutrition with a wide variety of foods is critical to overall health and healthy bones. Healthy bones need a variety of nutrients including calcium, vitamin D, magnesium, and others. Calcium plays an important role in muscle contraction, blood clotting, and bone health. When your diet provides enough calcium, your body deposits it in your bones, where it rebuilds and strengthens bone tissue. Bone formation starts in childhood, increases during adolescence, and continues until about age 25. After 25, your daily calcium intake helps maintain bone health. If calcium levels in the body drop below normal, calcium will be taken from bones and put into the blood to be used for other body functions. That's why it's important at all ages to consume enough calcium to maintain adequate levels in the body.
Nearly half of U.S. children and adults do not eat enough calcium, and more than 80 percent of women in Maricopa County get less than the daily recommended levels of calcium. The National Academy of Sciences recommends the following amounts of calcium per day for various ages.

The National Institute of Health Consensus conference and the National Osteoporosis Foundation support a higher calcium intake of 1,500 milligrams per day for postmenopausal women not taking estrogen and adults 65 years or older. No one should take more than 2500mg of calcium daily. In addition, the body can only absorb 500mg of calcium from food or supplements at a time. Therefore, calcium intake should be spaced out throughout the day.
Everyone needs calcium in their diet, everyday, to build and maintain healthy bones. Milk and foods made from milk are the most concentrated sources of calcium. One cup of reduced fat milk has 300 mg of calcium and one cup of nonfat yogurt has 490 mg. Some people avoid milk products because they don't like these foods, do not eat any animal products, or have lactose intolerance. Calcium fortified juices, cereals and pasta have 300 to 400 mg calcium per serving

• Activity/Exercise

Recent studies have shown that the risk of osteoporosis is lower for people who are active, and especially those who do load-bearing, or weight-bearing activities at least three times a week.
How can exercise prevent osteoporosis? Muscle pulling on bone builds bone, so weight-bearing exercise builds denser, stronger bones. The more bone mass you build before age 25 or 30, the better off you will be during the years of gradual bone loss. Exercise can also help you maintain bone density later in life.
The best exercises for building bone are weight- or load-bearing exercises. These include weight-lifting, jogging, hiking, stair-climbing, step aerobics, dancing, racquet sports, and other activities that require your muscles to work against gravity. Swimming and simply walking, although good for cardiovascular fitness, are not the best exercises for building bone. Thirty minutes of weight-bearing exercise daily benefits not only your bones, but improves heart health, muscle strength, coordination, and balance. Those 30 minutes don't need to be done all at once; it's just as good for you to do 10 minutes at a time.
If you already have osteoporosis, you might wonder whether you should exercise at all. The answer for most people is YES. You should speak to your doctor to learn what types of exercises you can safely do to preserve bone and to strengthen your back and hips. Keep in mind, however, that exercise alone can't prevent or cure osteoporosis.

• Weight bearing exercises and/or strength and resistance training (6)[B]
• Avoid exercises and maneuvers that increase compressive forces and mechanical stress on spine and peripheral bone sites.
• Rehabilitation procedures for back muscle spasm, to increase agility (e.g., decrease falls) and encourage ambulation
• Smoking cessation and Reduce intake of alcohol and caffeine.

Developed by Mathias and Nayak as a screen for balance testing

1. Stand up from a chair, walk 3 meters (6 feet), turn and return to the chair

Grading scale is 1 to 5, with 1 being excellent (normal) and 5 being severely abnormal
A score of 3 or higher indicates an increased risk for falls.
Mathias S, Nayak USL, Isaacs B.: Balance in the elderly patient: The "Get-up and Go" test. Archives of Physical Medicine and Rehabilitation 67:387-389, 1986. (Shumway-Cook & Woollacott, 2001)

• Medication for treatment of Osteoporosis

Many new medicines not only help stabilized bone density loss but can replenish lost bone density

FDA approved therapies for prevention and/or treatment of osteoporosis

• Fosamax "Alendronate" (oral once a week) with or without vitamin D 2800IU or 5600IU (Generic Alendronate will likely be available in Feb 2008)
• Actonel "Risedronate" (oral once a week or monthly dose pack, which is two tablets on consequetive days once a month)
• Boniva "Ibandronate" (oral once a month or intravenous every 3 months)
• Evista "Raloxifene" (oral daily)
• Miacalcin "Calcitonin" (nasal spray daily)
• Forteo "Teriparatide" or Parathyroid Hormone (injection daily for 2 years only)
• Reclast "Zoledronic Acid" (intravenous once a year)

Forteo is parathyroid hormone now approved for over 4 years for the treatment of osteoporosis. Forteo is the first bone forming agent that stimulates 'osteoblasts', the cells making bone. It can be taken as a daily subcutaneous injection (like insulin is taken) for either 2 years or alternated every few months with an anti-resorptive agent such as Fosamax, Actonel, Boniva (Oral or IV), Evista or even estrogen, (though estrogen use is usually limited to the lowest dose for the shortest time needed for menopausal symptoms).

Prognosis for patients with Osteoporosis

• With treatment, 80% of patients stabilize skeletal manifestations, increase bone mass, increase mobility, and have reduced pain.
• 15% of vertebral and 20-40% of upper femoral fractures may lead to chronic care and/or premature death.
• Mortality; 15-20% 1-5 years post-acute fracture

Complications of Osteoporosis fractures

• Severe, disabling pain
• Dorsal/lumbar neurologic deficits secondary to vertebral fracture (rare)
• Respiratory and GI symptoms
• Invalidism/death secondary to complications

Patient Monitoring in our Program

• Bimonthly initially, then every 6 months
• Periodic multiphasic screening; annual gynecologic exam, breast exam, and mammography
• Annual or every 2 year BMD with same test
• Radiographs for acute pain, suspected fractures