Osteoporosis
Dr.Hazar Ibrahim Yacoub
Pharmacy College .KSU
FACTS
AND
FIGURES
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
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
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.)
HIP FRACTURES
A woman’s 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
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
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
MYTHS OR FACTS
Low calcium intake during
adolescence can cause osteoporosis
later
Exercise is dangerous for older
people
MEN & OSTEOPOROSIS
Lifetime risk of getting
osteoporosis is the same as a
man’s 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
ALL
ABOUT
BONES
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
TYPES OF BONE
(1) Cortical – is hard, compact,
dense bone (example: midsection 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
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
OSTEOPOROTIC BONE
The loss of
living bone
tissue makes
bones fragile
and more
likely to
fracture
Note: arrow points to micro - fracture
BONE “REMODELING”
Resorptionremoves old
bone
Formationreplaces old bone
with new bone
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)
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)
BUILD YOUR BONE BANK
You build bone until about age 30
Steps to building healthy bones
include:
Calcium & vitamin D
Limit Caffeine & Alcohol
Exercise
Don’t Smoke
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
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
CHANGES IN BONE MASS
After menopause, bone removal
accelerates due to a decrease in estrogen
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
OSTEOPOROSIS
Normal Posture
Dowager’s Hump
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
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 fingers—no
relationship to osteoporosis
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
RISK
FACTORS
RISK FACTORS - CAN’T 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
RISK FACTORS - CAN’T 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
RISK FACTORS - CAN’T 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
RISK FACTORS - CAN’T CONTROL
Age: In your 40’s you start to
lose bone faster than you
build new bone. The
accumulated loss of
bone puts an older
person at higher risk
RISK FACTORS – CAN CONTROL
Calcium Rich Diet:
milk, cheese, yogurt
Weight Bearing Exercise:
walk, bike, run
Vitamin D:
sunshine, multivitamin, fortified food
RISK FACTORS – CAN CONTROL
Caffeine: RecommendationNo more than 2-3 cups of
caffeine beverages per day
Cola, coffee and
chocolate all
contain caffeine
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
RISK FACTORS – CAN CONTROL
Smoking: causes
lower bone density
Immobility: extreme
lack of exercise can
lead to bone loss
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
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
DRUGS-MAY CAUSE BONE LOSS
Cortisone
Isoniazid
Seizure drugs
Lithium
Cyclosporine
Heparin
Methotrexate
Some Hormones
Lupron®
Zoledex®
Ask your healthcare provider
PREVENTION
CALCIUM’S FUNCTION
Blood clotting (control bleeding)
Regulates heart beat
Muscle function
Nerve transmission
Bone formation
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
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
SERVING SIZE
1 ½ cup (12 oz) of liquid is the size of sodapop 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
SERVINGS-INCLUDE CALCIUM
Food
Fat:
Serving
Sparingly
Dairy:
2-3
Protein
2-3
Vegetable:
3-5
Fruit:
2-4
Grains:
6-11
Activity - Calcium Worksheet or Calcium Card Game
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
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
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
% 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
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
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
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
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
CARBONATE
CITRATE
Needs acid to
dissolve and for
absorption
Doesn’t require
stomach acid for
absorption
Less stomach
acid as we age
May be taken
between meals
Take “at” or
May cost more
“after” meals when
more stomach acid
TEST YOUR CALCIUM TABLET
Put a calcium tablet in a
cup of half water and
half vinegar. Stir
every 5 minutes.
If it doesn’t dissolve
in 30 minutes, it probably
won’t dissolve in your
stomach
VITAMIN D
•Vitamin D is
necessary for
calcium to be
absorbed
•Multivitamin or
calcium tablets may
contain 400 IU daily
(don’t exceed 800)
•Vitamin D is in milk
(100 IU in 1 cup)
EXERCISE!
Walking
Dancing
Gardening
Tennis
Jump Rope
Volleyball
Skating
Activity – Exercise Guide
ENVIRONMENTAL SAFETY
PREVENT
PAINFUL
FALLS
Activity –
Environmental Safety
Cartoon
BONE
DENSITY
TESTING
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
SCREENING TESTS
Portable scanners:
SXA - (Single Energy X-ray
Absorptiometry), measures wrist
or heel
pDXA - (Peripheral Dual Energy
X-ray), measures wrist or heel
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
DXA-BONE DENSITY TESTING
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
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”
MEDICATION
MEDICATIONS
Estrogen - “ERT”
Fosamax® - Alendronate
Actonel® - Risedronate
Evista® - Raloxifene
Miacalcin® - Calcitonin
ESTROGEN
Most cost-effective prevention
for osteoporosis
Slows bone loss and may
slightly increase bone mass
Estimated to reduce hip
fracture by 30-50%
EVISTA (Raloxifene)
SERMS-Selective Estrogen Receptor
Modulators-designer drugs
SERMS act like estrogen but doesn’t
stimulate breast or uterine tissue
Evista is the first and only SERM
approved for the prevention and
treatment of osteoporosis
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
FOSAMAX ® (Alendronate)
Approved for prevention and treatment
Approved for treatment of steroidinduced osteoporosis in men and
women
Prevention – 5 mg daily
Treatment – 10 mg daily or
70 mg once weekly
(for men and postmenopausal women)
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
MIACALCIN (Calcitonin)
Is a naturally occurring
hormone involved in calcium
regulation and bone
metabolism
Available by injection or nasal
spray
PUTTING
IT ALL
TOGETHER
SUMMARY
Calcium Rich Diet
Vitamin D
Prevent Falls
Weight-Bearing Exercise
SUMMARY
Don’t Smoke
Minimize Caffeine &
Alcohol
Testing & Medication if
Needed
HEALTHCARE PROVIDERS
Healthcare
providers are the
best source of
information about
osteoporosis and
medical options
Activity – Affirming a Positive Change
Please complete evaluation form-thank you!