Transcript 9. Osteoporosis

OSTOEOPOROSIS:
You CAN Do
Something About It!
Lisa Z. Killinger, DC
What do we know about OP?
• Now affects 25 million Americans
• 1/3 of women > 75 are osteoporotic*
• 94% of women > 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.
So, what can WE do?
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
Clinician’s Handbook of Preventive Services
recommendations)
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
patient’s risk factors
BMD testing: The DEXA Scan
• Recommended for:
– Women with risk factors
– Women whe 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
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 >2.5 SD below mean
• Your Z score = compares your BD to
people your size, age and gender (careful)
Tertiary Prevention:
(Minimizing osteoporosis’ impact and
disability/slowing progression)
• Employ safe chiropractic adjusting
strategies
• Keep patients physically active
• Monitor lifestyle and behaviors,
encouraging healthy choices
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!
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-It’s never too late;
AJPH)
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!
Risks for hip fractures/falls
• older age
• history of fx
• low weight
• caffeine intake (>2 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)
What about nutrition?
• Recommendation =1,200-1,500 mg/day of
calcium (hard to get in diet)
• Vitamin D=400 - 800 IU/day
• Other bone helpers = magnesium, boron,
Vit C (collagen), etc.
• Choosing where the calcium deposits…
through physical activities
• Watch out for calcium thieves:
phosphorus, caffeine, alcohol, smoking,
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)
The Acid Test
• 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!
• Don’t take more than 500 mg at a time
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!
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
Know the medical options...
• HRT, ERT, etc
• Alendronate (bisphosphonate)-”Fosomax”decreases osteoclastic activity, arrests
bone loss, may increase bone density,
reduces fractures (EXPENSIVE)
• Calcitonin-oral or nasal spray (hormone):
increases bone density in postmenopausal
women
Resources related to OP:
• Article: Management considerations for
patients with OA and OP: A chiropractic
perspective on what’s working. TICC
2002;9(1):48-60.
• National OP foundation: 1(800) 624-BONE
or “www.nof.org”
– info on prevention, patient pamphlets (free!),
bone density tests, research, causes, etc.
Take Home Messages...
• Counsel patients on diet/physical activity
• Screen patients for risks
• Assess bone density before designing
intervention
• Develop prevention/health promotion
strategies based on patient’s clinical
scenario
• Offer good, sound, safe chiropractic care