What is Osteoproosis

What is Osteoporosis?

Osteoporosis is a skeletal disease characterized by low bone mass that results in a reduction in the strength of the skeleton.

Normal Bone

Osteoporotic Bone

The Scope of the Problem

  • Osteoporosis affects as many as 44 million Americans
  • 80% of those affected are women
  • One in two women and one in four men over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime
  • While osteoporosis is often thought of as an older person’s disease, it can strike at any age

Consequences of Osteoporosis

  • Increased risk of fracture of the hip, spine, and wrist
  • Morbidity and mortality from fracture
    – Over 300,000 hip fractures/year
    – A 50-year-old white woman has a 15% lifetime probability of suffering a hip fracture
  • Healthcare costs
    – 2002: $18 billion

Fractures of the Hip and Spine


Reference:

National Osteoporosis Foundation

Osteoporosis and Osteoarthritis

Osteoporosis and Osteoarthritis

Osteoporosis Osteoarthritis
What is affected? Bones, which become more fragile and more likely to break Joints, especially weight-bearing joints (knees, feet, hips, and back)
Whom does it affect? 4 of 5 people suffering from osteoporosis are women occurs most commonly after the age of 45 Men and women equally; usually occurs after age 45
Why does it happen? Loss of bone mass, related to certain risk factors Join structure weaken and wear down

Who is at Risk? Risk Factors for Osteoporosis

  • Age
  • Gender
  • Race
  • Bone structure and body weight
  • Menopause and menstrual history
  • Lifestyle
  • Medications and disease
  • Family history
Osteoporosis and Menopause

Osteoporosis and Menopause

Bone loss due to decline in estrogen is the leading cause of osteoporosis in women

Bone Mass

Diagnosing Osteoporosis

If osteoporosis is painless, how do I know if my bones are healthy?

Keeping Bones Strong -The Keys to Prevention

  • The importance of calcium and vitamin D as part of a healthy diet
  • The value of weight-bearing exercise
  • Making lifestyle changes
  • Medications that prevent bone loss

The Importance of Calcium

Optimal Daily Calcium Intake*

Age Group (in years) Calcium (in milligrams)
1 – 5
6 – 10
11 – 24
800
800 – 1200
1200 – 1500
Men
25 – 50
Over 65
1000
1500
Women
25 – 50
50 – 65 taking estrogen
50 – 65 not taking estrogen
Over 65
Pregnant or nursing
1000
1000
1500
1500
1200 – 1500

Reference:

* Optimal Daily Calcium Intake. NIH Consensus Statement 1994

Vitamin D and Calcium Absorption

Vitamin D and Calcium Absorption

Your body needs vitamin D to absorb calcium

—>  Vitamin D  —>   Helps the body absorb calcium

The Value of Exercise

  • Weight-bearing: Jogging, walking, stair climbing, dancing and soccer are examples of weight-bearing exercise with different degrees of impact
  • Resistance: These activities include weight lifting, such as using free weights and weight machines found at gyms and health clubs

Making Lifestyle Changes

  • No Smoking
  • No Drinking

Medications That Help Prevent Osteoporosis

  • Estrogen/hormone therapy
  • Bisphosphonates
  • Calcitonin
  • Parathyroid hormone
  • Selective estrogen receptor modulators (SERMs)
Estrogen Can Dramatically Reduce Fracture Risk

Estrogen Can Dramatically Reduce Fracture Risk

Vertebral fracture frequency as a function of age among female patients in the Kaiser-Permanente population in San Francisco

Benefits and Risks of Estrogen

Benefits of Estrogen

  • Controls symptoms of menopause (vasomotor symptoms and urogenital problems)
  • Prevents osteoporosis
  • Decreases risk of cardiovascular disease

Risks of Estrogen

  • Increases risk of endometrial cancer if used without a progestational agent
  • Possible increased risk of breast cancer

Breast Cancer Risk and Postmenopausal Hormone Therapy

What Are the Facts?

  • Evidence for an association between postmenopausal hormone therapy and breast cancer risk is inconclusive
  • Virtually all studies show no increased risk with short-term, current use (i.e., < 5 years) or past use
  • Some studies show a slightly increased risk with long-term, current use (i.e., > 5 years
Medications That Help Prevent Osteoporosis

Medications That Help Prevent Osteoporosis

Bisphosphonates

Drug Type Bisphosphonate
Brand Name Fosamax®
How It Works Inhibits the cells in the skeleton that break down bone; decreases bone loss and allows bone mass to increase
Side Effects Gastrointestinal problems: musculoskeletal pain and/or headache


SERMs

Drug Type Selective estrogen receptor modulator (SERM)
Brand Name Evista®
How It Works Binds to the same receptor in bone as estrogen binds, and so mimics estrogen’s beneficial effects on bone density
Side Effects Hot flashes, leg cramps

Calcitonin

Drug Type Calcitonin
Brand Name Miacalcin®
How It Works Prescription nasal spray for the treatment of postmenopausal osteoporosis in women more than 5 years after menopause for which estrogens are not an option
Side Effects Nasal symptoms (runny nose, crusting, nosebleed, etc.), back and/or joint pain, and headache

Parathyroid Hormone

Drug Type Teriparatide (PTH 1-34)
Brand Name Fortéo®
How It Works Teriparatide is a man-made form of the active part of a natural hormone that is injected by the patient. It works by increasing bone mass and strength which decreases the chance of getting a fracture
Side Effects Dizziness, leg cramps, angina, nausea, vomiting, muscle weakness, constipation, sluggishness, angina
If You Have Osteoporosis

If You Have Osteoporosis

  • Exercise
  • Calcium
  • Medications
    – Estrogen
    – Bisphosphonates
    – SERMs
    – Calcitonin
  • Minimize the chances of breaking a bone

Osteoporosis Prevention Summary

  • Osteoporosis is preventable and treatable
  • Hormone replacement/estrogen replacement is first-line therapy for osteoporosis
  • Adequate calcium intake, exercise, and lifestyle changes also play an important role in helping to prevent osteoporosis
  • For those who cannot or will not take HRT, but have or are at risk for osteoporosis, other agents are now available