Clinical Treatment rotocol Emphasis on utrition to art ive of a Collectible eries
by: Anna Jurik, DC, RD, LDN, Daniel Richardson, MSc, PhD, CNC, Brett Martin, DC
Osteoporosis
History Osteoporosis takes mineral strength from bone and compromises integrity Means porous bone (honey combed app- earance)
18 million at risk Who should be tested? All postmenopausal women under 65 with 1 or more risk factors
Affects 10 million Americans 80% are women
Osteopenia is bone loss NOT a natural process of aging 1940 Dr. Albright associated drop in estrogen with bone density loss Started hormone replacement therapy Not considered a disease until recent years
ambulation Disc shrinks Disease
Hip fracture most serious (320,000) AVN, blood clot, or pneumonia particularly with coexisting condition Men have higher risk of mortality with hip fracture complications
Immobility, UTI, and bed sores Recovery can take up to a year
Better
Causes bone to become weak, brittle, and prone to fracture
Women over 50 at higher risk Estrogen has a protective effect on bone and helps regulate bone density
Causes chronic pain, anxiety, or depression 1/3 of affected end up in a nursing home Regardless of bone density all people over 75 are at risk of fracture
Age 30 reach peak bone mass bone mass and density begin to decline At a slow rate, this is normal More bone break down and less bone formation (skeletal maturity)
Cycle of break down and formation of bone takes 3-6 months in children, 6-12 months in adults, and 18 months in older adults Hormones control the cycling of break down and formation as well as absorption from calcium from the diet and elimination from the body
All women 65 and over Historectomy or oophorectomy at an early age Age 40 with fracture Hormone replacement therapy All people at risk due to a disease or medications If normal re-test every 5 years If osteoporotic measure every 1-2 years
Bone loss is irreversible Concentration should be on minimizing loss uality of bone is more important than density (resilience) Determined by genes and lifestyle
recovery and better prognosis health prior to fracture faster
(700,000) Less than 10% need hospital care Occurs during daily activity (17 lbs) Nagging pain with tenderness in the area
may
cause
pancake
fracture
Parathyroid hormone is released when calcium in the blood drops releasing calcium from the bone
Painless loss of bone density responsible for more than 1.5 million fractures Unfortunately fracture is the rst indication of the disease
Spine, hip, or wrist (FOOSH/pain with rotation) Reduces
height, 72 stooped posture, and
Parathyroid hormone activates vitamin D to increase absorption of dietary calcium
40% risk of fracture Fracture risk increases 2 times after rst fracture (independent of site or density/checked)
Due to heredity (genetic make-up), sex (men higher), race (Caucasian and Asian lower), diet (high levels of calcium and vitamin D), physical activity level, hormone production (estrogen, testosterone, late development), body size (petite women, pregnancy), medical conditions (chronic diseases), medications, and lifestyle (smoking and alcohol abuse) Medications: corticosteroids (prednis- one, prednisolone, cortisone and dexa- methasone), glucocorticoids (decrease blood levels of hormones), anticonvulsants (phenobarbitol, phenytoin and carbamaze- pine/liver conversion vitamin D), thyroid meds (levothroid, levoxyl and synthroid), diuretics (furosemide, bumetanide, etha- crynic acid and torsemide), and blood thinners (heparin and coumadin)
Primary vs. Secondary Known cause vs. unknown cause
Dietary insufciencies cause resorption of minerals for other organ systems (muscle, heart, nerves, and blood)
THE ORIGINAL INTERNIST JUNE 2016 (Continued on next page)
Abnormal outer layer starts to thin and inner layer becomes porous Loss of bone mass Open spaces within bone matrix widen
Osteoblasts less active, less absorption of calcium and vitamin D, more sedentary and lower levels of hormones
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