Most common primary forms are postmeno- pausal and age-related or combination Postmenopausal due to a reduction in bone forming hormone estrogen Average age is 50 Levels begin to drop 2-3 years prior to last menses and continue to drop 3-4 after
Bone loss slows at age 70 Most women lose 35-50% of bone density between 50-70 Age-related Lose 0.4-1.8% of bone each year until age 80
Due to a reduction in bone formation with the same rate of break down
Falls result from balance issues, loss of muscle mass, loss of fatty tissues, poor vision, medications causing dizziness, chronic disease and slower reaction times Reduce damage by trying to catch yourself or hip pads
Diseases (Parkinson’s, MS, arthritis, COPD, CHF, depression, dehydration, hypotension, or u)
Medications causing dizziness
Most falls occur in the home (loose cords, loose carpet, cluttered oors, poor lighting, and stairs)
Evaluation Screening Bone densitometer or US Low bone density
drowsiness or affect vision medications
Certain BP meds, sedatives, tranquilizers, antidepressants, cold and allergy, pain relievers, and sleep meds Certain
may also cause
Secondary is caused by diseases, medications and surgery Affects 50% of men 20-30% of postmenopausal women Onset prior to 50 Medications Medical conditions: endocrine disorders (hyperparathyroidism, Cushing’s syndrome and Type 1 diabetes), stomach, intestinal and liver disorders (Crohn’s disease, Celiac disease, primary biliary cirrhosis and lactose intolerance), rheumatoid arthritis, failure to menstruate, eating disorders, immobility, and surgical procedures (organ transplant and gastric surgery)
At age 65 men and women lose bone mass at the same rate
Wear and tear (occupational) Men lose bone density at 1% a year 1/8 men over 50 have fracture
First 5-7 years of menopause lose 1-3% of your bone per year As high as 20%
Bone marker tests (Not a substitute) Measure bone turnover (higherloss)
Monitoring meds DEA
Interpreting results T scores Compares bone density to same gender, weight and race with normal bone density
Z-scores Compare your bone density with that of the average person (gender specic) for your age group without osteoporosis
Not used to determine osteoporosis Specic for bone density (secondary disease)
Every standard deviation away from normal doubles the risk of fracture
Not an end all be all of osteoporosis (age, health, meds, fracture history, family history and overall bone health)
Treatment Overview Diet and supplementation Avoid dieting during teen years (consult a dietician)
Severe cases surgery required Step #1
Prevent falls and minimize pain Medications and hormone replacement therapy Osteoporotic fracture of the vertebra conservative treatment for pain more focused on future prevention
Diet and Nutrition 1. Increase foods with vitamin D and calcium 2. Avoid alcohol, caffeine and smoking 3. Increase chicken and cold water sh 4. Reduce carbonated beverages 5. Increase fruits and vegetables 6. Reduce saturated and trans fats 7. Reduce rened foods and simple sugar 8. Increase essential amino acid and protein intake 9. Increase soy
Step #2
Diagnosis with DEA or CT -ray doesn’t detect osteoporosis until 25-40% bone loss
THE ORIGINAL INTERNIST JUNE 2016
Supplements 1. Vitamin D 5,000 I.U. q.d. 2. Calcium citrate 2,000 mg q.d. 3. Vitamin B6 100 mg q.d. 4. Magnesium citrate 1,000 mg q.d. 5. Boron 3 mg q.d. 6. Vitamin B12 200-400 mcg q.d. 7. Folic acid 200-400 mcg q.d. 8. B-150 complex q.d.
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Exercise Maximize and maintain bone mass Starts in childhood
Prevention of fracture Improve balance and ability to move
Botanicals Lower than -1.5 -1 equals 12% bone loss
T-score of 0standard of that weight Normal is within 1 standard deviation (-1 to -2.5)
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