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 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 (higherloss)


 Monitoring meds DEA


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 specic) for your age group without osteoporosis


 Not used to determine osteoporosis  Specic 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 rened foods and simple sugar 8. Increase essential amino acid and protein intake 9. Increase soy


Step #2


 Diagnosis with DEA 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 0standard of that weight  Normal is within 1 standard deviation (-1 to -2.5)


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