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Objectives
Define osteoporosis and osteopenia
- Explain the process of both age related and menopausal bone loss
- Define criteria for osteoporosis and osterpenia
- Discuss osteoporosis preventative measures
- Discuss osteoporosis treatment measures
Scope of the problem
- Single most important health hazary associated with menopause
- 700,000 new fractures a year
- 13 billion dollars/year to treat fractures
Definition:
- Age related
- Menopausal (estrogen) related
- Loss begins with menopause. Faster loss with surgical menopause.. Lose 2.5 per year the first five years after menopause.
- Relationship to other medication such as steroids
Physiology/Pathophysiology
- Types of bone
- Bone Remoneling
- Takes 100 days
- Accelerated loss with alcohol, caffeine, tobacco and lack of calcium and Vitamin D
- Influence of estrogen
Diagnosis
- DEXA Scan (Dual Energy X-ray absorptiometry) This is the "gold standard"
- World Health Organization
- T score
- Relationship to peek bone mass in early 30’s.
- This is used to determine osteopenia and osteoporosis
zero or above to -1 SD |
Normal |
under -1 to -2.5 SD |
Osteopenia |
under -2.5 and below SD |
Osteoporosis |
Z score
- Relationship to age matched peers
- Important particularly in young women
Prevention
- Calcium and Vitamin D
- Exercise
- Habits
- Genetics. Born with low risk factors!!
- Treatment. Pharmacological
- Hormone therepy (standard)
- Estrogen
- Supports osteoblastic activity
- Miacalcin (Calcitonin-Salmon) 200 units/spray/day. Alternate nares. May be used IM or SQ q day.
- Selective estrogen receptor modulator (SERM)
- Raloxifene (Evista). Decreases absorption or resorption, osteoclastic activity.
- Phosphates
- Alendronate (Fosamax). 10 mg q day for prevention; 20 mgq day for treatment
- Others
Treatment. Non pharmacological
- Calcium requirement and Vitamin D
- Exercise
- Habits
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