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OTHER CHRONIC
DISEASES
&
CONDITIONS
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“Our health always
seems much more
valuable after we lose
it.”
- Author Unknown -
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DIMENSIONS OF
CHRONIC DISEASES
EPIDEMIOLOGICAL OVERVIEW
Affect women more often than they do men
Osteoarthritis, Rheumatoid Arthritis, Alzheimer
Disease
1 in 2 women age 50+ will have an osteoporosis-related
fracture in her lifetime
Diabetes affects 8.2% of all U.S. women
Lupus afflicts women 9X more often than men
Hypothyroidism is 50X more common in women
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ETHNIC & SOCIOECONOMIC
DIMENSIONS
White and Asian women have osteoporosis more
often than African American women
African American are more likely than white
women to die following a hip fracture
Asian American women have lower rates of
arthritis
African American women have highest prevalence
rates of diabetes
African women have higher prevalence rate of lupus
than white women
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ECONOMIC DIMENSIONS
Estimated Annual Costs
CONDITION
Hip Fractures
Arthritis
Diabetes
Alzheimer’s Disease
COST
$42 billion, worldwide
$22 billion, U.S.
$50 billion, U.S.
$50 billion, U.S.
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OSTEOPOSROSIS
HEALTHY BONE vs. OSTEOPOROTIC
BONE
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NON-MODIFIABLE RISK FACTORS
FOR OSTEOPOROSIS
Being female
Increased age/postmenopausal
Small frame and thin-boned
White or Asian
Family history of osteoporosis or fractures
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MODIFIABLE RISK FACTORS FOR
OSTEOPOROSIS
Diet low in Calcium and Vitamin D
Sedentary lifestyle
Cigarette smoking
Excessive use of alcohol
Certain medications
Glucocorticoids, Anticonvulsants
Amenorrhea
Anorexia nervosa or bulimia
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SCREENING & DIAGNOSIS FOR
OSTEOPOROSIS
Women Who Should Be Tested:
All postmenopausal women younger than age 65 who
have one or more additional risk factors for osteoporosis
besides menopause
All women age 65 and older
Postmenopausal women with fractures
Women who are considering therapy for osteoporosis or
who want to monitor the effectiveness of certain
osteoporosis treatments
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Bone Mineral Density Tests:
Dual-energy x-ray absorptiometry (DXA or
DEXA)
Single-energy x-ray absorptiometry (SXA)
Peripheral dual-energy x-ray absorptiometry
(pDXA)
Radiographic absorptiometry (RA)
Dual-photon absorptiometry (SPA)
Single-photon absorptiometry (SPA)
Quantitative computed tomography (QCT)
Ultrasound
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TREATMENT & PREVENTION FOR
OSTEOPOROSIS
Adequate supply of calcium
Vitamin D
Participate in weight-bearing and musclestrengthening exercises
Estrogen replacement therapy
Drugs: Raloxifene, Fosamax, Calcitonin
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ARTHRITIS
HEALTHY JOINT vs. OSTEOARTHRITIC
JOINT vs. RHEUMATOID ARTHRITIS
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RISK FACTORS FOR ARTHRITIS
Gender: women are 2-3X greater risk than men
Obesity
Infectious Diseases: Lyme Disease
Occupations
Excessive physical activity: Repetitive joint use
Hormonal levels: Higher estrogen levels
Diet: coffee and tea
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DIAGNOSIS FOR ARTHRITIS
No single test can diagnose arthritis
Family history and physical exam to check
joints, reflexes, and muscle strength
Radiographs
Blood tests
Joint aspiration
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TREATMENT AND PREVENTION FOR
ARTHRITIS
Maintaining weight
Avoid injuries during physical activity
Avoiding contact sports
Avoid repetitive joint motion, wear braces, pads,
proper shoes
Prevent lyme disease = vaccine, insect repellent
Drugs = NSAIDs, Corticosteroids, Hyaluronic
Acid, Immunosuppressants
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DIABETES
TYPES OF DIABETES
Type 1:
Insulin-Dependent
Diabetes Mellitus
(IDDM)
Type 2:
Non-Insulin
Dependent Diabetes
Mellitus (NIDDM)
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SYMPTOMS FOR DIABETES
Type 1:
Type 2:
Frequent
urination
Any Type 1 symptoms
Unusual thirst
Extreme hunger
Unusual weight
Extreme fatigue
Irritability
Frequent infections
Blurred vision
Cuts/bruises that are
hard to heal
Numbness of
hands/feet
Recurring skin,
bladder infections
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RISK FACTORS FOR DIABETES
Having a first-degree relative with diabetes
Being overweight
Having hypertension
Abnormal high-density lipoprotein (HDL)
Racial groups: African American, Hispanics,
Native Americans
Women who had gestational diabetes or delivered
a baby more than 9 pounds
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COMPARISON OF LIKELIHOOD OF
DIABETES ACROSS RACIAL
GROUPS
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COMPLICATIONS OF DIABETES
Heart disease
Periodontal disease
Stroke
Congenital malformations
High blood pressure
Neonatal mortality
Retinopathy
Macrosomia
End-stage renal disease Diabetic ketoacidosis
Damage of the nervous Susceptibility to infections
system
and illness such as
pneumonia
Lower-extremity
amputations
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DIAGNOSIS OF DIABETES
Routine Tests:
Fasting plasma glucose test
Oral glucose tolerance test
Blood sugar level above 140 mg/dL on at least
two occasions
Normal sugar level = 70-110 mg/DL
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TREATMENT & PREVENTION OF
DIABETES
Daily insulin injections
Diet control
Physical activity
Home blood glucose testing several times a
day
Oral medications
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AUTOIMMUNE
DISEASES
FEMALE-TO-MALE RATIO OF
CERTAIN AUTOIMMUNE DISEASE
Multiple Sclerosis
1.5 : 1
Type I Diabetes
2:1
Rheumatoid Arthritis
3 :1
Scleroderma
3 : 4.1
Grave’s Disease
7:1
Sjogren’s Syndrome
9:1
Hashimoto’s Disease
50 : 1
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CHARACTERISTICS OF LUPUS
Immune system forms antibodies that target healthy
tissues and organs
Primarily a disease of young women of childbearing
age
Affects women 9X more often than men
Affects American women 3X more often than white
women
Types
Cutaneous Lupus
Systemic Lupus
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SYMPTOMS OF LUPUS
Painful, swollen joints
Skin rash
Butterfly-shaped across face
Triggered by sun exposure
Arthritis
Seizures
Psychosis
Raynaud’s phenomenon
Extreme fatigue
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RISK FACTORS OF LUPUS
Exact cause is unknown
Genetic factors
Occurs within families
Environmental factors
Infections
Exposure to sunlight
Stress
Certain medications
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DIAGNOSIS OF LUPUS
Take note of symptoms
Skin rash, joint pain, chest pain, seizures,
photosensitivity, review of history of
medications
Blood count
Antinuclear antibody test (ANA)
Urinalysis
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TREATMENT AND PREVENTION
OF LUPUS
Avoid sun exposure and use sunscreen
Exercise
Non-steroidal anti-inflammatory drugs (NSAIDs)
Corticosteroids
Antimalarial agents
Immunosuppressant drugs
Steroids
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THRYOID DISEASE
Symptoms of Hashimoto’s Disease and
Graves’ Disease
HASHIMOTO’S DISEASE (Hypo)
GRAVES’ DISEASE (Hyper)
• Weight gain
• Weight loss
• Mental and physical slowing
• Nervousness and irritability
• Dry skin
• Increased energy expenditure
• Sensitivity to cold
• Heat intolerance
• Constipation
• Diarrhea
• Goiter
• Bulging of the eyes
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RISK FACTORS OF THYROID
DISEASE
Inherited
Family history of a family member
with thyroid disease
Hashimoto’s occurs with greater
frequency in people older than 60 years
of age
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DIAGNOSIS OF THYROID
DISEASE
Baseline testing to monitor thyroid function
Thyroid-stimulating hormone (TSH)
test
Blood tests measuring levels of thyroxine
(T4) can confirm presence of disease
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TREATMENT AND PREVENTION
OF THYROID DISEASE
Annual check-ups
Thyroxine for Hashimoto’s Disease
Antithyroid drugs for Graves’ Disease
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ALZEIMER’S DISEASE
A Women’s Risk Doubles Every Five Years
Beyond Age 65
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RISK FACTORS FOR
ALZEIMER’S DISEASE
Age
Genetic background
Lifestyle
Severe or repeated head injuries
Lower education levels
Environmental agents
Familial Alzheimer’s Disease (FAD)
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SYMPTOMS OF ALZEIMER’S
DISEASE
Memory loss
Decline in ability to perform simple tasks
Think less clearly
Affected language and reasoning skills
Lack of ability to make judgments
Personality changes
Emotional outbursts
Wandering and agitation
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TREATMENT AND PREVENTION
OF ALZEIMER’S DISEASE
Controlling symptoms with drugs
Haloperidol (aggressive behavior)
Sertraline (depression)
Zolpidem, Diphenhydramine (insomnia)
Alzheimer’s Drugs
Cogrex, Aricept, Exelon
Antioxidants: Vitamin E (reduce nerve cell damage)
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SUMMARY Of MEDICATIONS USED
TO TREAT CHRONIC CONDITIONS
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INFORMED
DECISION MAKING
SECONDARY PREVENTION FOR SENIORS
 Annual blood pressure screening
 Annual fecal occult blood test
Cholesterol screening
Sigmoidoscopy every 5 years
Height:Weight Measurements
Annual pap smear
Clinical breast examinations
annually
Evaluation for hearing loss
Cognitive function tests
Evaluation for visual acuity
Behavioral Assessment
Thyroid-stimulating thyroid
test
Routine Mammography screening
Bone mineral density test