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Osteoporosis:
The Silent Killer
Joseph F. Scordino, MD
Lincoln County
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Maine oldest state in the country
Lincoln county oldest county in the state
Osteoporosis
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Osteoporosis is a disease that causes
the bones to become brittle and
fragile and more likely to break.
It is a silent disease in that it does not
cause pain until the bone breaks.
Osteoporosis is most likely to cause
fractures of the spine, hip or wrist
which can lead to hospitalization or
loss of independent living. Spine
fractures can cause spinal deformity
and severe pain in the back
Osteoporosis Under the Microscope
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Build bone early in teens and twenty
Constantly remodeling
Normal Bone
Prevalence
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Approximately one in two women and one in four
men over age 50 will have an osteoporosis related
fracture in their remaining lifetime.
Major threat for 44 million Americans or greater
then 50% of Americans over age 50
Osteoporosis can affect any individual of any age
80% of this pool of patients are women
Osteoporosis is more predominant in White and
Asian ethnic groups then in other groups
Consequences
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Osteoporosis bone fractures are responsible for
considerable pain, decreased quality of life, lost
workdays, and disability.
Some 20% of women with a hip fracture will die in the
subsequent year as an indirect result of the fracture.
In addition, once a person has experienced a spine
fracture due to osteoporosis, he or she is at very high
risk of suffering another such fracture in the near
future (next few years).
Effect on Independence
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At six months after a hip fracture, only 15
percent of hip fracture patients can walk across
a room unaided.
Up to 30% of patients suffering a hip fracture
will require long-term nursing-home care.
Symptoms
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People cannot feel their bones getting weaker.
They may not know that they have osteoporosis
until they break a bone. A person with
osteoporosis can fracture a bone from a minor
fall, or in serious cases, from a simple action
such as a sneeze or even spontaneously.
Women can lose up to 20 percent of their bone
mass in the five to seven years after menopause,
making them more susceptible to osteoporosis.
Peak Bone Mass
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Peak bone mass is obtained at around age 20
healthy diet. Building strong bones in childhood
helps to decrease fracture risk later in life.
Vertebral Fractures
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Vertebral (spinal) fractures may initially be felt or
seen in the form of severe back pain, loss of
height, or spinal deformities such as kyphosis or
stooped posture. In many cases, a vertebral
fracture can even occur with no pain.
Postural Deformity
Who Should be Screened
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NOF Screen > 65.
Less then 65 based
on risk factors 1) ,
100 lbs 2) FH of
fracture 3)
incidence of
previous fracture
Risk Factors
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Age
Female Sex
Race
Low weight or BMI
Previous Fracture
Parental history of hip
fracture
Steroid use
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Current smoking
Alcohol > 3 drinks a day
Rheumatoid Arthritis
Inflammatory Bowel
disease
Prolonged
Immobilization
Type 1 Diabetes
Thyroid Disorder
Fractures
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1 in 2 women after age 50 will have a osteoporotic
fracture in their lifetime while for men this 1 in 4.
Fractures due to osteoporosis lower an individuals
quality of life
25% of individuals die within 1 year of an osteoporotic
fracture
1 in 6 individuals previously independent individuals
require long term care following a fracture
Diagnosis
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A specialized machine called a
bone mineral density test can
be used to measure the extent
of osteoporosis at various sites
BMD is safe and painless
Bone density testing helps to
monitor response to treatment
as well as predict the chance of
future fractures
Medicare reimburses for BMD
testing every 2 years
How to make sense of BMD testing
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BMD compares your BMD to a healthy 30 year
old this is the T score which stands for standard
deviations
Lower score is worse
-1 to 1 is a normal bone density test
-1 to -2.5 is termed osteopenia
-2.5 or less is termed osteoporosis
Z score is comparison to similar age adults and
is less helpful then the T score
When to Treat
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Individuals with T score
less then -2.5
Individuals with T score
from -1 to -2.5 with risk
factors
FRAX score
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Easy to use program to
give score for
probability of hip
fracture in 10 years time
Requires a DEXA scan
http://www.sheffield.ac.
uk/FRAX/
Preventative Steps
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Remove all obstacles like throw rugs and long
phone cords
Install handles next to toilets and showers
Do not wear sandals or slippers without backs
Use 100 watt light bulbs instead of low light
Install night lights to help to see when getting
up to go the bathroom
Review all medications with the doctor which
may cause dizziness
Treatment of Osteoporosis
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Fall prevention
Proper Nutrition
Exercise and weight bearing activities regularly
Medication
Measures to Decrease Risk
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Stop excessive alcohol use
Stop smoking – ask for help if needed
Exercises
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Hold onto the back of a sturdy chair and stand
on one foot for 1 minute
Hold onto the back of a sturdy chair and rock
onto your toes and your heels 10 times
Perform with 2 hands, then as you get stronger
go to one hand, then one fingertip, then no
hands and finally with your eyes closed.
Medication - Antiresportive
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Bisphosphonates orally (Actonel, Fosamax)
Bisphosponates IV once a year (Zolendronic
Acid or Reclast)
Calcitonin (Miacalcin)
Estrogen Therapy
Medication
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Calcium 1200 mg to 1500 mg by mouth every
day for postmenopausal women
Vitamin D 800 mg by mouth every day
Vitamin D3 has been shown to be equivalent to
vitamin D2.
Foods high in Calcium
Foods high in Vitamin D
Patient Non adherence
Greater then 50% of patients stop taking within 1
year associated with cost, concern for to many
medications, dosing regimen, side effects.
Summary
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Osteoporosis is a disease where bone becomes
more fragile with increase risk of fracture
Peak bone mass develops in 20’s then drops
Key risk factors for osteoporosis include genetic
factors, lack of exercise, lack of calcium and
vitamin D, personal history of fracture as an
adult, rheumatoid arthritis, cigarette smoking,
excessive alcohol consumption, low body
weight, and family history of osteoporosis.
Summary
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Patients with osteoporosis have no symptoms until
bone fractures occur.
Diagnosis can be suggested by X-rays and confirmed
by using tests to measure bone density.
Treatments for osteoporosis, in addition to prescription
osteoporosis medications, include stopping use of
alcohol and cigarettes, and assuring adequate exercise,
calcium, and vitamin D.
Miles Initiatives
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Beginning a new osteoporosis
treatment protocol to increase
treatment for osteoporosis and
cut down on future fractures
Increase screening for
osteoporosis through
reinforcement of education
with health care providers
Educate community and
increase awareness about
osteoporosis through talks,
press releases
Questions?