Download Only you can prevent osteoporosis related fractures

You can prevent osteoporosis related fractures:
Osteoporosis is a growing problem in our maturing population. It is the most common
bone disease in humans. It is commonly confused with osteoarthritis because it starts
with the greek prefix “osteo” which means “bone”. Osteo-arthritis is the wear and tear
arthritis that loudly announces itself with achy sore joints. Osteo-porosis is the word
used to describe thin or porous bones. Osteoporosis is known as a “silent disease”
because it has no warning symptoms. The underlying problem in osteoporosis is the
decrease in the amount of calcium structure in the bone. When looked at through a
microscope bone looks a lot like a
sponge with many tiny bridges forming
the stuff of bone. Bones with
osteoporosis have fewer bridges and
thinner bridges. As a result, thin bones
are at risk to fail when overstressed.
Osteoporosis is responsible for more
than 1.5 million fractures annually,
including 300,000 hip fractures, and
approximately 700,000 vertebral
fractures, 250,000 wrist fractures, and
more than 300,000 fractures at other
sites. Patients with osteoporosis are literally “one trip away from a fracture”. What
starts as a “silent disease” can lead to major life altering fractures of the hip, spine and
wrist. One out of every two white women will experience an osteoporotic fracture at
some point in her lifetime. After a hip fracture only half of patients return to the same
level of performance.
If you walk without a cane or a walker before your fracture, it’s a flip of the coin as to
whether you will need one after your fracture. If you use a cane or a walker, a hip
fracture could put you into a wheelchair. About 1 in 5 patients who have a hip fracture
die within a year. Fractures are certainly not limited to a major joint like your hip.
Fractures are even more common in the bones of your back – the vertebrae.
Osteoporotic fractures of the spine can lead to height loss, round back deformity, chronic
pain and death.
Fractures of the wrist come from attempts at breaking the fall using your hands. Wrist
fractures can lead to deformity and arthritis that make the routine daily activities of the
hands painful and difficult. These common fractures can also cause psychological
symptoms, most notably depression and loss of self-esteem, as patients grapple with pain,
physical limitations, and lifestyle and cosmetic changes. Anxiety, fear, and anger may
also impede recovery. These difficulties and the loss of independence that goes along
with these fractures strain interpersonal relationships and social roles for patients and
their families.
There is also a great cost to society for the fractures of osteoporosis. The National
Osteoporosis Foundation reports that the average cost for a hip fracture is $40,000. The
estimated cost of osteoporotic fractures to the health system is $17 billion each year.
Some estimate that this cost will triple by 2040 as our population continues to age. There
is great incentive from a personal and public perspective to prevent the problems of
osteoporosis.
It is clear that as we all become “less young” the
amount of calcium in our bodies goes down. As
our bones’ density decreases the risk of fracture
climbs exponentially. This is much more of
problem for women. As women go through
menopause, their bones can lose as much as 3% of
their calcium per year. Overly thin women have
less bone to lose and are at even higher risk.
Until the last 5 – 10 years most doctors were given little information on osteoporosis
other than to recognize that it is a problem. Newer medicines have caused increased
interest in the diagnosis and management of this public health problem. Fosamax,
Actonel, Miacalcin, Fortéo, Boniva, Reclast and other medicines have made it possible to
increase the calcium density of your bones and to decrease the likelihood of having an
osteoporotic fracture. The first step is become aware of your risk. The risk factors for
fractures due to osteoporosis are not difficult to identify:
MAJOR RISK FACTORS FOR OSTEOPOROSIS RELATED FRACTURES
Postmenopausal white female
Fracture as an adult
Osteoporotic fracture in mother or sister
Low body weight (< about 127 lbs)
Current smoking
Use of Prednisone for > 3 months
OTHER RISK FACTORS
Poor vision
Estrogen deficiency at an early age (<45 yrs)
Dementia
Poor health/frailty
Recent falls
Low calcium intake (lifelong)
Low physical activity
Alcohol >2 drinks per day
A simple painless test exists which measures
the amount of calcium in your bone. A bone
density scan (or DEXA scan) gives a number
that establishes or confirms the diagnosis of
osteoporosis. Bone density predicts fracture
risk just like blood pressure predicts the risk
of stroke or heart trouble. The lower your
number is, the more likely you are to get a
fracture. Because of the high numbers of hip
and spine fractures, these are the two most
frequent locations scanned. The bone
density scan can produce a pretty graphic
that shows where you stand compared to
normal (T score) and to folks your own age
(Z score). You may have thought that being
graded on a bell curve was something you
left back in high school or college, but when
doctors measure the amount of calcium in
our bones they compare the amount of
calcium in your bone to normal bones as measured on a curve. If you score -2.5 or less
on your bone density scan then you have osteoporosis and are at high risk of a fracture.
A T score between -1 and -2.5 signifies osteopenia, indicating some increase risk of
fracture and you should be working hard not to fall any lower.
The National Osteoporosis Foundation recommends BMD testing should be performed
on:
1. All women aged 65 and older regardless of risk factors.
2. Younger postmenopausal women with one or more risk factors
(Other than being white, postmenopausal, and female).
3. Postmenopausal women who present with fractures
(To confirm diagnosis and determine disease severity)
Once you know you are at risk then you can improve your bone density and work to
prevent the costly consequences of osteoporotic fractures. Steps that nearly all patients
can start to prevent fractures include adequate daily calcium and vitamin D in your diet
and regular weight bearing exercise. The recommended dietary allowance for calcium
for patients over age 50 is at least 1200 mg per day of elemental calcium. The safe upper
limit for total calcium intake has been set at 2500 mg/day. But just taking calcium
supplements isn’t enough. Eating calcium only puts the calcium in your gut. Equally
important is getting enough vitamin D in the diet. Vitamin D helps your gut absorb the
calcium and gets the calcium into you blood where it can be used. For patients at high
risk for osteoporosis 400 – 800 IU of Vitamin D is usually enough. Spending time
outside in the sunshine also helps your body make its own Vitamin D. You might think
that just popping the extra calcium and vitamins would be good enough to protect you
from fractures. However, to get the calcium out of the blood and into the bone the most
important step in prevention is regular weight-bearing exercise. The stress of the body’s
weight against gravity stimulates the bone to become stronger. Walking, jogging, stair
climbing, dancing, and tennis are all good forms of exercise. Besides building stronger
bones, strengthening muscles can also help prevent falls. Before beginning a vigorous
exercise program it is prudent to visit your family practice or internal medicine physician
for their guidance. A good source to begin an exercise program for seniors can be found
free online at the National Institute on Aging. For patients at risk, a bone density scan
will confirm the diagnosis of osteoporosis. If the T-score is less than -2 then you should
make an appointment with a primary care physician who cares for patients with
osteoporosis or an endocrinologist for the selection of one of the newer drugs that can
increase your bone mass.
Osteoporosis is a “silent disease” that can have major impact on your overall health and
you can help prevent the fractures.
To start preventing osteoporosis fractures:
Calcium 1200mg/day
Vitamin D 400 – 800 IU/day
Weight-Bearing Exercise
Bone Density Scan when at risk
Drug therapy if Osteoporosis
Dr. DeHart is a board certified orthopaedic surgeon who practices in the Austin, Cedar
Park and Central Texas area. He is a specialist in the treatment of hip and knee arthritis
and sports medicine. He completed a fellowship in adult hip and knee surgery at Johns
Hopkins Hospital. He holds a certificate of added qualification for sports medicine and is
a fellow in the American Academy of Orthopaedic Surgeons, the American Association
of Hip and Knee Surgeons, and the American Orthopaedic Association. He is available
for group talks on topics relating to orthopaedic surgery including sports injuries,
arthritis, osteoporosis and joint replacement. You can learn more about Dr. DeHart or
make and appointment by visiting our website at www.txortho.com or by calling (512)
439-1000.
For more information on osteoporosis and exercise, check out the following links:
NIH: National Institute of Health Osteoporosis Resource Center
http://www.osteo.org/
http://www.osteo.org/osteolinks.asp
WHO calculation of 10 year fracture risk:
www.shef.ac.uk/FRAX
National Osteoporosis Foundation
http://www.nof.org/
Alliance for Aging Research – good computer videos on osteoporosis and prevention.
http://www.agingresearch.org/section/standing_strong
National Institute of Aging: Exercise recommendations for those at risk
http://www.nia.nih.gov/HealthInformation/Publications/ExerciseGuide/
Institute of Medicine: Look under food and nutrition for recommended daily allowances
http://www.iom.edu/
General information on many orthopaedic topics:
http://www.orthoinfo.org
Calcium and the food we eat:
Dairy products
Serving Size
Calcium (mg)
American cheese
1 oz.
174
Blue cheese
1 oz.
150
Buttermilk(<1% fat)
1 cup
657
Cheddar cheese
1 oz.
204
Cottage cheese
1 cup
126
Frozen yogurt
1 cup
200
Ice cream
1 cup
176
Milk
1 cup
300
Parmesan cheese
1 oz.
390
Soy milk (calcium fortified)
1 cup
200-300
Soy milk (not calcium fortified)
1 cup
10
Yogurt (non-fat)
8 oz.
294
Fruits
Serving Size
Calcium (mg)
Cantaloupe
1 cup
18
Dried figs
10
269
Orange juice (calcium-fortified)
1 cup
300
Orange (medium)
1
52
Raisins
1/2 cup
35
Vegetables
Serving Size
Calcium (mg)
Asparagus (cooked)
1 cup
43
Broccoli (cooked)
1 cup
70
Carrots (cooked)
1 cup
48
Chickpeas (cooked)
1 cup
80
Collard greens (cooked)
1 cup
148
Green beans (cooked)
1 cup
58
Kidney beans (cooked)
1 cup
74
Lima beans (cooked)
1 cup
55
Potatoes(mashed w/milk)
1 cup
292
Soybeans (cooked)
1 cup
131
Spinach (cooked)
1 cup
245
Grains
Serving Size
Calcium (mg)
Cereals (calcium-fortified)
1 cup
300
Total® cereal
1 cup
1000
Oatmeal (cooked)
1 cup
300
Rice (cooked)
1 cup
21
Wheat bread (enriched)
1 slice
32
Others
Serving Size
Calcium (mg)
Almonds
1/2 cup
150
Salmon
4 oz.
300