Project osteoporosis

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1. A 60-year-old postmenopausal Caucasian woman is seeing her physician after her annual checkup. She has been in good general health for the past several years. She…
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  • 1. A 60-year-old postmenopausal Caucasian woman is seeing her physician after her annual checkup. She has been in good general health for the past several years. She experienced menopause in her early 50s and initiated hormone therapy (HT) with estrogen/ progestin for her menopausal symptoms; she has remained on HT primarily for prevention of osteoporosis. She is currently not on any chronic medications other than HT.
  • 2. Although the patient has no personal history of fractures, her older sister experienced a hip fracture. She is 5’7” and weighs 112 lbs. She smokes cigarettes, drinks several cups of coffee a day, and rarely exercises. Her height has remained stable over the past 4 years. Given the publicity surrounding the results of the Women’s Health Initiative (WHI) on estrogen/progestin and estrogen alone, she expresses concern about the risk/benefit of her continued use of HT.
  • 3. Osteoporosi s It is a systematic skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture. – Black and Hawks, 2008 Compromised bone strength comprises of two factors… ‘Fragile Bone Disease’ ‘The Silent Disease’
  • 4. Low Bone Mineral Density Cell deterioration outpaces new cell production BMD refers to the amount of mineral matter per square centimeter of bones.
  • 5. Clinical Manifestations
  • 6. Dowager’s Hump Dorsal Kyphosis
  • 7. Risk factors A g e History of Chronic Diseases such as: History of Previous Fractures Being Caucasian or Asian in origin …of maternal osteoporosis, fragility fractures or dowager’s hump Women lose greater amounts of bone calcium during the first few years after menopause… …the drop in estrogen levels appears to initiate bone loss 1:2 women and 1:5 men over the age of 50 will break a bone mainly because of poor bone health …particularly low truma or spontaneous fractures …thyroid disease, other bone diseases, metabolic diseases that impair absorption of nutrients
  • 8. Risk factors Chronic Heavy Alcohol Consumption Sedentary Lifestyle Nutrition/calcium intake Eating less than the recommended calories and intake of calcium Research show that alcohol appears to reduce bone density… …it may directly depress bone formation or may take the place of more nutritious foods Smokers tend to be of lower weight (less bone density) than non smokers It has been tied to urinary excretion of calcium. Reasonable use of caffeinated drinks, however, may be acceptable. A physically active lifestyle not only enhances calcium absorption but also helps to maintain bone matrix mineralization… …however, excessive exercise that results in extremely low body fat levels for women may be detrimental to bone density
  • 9. Anatomy and physiology
  • 10. Pathophysiology
  • 11. Reaching a diagnosis
  • 12. Dual N e g y ayr bsorptiometr EXA Two X-ray beams with different energy levels are aimed at the patient's bones. When soft tissue absorption is subtracted out, the BMD can be determined from the absorption of each beam by bone.
  • 13. Status Hip BMD Normal T-score of -1 or above Osteopenia T-score lower than -1 and greater than -2.5 Osteoporosis T-score of -2.5 or lower Severe osteoporosis T-score of -2.5 or lower, and presence of at least one fragility fracture WHO has developed general categories to clarify the definition of osteoporosis. The categories include the following:
  • 14. Medical Management
  • 15. Management of osteoporosis should Be directed to these aspects: 1) Medication Regimen3) Nutritional / Dietary Changes2) Lifestyle Changes
  • 16. Medications Include: Biphosphonates
  • 17. Medications Include:
  • 18. Surgical Management
  • 19. Prognosis
  • 20. Although osteoporosis patients have an increased mortality rate due to the complications of fracture, IT IS RARELY LETHAL.
  • 21. Prevention of osteoporosis should be directed to the “reversal” of the modifiable risk factors...
  • 22. It’sNEVERTOO earlyto inINVEST HEALTH
  • 23. CHILDREN, ADOLESCENT, ADULTS SHOULD: Ensure a dietNUTRITIOUS with ADEQUATEcalcium intake. Maintain an VITAMINsupply of ADEQUATE D.
  • 24. CHILDREN, ADOLESCENT, ADULTS SHOULD: Participate in physical REGULAR activity. AVOID and
  • 25. 99% bones, 1% in blood Factors Favoring Calcium Absorption Lactos e Sufficient Vitamin D
  • 26. Excessive Phosphorus Intake Factors Hindering Calcium Absorption Aging Drug Use
  • 27. Research
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