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.

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.

OsteoporosisOsteon (Greek):

BONEPoros (Greek): PORE

(having open spaces

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’

Low Bone Mineral Density

Cell deterioration outpaces new cell production

BMD refers to the amount of mineral matter per square centimeter of bones.

Osteopeni

a

Clinical Manifestations

Dowager’s Hump

Dorsal Kyphosis

Chronic back pain

Risk factors

A g e

Race

History of Chronic Diseases such as:

History of Previous Fractures

Family HistoryGender

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 loss1:2 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

Risk factors

Caffeine

Chronic Heavy Alcohol Consumption

Sedentary Lifestyle

SmokingNutrition/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

Anatomy and physiology

Pathophysiology

Reaching a diagnosis

DualNe

gy

ayr

bsorptiometr

EXAThe gold

standard for the

diagnosis of

osteoporosis

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.

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:

COMPUTERIZE

D

TOMOGRAPHY

(CT) SCAN

Medical Management

Management of osteoporosis should Be directed to these aspects:

1) Medication Regimen

3) Nutritional / Dietary Changes

2) Lifestyle Changes

Medications Include:

Calcitonin

Biphosphonates

Medications Include:

Hormone

Replacemen

t Therapy

Selective Estrogen Receptor Modulators (SERM)

Denosuma

b

SurgicalManagement

VERTEBROPLAST

Y

KYPHOPLASTY

Prognosis

Although osteoporosis patients have an

increased mortality rate due to the

complications of fracture,

IT IS RARELY LETHAL.

Prevention

of osteoporosis should be directed to the “reversal” of the modifiable risk factors...

It’sNEVERTOOearly to

B O N E

inINVEST

HEALTH

CHILDREN, ADOLESCENT, ADULTS SHOULD:Ensure a dietNUTRITIOUSwith ADEQUATE calcium intake.

Maintain an

VITAMINsupply ofADEQUATE

D.

CHILDREN, ADOLESCENT, ADULTS SHOULD:Participate in

physicalREGULAR

activity.AVOID and

Most

abundant99% bones, 1%

in blood

Muscle contraction / relaxation

Nerve

transmission

BP regulation

Factors Favoring Calcium Absorption

Acidity of

digestive

mass

LactoseSufficien

t Vitamin

D

Body’s need for

higher amounts

(as in pregnancy)

Sedentary Lifestyle

Laxative use

Excessive Phosphorus

IntakeFactors Hindering Calcium Absorption

Dietary

fat / fiber Aging

Drug Use

Binders such as

phytic and

oxalic acid

Research