Dr.maninder Ahuja Chairperson Geriatric gynaecology committe FOGSI Chairperson public awareness committee (IMS) 8/14/2015Dr.MANINDERAHUJA1

 Woman is the axle around whom the family, society nay! The whole universe is revolving.So her health is of utmost importance at all stages of life more so in Menopause 8/14/2015Dr.MANINDERAHUJA2

 Women have to spend more years in menopause as life expectancy is increasing from 26 yrs in Roman era to 65 yrs in India 80 yrs average world wide.  Average age of menopause is yrs so they have to spend 1/3 of their life in menopause  More women are there in menopause and more problems are being recognised  No family,social or state support system,so they have to remain active. 8/14/2015Dr.MANINDERAHUJA3

8/14/2015Dr.MANINDERAHUJA4 what is osteoporois? what is osteoporois? Bone with Osteoporosis Normal Bone Osteoporosis causes weak bones. In this common disease, bones lose strength. They become fragile and break easily. Fracture even on fall from standing height or silent vertebral fractures

 Often called the “silent disease”  Bone loss occurs without symptoms  First sign may be a fracture due to weakened bones  A sudden strain,bendingor bump can break a bone 8/14/2015Dr.MANINDERAHUJA5

 The number of osteoporotic hip fractures has quadrupled in the past decade  1 out of 3 females in India suffers from osteoporosis, largest affected.  26 million with the numbers projected to increase to 36 million by 2013.(Osteoporosis Society of India (2003)  By out of 2 hip fractures would occur in Asia  A woman’s risk of developing an osteoporosis-related hip fracture is equal to her combined risk of developing breast uterine and ovarian cancer. 8/14/2015Dr.MANINDERAHUJA6

Osteoporotic Fracture 1,200,000 Heart Attack 513,000 Strokes 228,000 Breast Cancer 1,84,000 1 million > 2.0 x > 4.4 x > 5.5 X OSTEOPOROSIS IN WOMEN : CONCERN 8/14/2015Dr.MANINDERAHUJA7 NO OF FRACTURES IS MORE >

8/14/2015Dr.MANINDERAHUJA8 “What will you do if you can’t drive?” Osteoporosis robs you of your independence, You can’t do anything parlour friends doctor worship shopping

 “If somebody had told me sooner what I know now about osteoporosis, none of this might be happening to me!” 8/14/2015Dr.MANINDERAHUJA9 HAD SOME BODY TOLD ME EARLIER!

8/14/2015Dr.MANINDERAHUJA10 “Medications are expensive. But I can’t afford to let my condition get worse and this medicine will help stop or slow down the bone loss.” Medicines ?cost?

Osteoporosis Is preventable 8/14/2015Dr.MANINDERAHUJA11

 Osteoporosis is for elderly women  Fact is it can strike at any age  You’re never too young or old to improve bone health! So start at any age. 8/14/2015Dr.MANINDERAHUJA12

 By DXA SCAN  WHO CLASSIFICATION  NORMAL A T-score within 1 SD (+1 or -1) of the young adult  OSTEOPENIA A T-score of 1 to 2.5 SD below the young adult mean (-1 to SD)  OSTEOPOROSIS A T-score of 2.5 SD or more below the young adult mean (> SD)  It takes about 10 years for change of 1 SD 8/14/2015Dr.MANINDERAHUJA13 For each standard deviation decrease in femoral neck BMD,there is an approximate 2.5-fold increased risk of hip fracture.

8/14/2015Dr.MANINDERAHUJA14 wrist spine HIP

8/14/2015Dr.MANINDERAHUJA15 Hip fractures account for 300,000 hospitalizations annually. Costs involved is very heavy in lacs for individual and in billions for the State RISK OF DYING WIHTIN FIVE YEARS IS DOUBLED You may not be able to walk again!!

8/14/2015Dr.MANINDERAHUJA16  Most of time undiagnosed 500,000 spinal fractures,compression or wedge fractures,  Losing height.>2cms  Back pain  Kyphosis  In extreme cases chest compression  Abdominal space reduced and problems of eating and digestion SILENT FRACTURES OF BACK BONES!

 Dowager’s hump.  Marked thoracic kyphosis due to multiple osteoporotic fractures in elderly woman. 8/14/2015Dr.MANINDERAHUJA17

8/14/2015Dr.MANINDERAHUJA18 200,000 broken wrists Limited movement Quality of life impaired

 Calcium is deposited and withdrawn from bones daily.  Bones build to about age 30.  We need to build up a healthy bone account while young and continue to make deposits with age. 8/14/2015Dr.MANINDERAHUJA19

 After mid-30’s, you begin to slowly lose bone mass at increased rate of 4-5% /yr  Women lose bone mass faster after menopause,  Bones can weaken early in life without a healthy diet and the right kinds of physical activity. 8/14/2015Dr.MANINDERAHUJA20

If you have any of these “red flags,” you could be at high risk for weak bones. Talk to your doctor. 8/14/2015Dr.MANINDERAHUJA21

 Older than 65  Broken a bone after age 50  Close relative has osteoporosis or.has broken a bone  Health is “fair” or “poor”  Smoke  Underweight for your height /BMI<19 8/14/2015Dr.MANINDERAHUJA22 1

 You started menopause before age 40  You never got enough calcium  You take more than two drinks of alcohol.several times a week  You have poor vision, even with glasses,poor hearing  you sometimes fall  you are not active 8/14/2015Dr.MANINDERAHUJA23 2

You have one of these medical conditions:  Rheumatoid arthritis  Hyperthyroidism  Chronic lung disease  Cancer  Inflammatory bowel disease  Chronic liver or kidney disease  Hyperparathyroidism  Vitamin D deficiency  Cushing's disease  Multiple sclerosis  8/14/2015Dr.MANINDERAHUJA24 3

You take one of these medicines:  Oral glucocorticoids (steroids)  Cancer treatments (radiation, chemotherapy)  Thyroid medicine  Antiepileptic medications  Gonadal hormone suppression  Immunosuppressive agents 8/14/2015Dr.MANINDERAHUJA25 4

 Start building healthy bones while young.  Healthy diet and lifestyle are important for BOTH men and women. 8/14/2015Dr.MANINDERAHUJA26

8/14/2015Dr.MANINDERAHUJA27

Latest reports say “in utero origin of osteoporosis also,genetic factor Chan GM et al. Growth and bone mineralization in children born prematurely. J Perinatol 2008 Sep; 28:619 8/14/2015Dr.MANINDERAHUJA28 AGE IS NO BAR

Get your daily recommended amounts of calcium and vitamin D. 8/14/2015Dr.MANINDERAHUJA29

Engage in regular weight- bearing /resistance exercise. 8/14/2015Dr.MANINDERAHUJA30 Even simple activities such as walking, stair climbing and dancing can strengthen bones.

Avoid smoking and excessive alcohol. 8/14/2015Dr.MANINDERAHUJA31 12 oz. 5 oz. 1.5 oz. no more than 1 drink per day for women and 2 for men. beer wine whis key

Talk to your doctor about bone health. 8/14/2015Dr.MANINDERAHUJA32

Have a bone density test and take medication when appropriate. 8/14/2015Dr.MANINDERAHUJA33 Source of photo: USDA ARS Photo Unit Photo by Peggy Greb Testing is a simple, painless procedure.

 No loose rugs  Good lighting at night  Supports in the bath rooms  Don’t lock bath rooms  Proper glasses for eye sight  Balance exercises  No sedatives  Proper hearing aids  Vit. D also helps in fall preventio 8/14/2015Dr.MANINDERAHUJA34

8/14/2015Dr.MANINDERAHUJA35