1. Moji Saberin-Williams, M.D. Paoli Hospital Obstetrician/Gynecologist
Osteoporosis
Moji Saberin-Williams, M.D.
Paoli Hospital Obstetrician/Gynecologist

2. Osteoporosis The Most Common Bone Disease
Characterized by low bone mass and deterioration of bone structure
Not a natural part of aging
Increased risk for women, post-menopausal, over age 65
All races, sexes, and ages are susceptible
Preventable and treatable!

3. Frequency of Common Medical Events in Women
1,500,000
500,000
1,000,000
2,000,000
Osteoporotic
Fractures
1. Riggs, B.L., and Melton, L.J. III, Bone 17(5)(Suppl.):505S-511S, 1995
2. Heart and Stroke Facts: 1996 Statistical Supplement, American Heart Association
3. Cancer Facts & Figures—1996, American Cancer Society
* annual incidence all ages
** annual estimate women 29+
† annual estimate women 30+
‡ 1996 new cases, women all ages *
513,000
Heart Attack **
228,000
Stroke †
184,300
Breast Cancer ‡
750,000 vertebral
250,000 other sites
250,000 forearm
250,000 hip
Annual incidence of common diseases

4. Osteoporosis: Definition
A condition of skeletal fragility characterized by compromised bone strength predisposing to an increased risk of fracture
Normal Bone
Osteoporosis
NIH Consensus Development Conference Statement, on Osteoporosis Prevention, Diagnosis, and Therapy, 2000.
Source: Dempster DW, et al. J Bone Miner Res. 1986:1:15-21; Reprinted with permission from the American Society of Bone and Mineral Research

5. Entire Skeleton Is at Risk for Fractures
NIH/ORBD National Resource Center. October 2000.

6. 250,000 Hip Fractures Each Year
Up to 24% excess mortality within 1 year
Nearly 65,000 American women die from complications of hip fracture each year
50% of hip fracture survivors are permanently incapacitated3
20% of hip fracture survivors require long-term nursing home care4
1. Ray NF et al. J Bone Miner Res 1997;12:24-35
2. Col NF et al. JAMA 1997;227:
3. Consensus Development Conference. Am J Med, 1993;
4. Chrischilles EA et al. Arch Intern Med 1991;151

7. EPIDEMIOLOGY Major Health threat in an estimated 44
Million people ages 50 and older
1 in 2 women and 1 in 6 men over 50 will have an osteoporosis-related fracture
1 out of 3 women age 90 have had a hip
fracture

8. Hip Fracture Incidence in 1997
* Fracture rate per 1000 patient-years for 5-year intervals of age, from U.S. National Inpatient Sample database composed of >13 million white women, age

10. Osteoporosis Risk Factors
Non-modifiable
Previous fragility fracture
History of fracture in a first degree relative
Increased age
Female gender
Caucasian or Asian
Premature graying of hair
Modifiable
- Estrogen deficiency
- Propensity to fall
- Impaired vision
- Calcium deficiency
- Vitamin D deficiency
- Low body weight
- Physical inactivity
- Excessive Alcohol consumption
NOF guidelines – 2000

11. How do I know if I have osteoporosis?
Bone Mineral Density Test (BMD Test)
Measures bone density at various sites
Helps determine risk for fractures
Understanding your risk factors is important, but having a bone mineral density test (BMD Test) is the most effective way to understand if you actually have osteoporosis. There are different types of BMD testing. Bone density can be measured at one or more sites on your body, such as your spine, hip, foot, or wrist. Your BMD test score, called a T-Score, can help your doctor understand whether you have osteoporosis.

12. What kinds of BMD tests are there?
DEXA (dual energy x-ray absorptiometry)
Gold standard
Measures hip, and spine
Compares bone density to that of a young adult (T-score)
Peripheral measures (ankle, hand, finger)
A screening tool
Indicate possible risk of future fracture
The gold standard in BMD testing is called a DEXA (pronounced decks – ah) which stands for dual energy x-ray absorptiometry. It can measure at the hip and spine, and compares bone density to that of a young, healthy adult. This result is called a T-score.
Other BMD tests use peripheral measures such as at the ankle, hand, or finger. This is best used as a screening tool to indicate possible risk of future fracture.

13. Who Should Get a Baseline Bone Density Test?
National Osteoporosis Foundation Recommendation:
All women 65 years old or older
All women with a history of fragility fractures
All postmenopausal women with at least one risk factor
Adults with a disease or medication history associated with bone loss
Who should get a baseline bone density test?
A baseline BMD tests is needed to determine the health of your bones relative to a young, healthy adult of the same gender and form a basis from which to compare your future scores to understand your bone health over time.
According to the National Osteoporosis Foundation (NOF), you should get a baseline if:
You are a women 65 or older
You are a women with a history of fracture, because this is a key risk factor
If you are past menopause with at least one risk factor
If you are an adult who has taken high doses of medications such as steroids for long periods of time that can cause bone loss.

14. World Health Organization (WHO) Osteoporosis Guidelines
T-Score
WHO, Guidelines for Preclinical Evaluation and Clinical Trials in Osteoporosis, 1998.

15. Management of low Bone Mass
Vitamin D and Calcium
Exercise
Hormone Treatment
Fosamax / Actonel / Boniva
Evista / Tibolone
Calcitonin
PTH (Parathyroid hormone)

16. Vitamin D Supplementation
In conjunction with Calcium
Attenuation of Bone Loss
Reduction of fall risk
Main sources for Vitamin D: skin and milk
Slows progression of Osteoarthritis

17. Calcium Supplementation
Calcium Citrate
Calcium Carbonate
(Shells)
Divided doses

18. Calcium Supplementation
With Vitamin D  fracture risk reduction
 tooth loss reduction
Without Vitamin D  ?
Reduces the rate of bone loss
Premenopausal women: 1000 mg/day
Postmenopausal women: 1500 mg/day

19. Role of dietary Calcium
# servings of dairy X = mg of Calcium
One serving: 8 oz milk (240 cc)
8 oz Yogurt
16 oz cottage cheese
1 oz hard cheese

20. Physical activity Aerobic exercise Weight bearing exercise
Resistance training
Bone mineral density improvement
? Fracture risk reduction

21. CONCLUSION Osteoporosis is the most common bone disorder
It is treatable
It is preventable