2. Are your bones healthy? Normal boneOsteoporosis

3. Definition A systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue lead to bone fragility and susceptibility to fracture. Osteoporosis, or porous bone, is a devastating disease that robs its victims of bone mass.

4. Prevalence of osteoporosis OsteopeniaOsteoporosis Female ; Age > 50 year37-50%13-18% Male ; Age > 50 year28-47%3-6% NHANES III. J Bone Miner Res.1997 Melton L. J. J Bone Miner Res.1992

5. Wrist Fractures: 200,000+ Hip Fractures: 300,000+ Vertebral Fractures: 700,000+ Other Fractures: 300,000+ Source: National Osteoporosis Foundation, 2000 1.5 Million Fractures Annually

6. 6

7. Incidence of osteoporotic Fracture Riggs BL. Bone 1995;17(s5)

8. Incidence of osteoporotic Fracture Vertebral Fracture Forearm Fracture Hip Fracture

9. Normal SpineOsteoporotic Spine Source: National Osteoporosis Foundation, 2000

10. Incidence of osteoporotic Fracture The European Prospective Osteoporosis Study Group ( EPOS ) J Bone Miner Res 2002;17

11. 11 Symptoms and Warning Signs Persistent, unexplained back pain Shorter than you used to be Spinal deformities Recurrent fractures Fracture from minimal trauma Experiencing chronic medical problems

12. 12 Risk Factors Female Thin or small frame Low body weight Smoker Advanced age History of fragility fracture Family history- primary relative with Osteoporosis or fragility fracture

13. Post Menopausal ( 폐경 후 ) Hormonal imbalances can result in rapid bone loss Women can lose up to 20% of their bone mass in 5-7 years Amenorrhea ( 무월경 ), Anorexia ( 식욕부진 ) & Bulimia ( 폭식증 ) Diet low in calcium Certain medications Low testosterone in men

14. Inactive lifestyle Cigarette smoking Excessive alcohol consumption Risk Factors

15. 15 Ethnicity ( 인종 ) & Osteoporosis Hispanic Women at Highest Risk 13-16% with Osteoporosis now 36-49% of Mexican American women 50+ have experienced significant bone loss

16. 16 Caucasian & Asian-American Women Also High Risk

17. 17 10% of African-American women 50+ have Osteoporosis 30% more have low bone density

18. 18 300,000 African-American women suffering from Osteoporosis today 80-95% of all fractures suffered by African- Americans 64+ are osteoporotic African-American women more likely to die from hip fractures

19. 19 Underdiagnosed Unrecognized Underreported Inadequately researched Men & Osteoporosis

20. 2 million American men suffer from Osteoporosis 3 million more are at risk 1/3 of male hip fractures related to Osteoporosis 1/3 of these men will not survive 1 year after fracture

21. Prevention Calcium and Vitamin D Intake 400-800 Units per day Consult your doctor for dosage

22. Calcium Is needed for heart muscles, and nerves to function properly. Inadequate amounts contribute to osteoporosis. Appropriate calcium intake falls between 1000 and 1300 mg a day. Increase calcium: Consume calcium rich foods such as, low-fat milk, cheese, broccoli, and others. Calcium supplement, if dietary calcium consumption is inadequate

23. Calcium Requirements Recommended elemental calcium needs by age in mg/ca/day Children 800 Up to age 24 1,200~1,500 Women 25 –50 1,000 Pregnant and breast feeding 1,200~1,500 Women over 50 Taking ERT 1,000 Not taking ERT 1,500 Women over 65 1,500 Men 25 to 65 1,000 Men over 65 1,500 ERT ; Estrogen Replacement Therapy

24. Vitamin D Is needed for your body to absorb calcium. Comes from 2 sources : the sun and Fortified dairy products, egg yolks, saltwater fish, and liver. Need 400-800 IU a day.

25. Weight-Bearing Exercise Consult your doctor first

26. Tai-chi helps reduce falls

27. 10-20 Year Olds Prevention

28. 28 20-35 Year Olds Prevention

29. 29 35-50 Year Olds Prevention

30. 30 Prevention Over 50

31. 31 Bone Densitometry

32. ERT  Advantages  Increases bone density (1-5%) and decreases risk of fracture (25%)  Relief of hot flashes, vaginal dryness  Decreases LDL, increases HDL  Prevention of Alzheimer’s disease  Relatively inexpensive

33.  Disadvantages  Accelerated bone loss after stopping  Increased risk of uterine ca (if unopposed)  Increased risk of thromboembolic events  Possible increased risk of breast cancer  Side effects: breast tenderness, breakthrough bleeding  Increased risk of coronary events in women with known CAD in first year of use (HERS trial)

34. Selective Estrogen Receptor Modulators (SERMs)  Indication: Treatment and prevention of osteoporosis  Mechanism: Decreases bone resorption  Dose: Raloxifene (Evista) 60mg qd

35. SERMS  Advantages  Increases bone density (2%) and decreases fracture risk (30%)  No stimulation of breast or endometrial tissue  No need for progestin in women with uterus  Decrease LDL  Disadvantages  Increased risk of thromboembolic events  Doesn’t treat post- menopausal sx  May increase hot flashes  No effect on HDL  $60.90/30 day supply

36. Calcitonin  Indication: Treatment only  Decreases bone resorption  Dose:  Nasal (Miacalcin) 200IU alternate nostrils qd  SC, IM increased risk of anaphylaxis  Advantage – May provide analgesic effect on bone pain associated with fractures  Disadvantage – Inconsistent effects on BMD and fracture risk

37. Exercise Exercising regularly in childhood and adolescence can ensure that you will reach peak bone density. Need to participate in weight bearing exercise. For example, walking, dancing, jogging, stair climbing, racquet sports and hiking.

38. Medications There is no cure, but several medications have been approved. Each stops or slows bone loss, increases bone density, and reduces fracture risk. Estrogen Replacement, Alendronate,raloxitene and risedronate are prescribed to prevent and treat the disease.

39. Bone-Building Checklist Maintain a calcium rich diet. Get plenty of vitamin D Engage in weight-bearing exercise Don’t smoke and limit alcohol intake Consider Hormone Replacement or other medications if you are at risk.