1. (Relates to Chapter 64, “Focous on osteoperosis ,” in the textbook)
Focus on Osteoporosis
(Relates to Chapter 64, “Focous on osteoperosis ,” in the textbook)

2. Osteoporosis
Chronic, progressive metabolic bone disease characterized by
Porous bone
Low bone mass
Structural deterioration of bone tissue
Increased bone fragility

3. OSTEOPOROSIS (Cont’d)
At least 10 million people in the United States have osteoporosis
One in two women and one in eight men over 50 will sustain an osteoporosis-related fracture

4. OSTEOPOROSIS (Cont’d)
Eight times more common in women than men for several reasons
Lower calcium intake than men
Less bone mass because of smaller frame
Bone resorption begins earlier and accelerates after menopause

5. OSTEOPOROSIS (Cont’d)
More common in women than men (cont’d)
Pregnancy and breastfeeding deplete woman’s skeletal reserve of calcium
Longevity increases likelihood of osteoporosis; women live longer than men

6. Etiology and Pathophysiology
Risk factors
Female gender
Increasing age
Family history
White or Asian ethnicity
Small stature
Early menopause
Excess alcohol intake

7. ETIOLOGY AND PATHOPHYSIOLOGY (Cont’d)
Risk factors (cont’d)
Cigarette smoking
Anorexia
Oophorectomy
Sedentary lifestyle
Insufficient calcium intake
Low testosterone levels in men

8. ETIOLOGY AND PATHOPHYSIOLOGY (Cont’d)
Peak bone mass is achieved before age 20
Peak mass determined by heredity, nutrition, exercise, and hormone function
Bone loss after midlife is inevitable but rate of loss is variable

9. Normal vs. Osteoporotic Bone
Fig

10. ETIOLOGY AND PATHOPHYSIOLOGY (Cont’d)
In osteoporosis, bone resorption exceeds bone deposition
Occurs most commonly in spine, hips, and wrist
Many drugs can interfere with bone metabolism

11. ETIOLOGY AND PATHOPHYSIOLOGY (Cont’d)
Diseases associated with osteoporosis
Intestinal malabsorption
Kidney disease
Rheumatoid arthritis
Hyperthyroidism
Chronic alcoholism
Cirrhosis of the liver
Hypergonadism
Diabetes mellitus

12. Clinical Manifestations
Often termed the “silent disease” because there are no symptoms
Since no symptoms, the usual first signs are back pain and spontaneous fractures

13. CLINICAL MANIFESTATIONS (Cont’d)
Manifestations include
Sudden strain
Fractures
Back pain
Loss of height
Spinal deformities

14. Diagnostic Studies History and physical exam
Bone mineral density (BMD)
Quantitative ultrasound
Dual-energy x-ray absorptiometry (DEXA)

15. DIAGNOSTIC STUDIES (Cont’d)
Osteoporosis is a BMD of at least 2.5 standard deviations below that of a young adult BMD
Osteopenia is more than normal bone loss but not yet at the level of osteoporosis

16. Collaborative Care
Focus on proper nutrition, calcium supplements, exercise, prevention of fractures, and drugs
Prevention and treatment depend on adequate calcium intake
Increased calcium prevents future loss but will not form new bone

17. COLLABORATIVE CARE (Cont’d)
Good sources of calcium
Milk
Yogurt
Turnip greens
Spinach
Cottage cheese
Ice cream
Sardines

18. COLLABORATIVE CARE (Cont’d)
Poor sources of calcium
Eggs
Beef
Cream cheese
Poultry
Pork
Apples and bananas
Potatoes and carrots

19. COLLABORATIVE CARE (Cont’d)
Supplemental vitamin D may be recommended
Exercise should be encouraged to build up and maintain bone mass
Patients should be instructed to quit smoking or cut down on alcohol intake to ↓ losing bone mass

20. COLLABORATIVE CARE (Cont’d)
Calcium intake
Premenopausal
1000mg/day
Postmenopausal
1500 mg/day
Supplemental vitamin D
Sunshine
Supplemental (800 iu/day)

21. COLLABORATIVE CARE (Cont’d)
Drug therapy
Estrogen replacement after menopause
Calcitonin
Bisphosphonates inhibit osteoclast-mediated bone resorption (e.g., etidronate (Didronel), alendronate (Fosamax)

22. COLLABORATIVE CARE (Cont’d)
Drug therapy (cont’d)
Selective estrogen receptor modulators
Raloxifene (Evista)
Teriparatide (Forteo)
Portion of parathyroid hormone
First drug to stimulate new bone formation