1. UNDERSTANDING OSTEOPOROSIS 1 I.M. Doctor, M.D. My Office My City, State

2. Understanding Osteoporosis  What is Osteoporosis  Osteoporosis myths  Osteoporosis facts

3. Understanding Osteoporosis  Osteoporosis symptoms and warning signs  Who is at risk?  Diagnosing Osteoporosis

4. Understanding Osteoporosis  Treatment options  Medication  Treatments  Steps you can take to prevent Osteoporosis

5. What is an orthopaedic surgeon? MD or DO who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)

6. What is an orthopaedic surgeon?  The expert in treating the musculoskeletal system  The expert in maintaining musculoskeletal health

7. Educating an Orthopaedic Surgeon  College  Medical School  Internship  Orthopaedic Residency  Fellowship (optional)  2 Years Practice TOTAL 4 1 4 (1) 2 16 years!

8. What do orthopaedic surgeons do?  Diagnose  Treat  Medication  Physical Therapy  Exercise  Brace  Surgery  Prevent Injury and/or Disease Progression

9. Osteoporosis Osteoporosis, or porous bone, is a progressive disease that robs its victims of bone mass.

10. Osteoporosis Normal BoneOsteoporotic Bone

11. Myth #1: “Osteoporosis is not serious enough for me to worry about”  It is a progressive disease and irreversibly weakens bones  Minor trauma can cause debilitating fracture  Chronic pain and disability are the potential outcomes  Hip fractures can cause death

12. Myth #2: Osteoporosis Myths “I’m a healthy person. I eat right and exercise so I am not at risk.”

13. Myth #3: Osteoporosis Myths  It is never too early to prevent Osteoporosis  Osteoporosis can strike at any age  Bone is a living, growing tissue that constantly rebuilds “I’m too young to worry about osteoporosis.”

14. Myth #4: Osteoporosis Myths “It’s too late for me to do anything about Osteoporosis.” 14

15. Prevalence  More than 10 million Americans suffer from Osteoporosis  80% are women  1 in 2 women and 1 in 4 men over 50 years old will be diagnosed Source: National Osteoporosis Foundation

16. Wrist Fractures: 400,000+ Hip Fractures: 300,000+ Vertebral Fractures: 550,000+ Other Fractures: 810,000+ Source: National Osteoporosis Foundation, 2000 2 Million Fractures Annually 16

17. Burden of Disease  $19 billion in 2005  Approximately $52 million daily

18. Burden of Disease

19.  Most patients with hip fractures are hospitalized for about one week.  One in four adults who lived independently before their hip fracture has to stay in a nursing home for at least a year after their injury.  One in five hip fracture patients dies within a year of injury. Source: National Center for Injury Prevention and Control, Centers for Disease Control and Prevention

20. Osteoporosis Normal Spine Osteoporotic Spine Source: National Osteoporosis Foundation, 2000 20

21. Symptoms and Warning Signs  Persistent, unexplained back pain  Shorter than you used to be  Can no longer stand up straight  Spinal deformities

22. Symptoms and Warning Signs  Recurrent fractures  Fracture from minimal trauma  Experiencing chronic medical problems

23. Risk Factors  Female  Thin or small frame  Older age  Family history  Smoking

24. Risk Factors  Advanced age  History of fragility fracture  Family history - primary relative with Osteoporosis or fragility fracture

25. Risk Factors  Post Menopausal  Hormonal imbalances can result in rapid bone loss  Women can lose up to 20% of their bone mass in 5-7 years

26. Risk Factors  Amenorrhea, anorexia, and bulimia  Diet low in calcium  Certain medications  Low testosterone in men

27. Risk Factors Inactive lifestyle Cigarette smoking Excessive alcohol consumption

28. Ethnicity & Osteoporosis zHispanic women at highest risk z10% of Hispanic women over 50 have osteoporosis now z49% are estimated to have low bone mass, putting them at risk for the disease Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services

29. Ethnicity & Osteoporosis Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services zHispanic women get less calcium than RDA zTwice as likely to develop diabetes zRate of hip fractures on the rise

30. Ethnicity & Osteoporosis Caucasian and Asian-American Women also at high risk Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services

31. Ethnicity & Osteoporosis  African-American women get 50% of RDA of calcium  Lupus and sickle- cell anemia can raise osteoporosis risk Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services

32. Ethnicity & Osteoporosis  Osteoporosis undertreated in African-American women  Risk doubles every 7 years  African-American women more likely to die from hip fractures Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services

33. Men & Osteoporosis Underdiagnosed Unrecognized Underreported Inadequately researched 33

34. Men & Osteoporosis  2 million American men suffer from osteoporosis  Millions more are at risk  80,00 hip fractures each year  One-third die one year after fracture Source: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Department of Health and Human Services

35. Diagnosis zMedical history zPhysical exam zX-rays zBone densitometry zSpecialized lab tests

36. Bone Densitometry

37.  Anyone with a fragility fracture  All women age 65 and older  Postmenopausal women younger than 65 with risk factors  Men over 50 with risk factors

38. Diagnosis Before Your Appointment yPrepare to describe your symptoms yGather medical history yMake list of medications yWrite down concerns and questions and bring them

39. Diagnosis 1. Expect what from treatment? 2. Treatment effect on daily activities? 3. How to prevent further disability? During Your Appointment

40. Treatment

41. Medication  Bisphosphonates  Estrogen Replacement Therapy  Medications made from natural hormones  SERMs (Selective Estrogen Receptor Modulators)

42. Treatment  Appropriate treatment of fragility fractures  Surgery if necessary

43. Prevention Calcium and Vitamin D Intake  Adults: 1000-1200 Units per day  4 00-800 IU vitamin D per day  Consult your physician for dosage

44. Prevention

45. Weight-Bearing Exercise Consult your physician first 45

46. Prevention: 10-20 Year Olds

47. Prevention: 20-35 Year Olds

48. Prevention: 35-50 Year Olds

49. Prevention: Over 50

50. Getting You Back In the Game Name: Ruth C. Snyder Age:Over 50 Injuries/conditions: Fracture of dorsal lumbar spine, Osteoporosis, hip fracture, and trigger finger

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52. Osteoporosis While you cannot change your genetics or heredity, skeletal frame, gender, race or age, you can control other risk factors

53. Resources National Osteoporosis Foundation (202) 736-1656 www.nof.org American Academy of Orthopaedic Surgeons 6300 North River Road Rosemont, IL 60018 www.orthoinfo.org

54. What are your questions and concerns? Understanding Osteoporosis

55.  Thank you for participating today  Remember, your orthopaedic surgeon can help get you back in the game