1. Should we be concerned? OSTEOPOROSIS: Should we be concerned?

2. What is osteoporosis? Osteoporosis is a disease of bone where there is a decrease in bone density NormalOsteoporosis

3. Why is bone density important? With decreased bone density, bones are more fragile and are more likely to break (Fracture)

4. Why is bone density important? With decreased bone density, vertebral bones may collapse and cause excessive curvature of the spine

5. Osteoporosis is a growing problem Millions of Filipinos have osteoporosis… …but will not know it until they get a fracture

6. Osteoporosis is a growing problem Of the Filipinos who are diagnosed with osteoporosis.. …only a small percentage will receive adequate medical treatment

7. COULD I HAVE OSTEOPOROSIS? COULD SOMEONE I LOVE HAVE OSTEOPOROSIS?

8. What are the risk factors for developing osteoporosis?

9. Age The older you are, the greater your risk of osteoporosis. Your bones start to become weaker and less dense after the age of 35.

10. Being female Women are 4x more likely to develop osteoporosis than men Women have less bone tissue and lose bone more rapidly than men because of the changes involved in menopause

11. Family History and Personal History of Fractures as an Adult Young women whose mothers have a history of vertebral fractures also seem to have reduced bone mass. A personal history of a fracture as an adult also increases your fracture risk.

12. Bone structure and body weight Small-boned and thin women (under 127 pounds) are at greater risk. Menopause / Menstrual history Normal or early menopause (brought about naturally or because of surgery) increases your risk

13. Lifestyle/modifiable risk factors Smoking Excessive alcohol Inadequate calcium Lack of exercise

14. Medications Steroids (Prednisone, dexamethasone..) Excessive thyroid hormones (Thyroxine) Anticonvulsants Antacids containing aluminum Others: –GnRH used for treatment of endometriosis –Methotrexate for cancer treatment –Cyclosporine A, an immunosuppressive drug –Heparin and –Cholestyramine, taken to control blood cholesterol levels.

15. Can osteoporosis be prevented?

16. How you can prevent osteoporosis Take adequate amounts of calcium –Low-fat milk –Cheese –Broccoli –Orange juice –Cereals –Breakfast bars –Calcium supplements (Caltrate, Calci- aid, Calvit..)

17. How you can prevent osteoporosis Adequate amounts of Vitamin D Sunlight Vitamin D rich foods –Dairy products –Egg yolks –Saltwater fish –Liver Recommend 400-800IU/day, but not more than 800IU/day

18. How you can prevent osteoporosis Stop smoking Drink alcohol in moderation Exercise! –Bone becomes stronger and denser when you place demands on it

19. What should I do? I might have osteoporosis! ME TOO!

20. Your doctor my request a bone mineral density test to evaluate your bones

21. Bone Mineral Density Test The best way to diagnose osteoporosis Compares your bone density with –A young normal person –A person your age and body size

22. Based on your doctor’s evaluation and your tests, you may need to take medications for osteoporosis

23. Some medications used for the treatment of osteoporosis: Bisphosphonates: –Alendronate (Fosamax) –Risedronate (Actonel) –Ibandronate (Bonviva) Hormone Replacement SERMs –Raloxifene (Evista) Others: –Strontium (Protos) –PTH –Cacitonin

24. What else can be done? Prevent falls! Floors. –Remove all loose wires, cords, and throw rugs. Minimize clutter. Make sure rugs are anchored and smooth. Keep furniture in its accustomed place. Bathrooms. –Install grab bars and non-skid tape Lighting. –Make sure halls, stairways, and entrances are well lit. Install a night light in your bathroom. Turn lights on if you get up in the middle of the night.

25. What else can be done? Prevent falls! Kitchen. –Install non-skid rubber mats near sink and stove. Clean spills immediately. Stairs. –Make sure treads, rails, and rugs are secure. Other precautions. –Wear sturdy, rubber-soled shoes. Keep your intake of alcoholic beverages to a minimum. Ask your doctor whether any of your medications might cause you to fall.

26. The Philippine College of Physicians wishes to acknowledge the following for their invaluable efforts in the preparation of this module Gabriel Jasul, MD Jose Ma Ibarra Co, MD Rosa Allyn G. Sy, MD Committee on Advocacy & Public Relations Philippine Society of Endocrinology and Metabolism