Unformatted text preview: OSTEOPOROSIS & OSTEOPOROSIS & OSTEOARTHRITIS You CAN Do Something About It!
Lisa Z. Killinger, DC REFERENCE FOR THIS REFERENCE FOR THIS PRESENTATION:
Gleberzon B, Killinger LZ. “Management considerations for patients with OA and OP: A chiropractic perspective on what’s working.” TICC 2002;9(1):4860. What do we know about OP?
What do we know about OP?
• Now affects 25 million Americans
1/3 of women > 75 are osteoporotic*
94% of women > 75 have low bone mass
1.5 million OPrelated fractures/year
700,000 vertebral fx/year
*2.5 standard deviations below the mean of a young adult reference popul. So, what can WE do?
So, what can WE do? Primary Prevention:
Primary Prevention (Prevent OP from ever happening) • Counsel pts about diet and physical activity at all ages, to maximize bone density in the third decade of life and slow the rate of bone loss after that.
– Most important factor = physical activity!!!! (National Osteoporosis Foundation and Clinician’s Handbook of Preventive Services HP2010) Secondary Prevention: Secondary Prevention
(Early detection) 1. Screen all patients: OP checklist
2. Identify preventable risks
3. Get baseline bone mineral density test (Dexa scan of the hip is the gold standard)
4. Design a prevention plan suited to patient’s risk factors BMD testing: The DEXA Scan
BMD testing: The DEXA Scan
• Recommended for: – Women with risk factors
– Women who have had a fracture (as an adult)
– Those 65 and older
– Those who are considering OP therapies
– Those who have been on or are starting HRT But, what does it all mean?!!
But, what does it all mean?!!
• Normal = BD within 1 Standard deviation of a young healthy adult
• Low Bone Mass = BD is 12.5 SD below mean
• Osteoporosis = BD is >2.5 SD below mean
• Your Z score = compares your BD to people your size, age and gender (careful) Tertiary Prevention:
Tertiary Prevention (Minimizing osteoporosis’ impact and disability/slowing progression) •
• Employ safe chiro. adjusting strategies
Fall prevention (IMPORTANT!)
Keep patients physically active
Monitor lifestyle and behaviors,
Encouraging healthy dietary choices
Supplementation!! So, what do we tell our patients?
So, what do we tell our patients?
• Physical activityWeight bearing (axial loading) activities are best – Stair climbing
– Step aerobics
– 3 times a week for 1520 minutes
– Find a friend to be active with! Pumping Iron
• Free weights work wonders!
• Focus on lifting weights with muscles that tug against the spine (traps, rhomboids, lats, etc)
• Start small and work up to more weight
• Can be done while watching TV, etc.
• Lower body?
(Jette, ExerciseIt’s never too late; AJPH) Later years: Fall prevention
Later years: Fall prevention
• Strengthen lower body
Home safety checklist
Modify unsafe surroundings
Assess and monitor meds
Regular chiropractic careIMPORTANT! Risks for hip fractures/falls
Risks for hip fractures/falls
• older age
history of fx
caffeine intake (>2 cups coffee/day)
lack of walking/exercise
meds that have dizziness or bone loss as a side effect (steroids, anticonvulsives, BP meds) What about nutrition?
What about nutrition?
• Recommendation =1,2001,500 mg/day of •
• calcium (hard to get in diet) Vitamin D=400 800 IU/day
Other bone helpers = magnesium, boron, Vit C (collagen), etc.
Choosing where the calcium deposits… through focused physical activities Watch out for calcium thieves: phosphorus, caffeine, alcohol, smoking, oxalic acids, etc. But what kind of Calcium?
But what kind of Calcium?
• Calcium citratemost easily digested (expensive) 22% usable Ca++/big pills
• Calcium carbonateneeds acidic gastric envir (but cheaper!) 40% elemental or usable Ca++/smaller pills)
• Dairyyogurt and lowfat milk are the gold standard calcium sources (all other sources are viewed in comparison to these) The Acid Test
The Acid Test
• Calcium supplement tablet should dissolve completely in a small glass of vinegar in 30 minutes or less
• Beware of coated, compressed supplements with a shelf life of a zillion years!
• Don’t take more than 500 mg at a time Foods for Calcium
Foods for Calcium
Ca++ fortified Juice
Fortified soy milk/cheese, etc
Canned sardines with bones
Legumessoak the phylates out first! Calcium Interference
• Oxalates and phylates
High protein diets (esp. meatbased)
High sodium diets (causes kidneys to dump Ca++)
High iron intake
High phosphorus intake
Alcohol, smoking, etc Know the medical options...
Know the medical options...
• HRT, ERT, etc
• Alendronate (bisphosphonate)”Fosomax” decreases osteoclastic activity, arrests bone loss, may increase bone density, reduces fractures (EXPENSIVE $20/pill)
• Calcitoninoral or nasal spray (hormone): increases bone density in postmenopausal women Resources related to OP:
Resources related to OP:
• National OP foundation: 1(800) 624BONE or “www.nof.org” – info on prevention, patient pamphlets (free!), bone density tests, research, causes, etc. Take Home Messages: OP...
Take Home Messages: OP...
• Counsel patients on diet/physical activity
Screen patients for risks
Assess bone density and risk factors before designing intervention
• Develop prevention/health promotion strategies based on patient’s clinical scenario
• Offer good, safe & sound chiropractic care Osteoarthritis Osteoarthritis •
• Affects about 50% of all people over 65
Costs: 10,000,000 per year in US
Leading cause of disability in older adults What’s working?
(Summary of research on OA)
• Physical activity Best strategy (++++)
• Adjust: Bones that are not aligned •
• degenerate faster (animal models, human studies of the knee)
PT: TENS 7 trials (+); Ultrasound (+/)
Acupuncture7 clinical trials (++)
Glucosamine16 clinical trials (effective and safe). 1,500 mg/day in 3 doses (++)
Ginger: 1 clinical trial (+) Medical Interventions:
• NSIADS: first line of therapy, but… – 0.04% fatality rate
– 2,600 3,200 deaths annually in US
– 20,000 hospitalizations annually
– 2.74% rate of serious adverse events (GI) • COX2 inhibitors: interrupts body’s perception of pain: Celebrex, Vioxx Hypertension, Renal failure Stay up on the literature!!
This is a growing area of
investigation in an aging
Patients come in asking
informed questions! ...
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- Summer '09
- Bone loss, op, Low Bone Mass