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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 – Walking – Step aerobics – Jazzercise – 3 times a week for 15­20 minutes – Find a friend to be active with! Pumping Iron 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 Proprioceptive training Balance/gait focus 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 low weight caffeine intake (>2 cups coffee/day) alcohol use lack of walking/exercise vision impairment 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 • • • • • • • Yogurt/milk Ca++ fortified Juice Fortified cereals Acidophillus milk Fortified soy milk/cheese, etc Canned sardines with bones Legumes­soak the phylates out first! Calcium Interference Calcium Interference • • • • • • • Oxalates and phylates High protein diets (esp. meat­based) High sodium diets (causes kidneys to dump Ca++) Wheat bran­phylate 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? 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: 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 population. Patients come in asking informed questions! ...
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