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Osteoporosis. Critical reduction in bone mass to the point that fracture vulnerability increases Affects cancellous bone more than cortical bone. Osteoporosis. Definition:

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osteoporosis
Osteoporosis
  • Critical reduction in bone mass to the point that fracture vulnerability increases
  • Affects cancellous bone more than cortical bone
osteoporosis1
Osteoporosis
  • Definition:
  • A disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures of the hip, spine, and wrist.
common osteoporotic fractures
Common Osteoporotic Fractures
  • common sites of fractures

(1) thoracic vertebrae

    • crush
      • Dowager’s hump

(2) distal radius

(3) neck of femur (hip)

common osteoporotic fractures1
Common Osteoporotic Fractures
  • common sites of fractures

(1) thoracic vertebrae

    • crush
      • Dowager’s hump

(2) distal radius

(3) neck of femur (hip)

osteoporosis health implications
Osteoporosis- Health Implications
  • Affects 10 million Americans
  • Estimated cost of 17 billion dollars annually
  • estimated that these #s will triple by 2060
  • ~ 32% of women and ~ 17% of men will suffer hip fracture by age 90
  • 12-20% w/ hip fracture die because of complications
    • Blood clots
    • Bed ridden
      • Underlying chronic diseases (heart disease)
      • pneumonia
osteoporosis health implications1
Osteoporosis- Health Implications
  • 55% of the people 50 years of age and older, have low bone mass: risk of developing osteoporosis and related fractures
  • Often thought of as an older person’s disease, it can strike at any age.
  • Responsible for more than 1.5 million fracturesannually including:
    • 300,000 hip fractures
    • 700,000 vertebral fractures
    • 250,000 wrist fractures
    • 300,000 fractures at other sites
risk factors for osteoporosis
RISK FACTORS FOR OSTEOPOROSIS
  • Risk Factor High RiskLow Risk

family history yes no

ethnic background Caucasian African-American

Frame size small large Gender female male

amenorrhea yes no

menopause early late

given birth no yes

age over 50 yes no

risk factors for osteoporosis1
RISK FACTORS FOR OSTEOPOROSIS
  • Risk Factor High RiskLow Risk

Weight underweight overweight

obesity (fractures, not osteopenia)

Physical activity sedentary regular

(overtraining)

Smoking yes no

Calcium intake low high

Vitamin D intake low adequate

Soft drink intake high low

risk factors for osteoporosis2
RISK FACTORS FOR OSTEOPOROSIS
  • Risk Factor High RiskLow RiskFiber intake high moderate

Alcohol intake high low/moderate

Caffeine high low or none

    • Coffee (150 mg); tea (100 mg); Coke (50 mg)

estrogen low normal

parathyroid hormone low normal

exercise and osteoporosis in female athletes
Exercise and Osteoporosis in Female Athletes??

15 yrs ago: scientist found some young female athletes had bone loss (osteopenia) in the spine

• some had bone mineral content similar to elderly women

osteopenia in young female athletes
OSTEOPENIA in Young Female Athletes
  • 2. Female Athlete Triad (poor nutrition, amenorrhea, bone loss)

* occurs in a significant % of population of athletes, active instructors (10 - 40%)

* most common in running, gymnastics, aerobics instructors

* associated with disturbances in menstrual cycle

> reduction in estrogen

exercise and osteopenia in female athletes continued
Exercise and Osteopenia in Female Athletes (continued)

Female Athlete Triad (continued)

A. Poor overall nutrition - caloric restriction and eating disorders; decrease in dietary Ca2+

• Primary factor

B. Overtraining

C. Low % body fat? “Set point” below which normal menstrual cycle is disturbed

• varies from person to person, nutritional status, etc

Result: disrupted menstrual cycle and osteopenia

menstrual disturbances
Eumenorrhea: 10-13 cycles per year

Oligomenorrhea: 3-6 cycles per year

Amenorrhea: fewer than 3 cycles per year or no cycles for the past six months

Primary: never menstruated (Delayed menarche)

Secondary: menstruation has been present for a variable period of time in the past and has ceased

Menstrual Disturbances
slide15

BONE MINERAL CONTENT

Dr. J. Wilmore

intervention for female athlete triad
Intervention for Female Athlete Triad
  • If nutrition, low caloric intake, overtraining, and low % body fat issues are addressed, normal menstrual cycle usually resumes
  • Partial recovery of bone mass noted (long-term effect unknown?)
      • Barbara Drinkwater (Pacific Medical School)
intervention for female athlete triad1
Intervention for Female Athlete Triad
  • Education of coaches, athletes to this problem while the athletes are teens is absolutely critical.
    • Improvement - last 10 years - college +
    • Concern now - teens, youth sports
  • Luteinizing hormone (LH; pituitary hormone needed for ovulation) ∆ 6 months before disturbances in menstrual cycle. Screening/prevention tool???
    • Blood draws over 24 hours, expensive
intervention for osteoporosis
INTERVENTION FOR OSTEOPOROSIS

1) Prevention - maximize bone growth during growth phase, maintenance phase; some bone loss with age appears inevitable.

intervention for osteoporosis1
INTERVENTION FOR OSTEOPOROSIS

2) Exercise - both weight bearing and weight training; however, avoid overtraining

intervention for osteoporosis2
INTERVENTION FOR OSTEOPOROSIS

3) Calcium supplementation

Good overall nutrition

  • watch out for:
  • * yo-yo diets

* rapid weight loss

intervention for osteoporosis3
INTERVENTION FOR OSTEOPOROSIS

4) Hormone Replacement Therapy

Estrogen: post-menopausal, amenorrheic women

• Alternative - “Estrogen receptor modulators”

or "designer estrogens" - raloxifene

(68% reduction in fractures)

Ca2+ regulating hormones

• calcitonin (nasal spray)

• parathyroid hormone

intervention for osteoporosis continued
INTERVENTION FOR OSTEOPOROSIS (continued)

5) Ensure adequacy of vitamin D

6) Biphosphonates - increased used, builds bone mass; reduces osteoclast activity; most widely prescribed today

Studies have shown that a combination of these therapies is more effective than one alone!

slide23
Studies have shown that a combination of these therapies is more effective than one alone against osteoporosis!

Notelovitz et al.,

1990