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Osteoporosis

Osteoporosis. By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons. Osteoporosis. “ Porous bone “ Bones lose protein & mineral content. Clinical Definitions of OP. Vertebral height loss of > 25% of the vertebral body 2 compression fractures

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Osteoporosis

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  1. Osteoporosis By Jody Vulk PA-C Northwest Iowa Bone, Joint & Sports Surgeons

  2. Osteoporosis “Porous bone“ Bones lose protein & mineral content

  3. Clinical Definitions of OP Vertebral height loss of > 25% of the vertebral body 2 compression fractures 2 or more fragility fractures

  4. Fragility Fractures • A fracture from forces that would not ordinarily cause fracture in a healthy young adult. • Quantified as forces equivalent to a fall from a standing height or less.

  5. Types of Fragility Fractures • Compression Fractures of the Vertebra • Proximal Humerus • Distal Radius Fractures • Hip Fractures

  6. True or False Most Common Fragility Fractures are: #1 Spine #2 Wrist #3 Hip

  7. True Spine 27% Wrist 19% Hip 14%

  8. Bone Cells

  9. Osteoclasts Osteoblasts Create new bone Best before age 35 & before menopause • Remove or retire old bone. • Active throughout lifetime.

  10. Osteoclasts Remove Old Bone (Classic) Osteoblasts Create new bone (having a Blast!)

  11. In Osteoporosis More of these working… than these.

  12. Osteoclasts Osteoblasts Create new bone Best before age 35 & before menopause • Remove or retire old bone. • Active throughout lifetime.

  13. Dual Energy X-ray Absorptiometry

  14. BMD Levels

  15. Who needs a BMD? • A woman nearing menopause (for baseline) • Men over the age of 70 • Women 65 or older (& have never had one) • Those with risk factors for osteoporosis

  16. How often to Test • Normal BMD=15 years • Osteopenia=5 years • Severe Osteopenia=1 year • 85 or older=3 years

  17. Bone Minerals

  18. True or False To avoid Osteoporosis-- just is drink more milk.

  19. False Calcium + Vitamin D + Magnesium+ Phosphorus + Alkaline Phosphatase = Good Quality Bones

  20. Foods for Healthy Bones

  21. Calculate Need 1000-1500mg Daily

  22. Calcium supplements Calcium Citrate Calcium Carbonate Requires stomach acid, take with food 40% Calcium Fewer side effects Inexpensive • Take with or without food • 21% Calcium • More frequently causes gas, bloating, constipation

  23. Calcium Zappers

  24. Osteoporosis & Vitamin D Deficiency • 1 Billion worldwide • 1/3 of OP patients also Vitamin D deficient • Vitamin D deficiency is not age dependent.

  25. Vitamin D is created through the skin by exposure to sunlight

  26. Vitamin D and Sunlight You must live near the equator to rely on its benefits.

  27. True or False Caucasians are more prone to Vitamin D deficiencies than those with darker skin.

  28. False Darker skin does not absorb Vitamin D as well.

  29. Vitamin D Rich foods Fatty fish *Cod Liver oil(1360 IU) Swordfish(566 IU) Salmon(sockeye)(447 IU) Tuna(154 IU) *avoid Cod liver oil Fortified foods: Milk (115 IU) Orange juice (137 IU) Egg yolks (41 IU).

  30. Vitamin D Supplements Ergocalciferol (Vitamin D2) Cholecalciferol (Vitamin D3) Synthesized in the skin Wool oil Preferred supplement • Fungal derivative • Vegan supplement

  31. New Guidelines Normal Vitamin D level, do not exceed 4,000IU daily. *Do not commit these to long term memory, follow-up research pending.

  32. Vitamin D Deficiency Risk Factors

  33. Risk Factors of Vitamin D deficiency • Northern Latitudes • <15 minutes of sun • African American, or dark skinned • Elderly • Obesity

  34. Vitamin D • Vitamin D is fat soluble, stored in fat • Testing is on blood • Loose weight, boost Vitamin D

  35. Who is at risk?

  36. True or False Men do not need to be tested for Osteoporosis.

  37. False • 2 million men have OP • Men are more likely to die in the first year after hip fracture. • Men who fracture are less likely to be tested.

  38. Early Signs of Osteoporosis

  39. Joan Surber • Age 68 • Pelvic Fracture 1/28/2012 • T-Score of -2.5 in her Lumbar Spine, -1.8 in the Right hip and a -2.2 in the Left hip. • Vitamin D=12ng/mL

  40. Severe Osteoporosis T-score –2.5 or less & a fragility fracture has occurred.

  41. Risks factors & Prevention Don’t have it in your genes Hormone replacement (at the guidance of your PCP) Not recommending to avoid this one. Avoid long-term use of bone depleting medications Heredity/Ethnicity Hormonal Changes (Estrogen & Testosterone) Aging Pharmaceuticals

  42. (Cont.) Risk Factors & Prevention Low BMI History of Fracture EAT! -a diet rich in colors and eat real foods! Bubble wrap

  43. (Cont.) Risk Factors & Prevention Malabsorption Poor Diet Smoking Alcohol in excess Lack of Exercise Avoid Gastric Bypass, Celiac Sprue, Anorexia… Eat FOODs rich in Vitamins and minerals Don’t do that! Limit alcohol to no more than 2 beverages daily Weight bearing exercises such as walking, tia chi, & weight lifting/resistance exercises

  44. Types of Osteoporosis Primary Relatively unknown cause other than advancing age and postmenopausal Secondary Has a known cause or reason for having developed (i.e.=oral corticosteroid use, other medications, diseases or conditions)

  45. True or False Kyphosis of the spine is “normal for aging.”

  46. False Decreasing height and humped back are not normal. They are indications of compression fractures.

  47. NWIA Bone Approach

  48. But orthopedists fix bones, Right?

  49. We Evaluate Anyone over 50 with a fractured bone from ground height.

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