1MEN’S AND WOMEN’S HEALTH – OCTOBER 29TH, 2007

OSTEOPOROSIS

LECTURE 16
Osteoporosis- 1 Page double-sided handout

Indications for a dexa scan:

o Fragility fracture
o Low BMI, anorexia
o Long term glucocorticoid use
o Family hx of osteoporosis
o To monitor treatment

o T-score in the more useful measure

o Other ways to monitor osteoporosis: measure height, pain level, observe if they are hunched over (hunched back to
d/t compression factor in anterior part of vertebral body)

o Osteophytes and scoliosis can interfere w/reading of dexa

Reading a BMD scan

o Lumbar- different heights of vertebrae is a sign of a compression fracture
o Look at total values

Medications:
o Inhibitor of bone resorption- can thicken trabeculi but can’t reconnect structure. Inhibit action of osteoclasts.
o Side effects of bisphosphonates: nausea, abdominal pain, loose BM, skin ulcers rash
o SERMS: selective estrogen receptive modulator
o SERMS only stimulate estrogen receptors at bone therefore okay in px w/hx of CA
o Stimulators of bone formation: increase density but not quality.
o Fluoride side effects: GI irritation, tendonitis, lower extremity pain, stress fractures
o Endogenous PTH take ca out of bone into blood. But the synthetic kind used in tx does not have this affect. It
increases both OB & OC activity. It is very expensive.

Osteoporosis- note pack Dr. Kennedy

o Post hip fracture death in first year related to that fact that px is bedridden increases risk of pneumonia.
o Osteoporosis affects mainly the trabecular bone
o Dexa only measures density not quality, you have to infer quality.
o Osteoporosis is a pediatric disease that manifest in one’s 50’s (she said this many times). Reaching peak bone
mass is key!
o life time risk in men over 50 is 30% mainly d/t prostate cancer
o In post menopausal women: bone formation is normal but there is an increase in bone resorption

Risk Factors:
1. Illness
o Cushing’s disease- d/t increased glucocorticoids
o Hx bed rest (> 2wks)
o Glucorticoid use (>3wks)
o Celiac, chron’s, IBS
o Anorexia
o Primary hyperparathyroidism
o Hyperthyroidism- d/t increased metabolic rate
o Anti-convulsion meds, SSRI’s, Cholesterol lowering drugs

2. Lifestyle:
o Sedentary lifestyle

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o Excess caffeine (4 cups/day)
o Excess alcohol (2 cups/day)
o Cigarette smoking- speeds up the processing of estrogen in the liver

3. Hormonal:
o Late menarche, early menopause (<45 yrs)
o Amenorrhea
o Depoprovera (progesterone only)
o Aromatase inhibitors

4. Nutritional:
o Inadequate protein intake
o Inadequate ca + vitamin D
o High salt intake
o High sugar intake
o Soft drinks- linked w/lower bond density in adolescent girls b/c phosphate competes w/Ca for absorption

Diagnostic Tools:
o Heel ultrasound: heel is all trabeculae, less expensive, can’t monitor tx, can’t asses fracture risk.

Calcium
o only 21-26% of calcium carbonate or calcium citrate is absorbed
o Take with meals
o Take highest dose of Ca earlier in day b/c PTH is highest at night.

o Vitamin A- studies showed negative impact on bone health

o Mg- regulate PTH, vit D (dose = ½ of calcium dose)

o Silicon- makes new bone matrix

o Boron- reduces urinary excretion of Ca

o Exercise- increases stability and agility. Reduces risk of falling

Bottom line:
o Peak bone mass determines future risk of developing osteoporosis
o Assess future risk
o Ensure balanced alkaline diet
o Supplement to maintain & enhance

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