Osteoporosis Dr Gordon MacDonald BSc MB BChir MRCP Consultant Rheumatologist Rheumatology and Arthritis Seminar Tuesday 5 th February 2013
Plan What is osteoporosis? Consequences of osteoporosis Risk factors Diagnosis Treatment Calcium and vitamin D Exercise Can we improve bone health? 2
What is Osteoporosis? Porous or fragile bones No specific symptoms Silent disease Until first broken bone (fracture) Increased risk of broken bone Minor bump or fall fragility fractures 3
Microscopic effects of osteoporosis on bone Normal bone Osteoporotic bone
Bone turnover 5
Bone density throughout life 6
After hip fracture 50% not returning home 1:10 dead at 1 month 1:3 dead at 12 months More bed days than heart attack or stroke 2.3 billion pounds in hip fracture costs/ year
After spinal and wrist fractures 66% of patients with spinal fractures develop long term back pain 50% of wrist fracture patients report a good outcome at 6 months
What happens after first fracture? 1,921 patients with spinal fracture 17.6% refractured within 5 years
Risk factors for osteoporosis - Genes Age Gender Falls Previous fractures 11
Which of the following are risk factors? - Being underweight - Excessive alcohol - Smoking - Physical inactivity - Jogging/ running 12
Which of the following are risk factors? - Being underweight - Excessive alcohol - Smoking - Physical inactivity - Jogging/ running 13
Other risk factors Rheumatoid arthritis Early menopause Anorexia nervosa Conditions affecting absorption of food (e.g. Crohn s disease and Coeliac disease) Conditions that affect hormones (e.g. over active thyroid and parathyroid) Steroid tablets for more than 3 months Aromatase inhibitors for breast cancer 14
Diagnosis Bone density (DEXA) scan Painless, non-invasive Very low dose of radiation 16
Bone density (DEXA) scan results 17
Treatments Bisphosphonates (e.g. alendronic acid) Strontium ranelate Selective Oestrogen Receptor Modulators (SERMS) Hormone replacement Therapy (HRT) Parathyroid Hormone analogues (teriperatide) Denosumab Calcium and vitamin D supplements 18
Calcium Vital for strong teeth and bones 99% calcium found in our bones Most people should get enough calcium through healthy eating Reference nutrient intake 700mg/ day Recommended intake 1000-1200mg/ day (on osteoporosis medication) 19
Calcium rich foods Weight Food Calcium content (mg) 1/3 pint Semi-skimmed milk 224 150g (5oz) Low-fat yoghurt 225 112g (4oz) Ice cream 134 28g (1oz) Cheddar cheese 202 3 large slices Brown or white bread 215 112g (4oz) Baked beans 59 60g (2oz) Sardines 260 115g (4oz) Boiled cabbage 40 20
Vitamin D Helps body absorb calcium How do we get most of our vitamin D? 21
Vitamin D > 90% produced through exposure of skin to sunlight 10 minutes sun exposure 3 times per week Vitamin D in margarine, egg yolks, old liver oil and oily fish (e.g. herrings and sardines) 22
Who might benefit from vitamin D supplement? Housebound, frail, older people Those with a poor diet Asian women and children Pregnant/ breast feeding women Some anti-epileptic medication People with severe liver, kidney disease or malabsorption problems 23
Exercise Weight bearing exercise Promotes strong bone development in young people Delay rate of bone density loss Balance and coordination 24
Weight bearing exercise Dancing - Running up and down stairs Walking - Jogging Aerobics Tennis/Squash Football/ Netball 25
Building stronger bones ( banking bone ) Improving diet Weight bearing exercise Reduce alcohol intake Stop smoking 26
Presentation title here Very common Bone health assessment after fragility fracture Good treatments Exercise and diet 27
Presentation title here Thank you National Osteoporosis Society www.nos.org.uk gordon.macdonald@royalberkshire.nhs.uk 28