Osteoporosis. Am I at Risk?

Osteoporosis Am I at Risk?

TABLE OF CONTENTS What is osteoporosis?...1 Who gets osteoporosis?...2 How can I prevent osteoporosis?...3 How do I know if I have osteoporosis?...4 What is a bone mineral density (BMD) test?...5 What treatments are available?...6 Osteoporosis in men...8 Bone Health Clinic...9

WHAT IS OSTEOPOROSIS? Normal bone Osteoporosis is a disease in which bones become thin. As a result, the bones are more likely to break. Bones most often affected are in the hip, spine, and wrist, but the ribs and other bones are also at risk. The incidence of these fractures increases with age in both men and women. Nearly 25 million Americans have osteoporosis and most of them are women above the age of 60. Men are also vulnerable to the disease. In the early stages of disease, there are no signs or symptoms, which is why it has been given the nickname the silent disease. The loss of bone progresses gradually until a bone breaks. Other signs include loss of height and bad posture. Breaking a bone is a serious complication. It can cause severe pain and keep you from getting around and doing the things you enjoy. It can also lead to other health problems. Twenty percent of seniors who break a bone die within one year from problems related to their broken bone or from surgery to repair the broken bone. Many of those who do survive are not able to go back to independent living and may require long-term nursing care. The occurrence of osteoporosis is expected to rise as more and more people are living longer and leading more sedentary lives. It is, therefore, important to understand the factors that put one at risk for osteoporosis, as well as how to prevent it. Normal bone Microscopic view showing strong, dense, and compact bone osteoporosis Osteoporotic bone Microscopic view showing thin, weak, and disconnected bone at risk for fracture Figures courtesy of Synthes, Inc. 1

WHO GETS OSTEOPOROSIS? Anyone can get osteoporosis, but certain people are more likely to develop it than others. Common osteoporosis risk factors include: Being older than 65 years of age Having broken a bone after age 50 Having a close relative that has osteoporosis or has broken a bone Being in fair or poor health Smoking Being underweight for height Starting menopause before age 45 Having low levels of testosterone in men Lacking calcium intake Having two or more ounces of alcohol per day Having poor vision, even with eye glasses History of falling Physically inactive Patients who have one of the following medical conditions may be prone to osteoporosis: Patients who take the following medicines may be prone to osteoporosis: Oral glucocorticoids (steroids) Cancer treatment (chemotherapy, radiation) Thyroid medicine Antiepileptic medicine Gonadal hormone suppression Immunosuppressive agents Hyperthyroidism Chronic lung disease Cancer Inflammatory bowel disease Chronic hepatitis or renal disease Hyperparathyroidism Vitamin D deficiency Cushing s disease Multiple sclerosis Rheumatoid arthritis 2

HOW CAN I PREVENT OSTEOPOROSIS? You are never too old or too young to improve your bone health. Maintaining a healthy lifestyle can help prevent osteoporosis. Here are some things you can do to keep your bones strong and healthy: get enough Calcium and Vitamin D Getting enough calcium helps build strong bones when you are younger and keeps them strong later in life. Your body needs vitamin D to absorb calcium. Sunlight is a great source of vitamin D though many people may not get enough, especially those that are house-bound, live in high altitudes, or regularly use sunscreen. The National Osteoporosis Foundation makes the following recommendations: Adults under age 50 need a total of 1,000 mg of calcium and 400-800 IU of vitamin D daily. Adults age 50 and older need a total of 1,200 mg of calcium and 800-1,000 IU of vitamin D daily. Exercise Exercise makes bones and muscles stronger and helps prevent bone loss. Recommended exercises include weight-bearing exercises (walking, jogging, aerobics, dancing), resistance or muscle-strengthening exercises (weights, stretch bands), and balance exercises (yoga, Pilates). Swimming, cycling, and other machines such as elliptical trainers provide a great source of cardiovascular exercise, but are not as helpful for improving bone health as weight bearing exercises. eat Fruits and Vegetables Eating healthy is important for building strong bones and food remains the best source of calcium. Foods rich in calcium include milk, cheese, yogurt, pudding, ice cream, fish, and shellfish (sardines, salmon, shrimp). Dark, leafy vegetables such as bok choy, broccoli, spinach, kale, and collard greens, as well as fruits such as oranges, rhubarb, and dried figs are also high in calcium. Some foods are fortified with calcium (calcium has been added to the food) and include some brands of juices, soy milk, rice milk, tofu, cereals, breads, breakfast bars, and snacks. Look at the food label to see if calcium has been added. A simple way to add calcium to your food is to add non-fat powdered milk to puddings, homemade cookies, breads, muffins, soups, gravy, or casseroles. A single tablespoon of non-fat powdered milk contains about 50 mg of calcium. quit Smoking Smoking is harmful to your bones in many ways. The chemicals in cigarettes are bad for your bone cells. Smoking also might make it harder to absorb calcium. For women, smoking can prevent estrogen from protecting the bones. limit alcohol consumption It is recommended that you do not drink more than two ounces of alcohol per day. Too much alcohol reduces bone formation and many people who drink too much do not get enough calcium in their diet. prevent Falls Fall prevention is important to reduce fractures. Many factors can lead to falls including poor balance, weak muscles, vision problems, certain diseases or medications, and alcohol use, as well as tripping hazards in your home. Make your home safe by keeping rooms free of clutter and having plenty of light. Be careful both indoors and outdoors. 3

HOW DO I KNOW IF I HAVE OSTEOPOROSIS? do you have any of these risks factors? I am a woman older than 65 years or a man older than 70 years I am Caucasian or Asian I have broken a bone after age 50 I have a close relative with osteoporosis I smoke I am underweight for my height (petite and thin) I started menopause before age 45 I am a man with low levels of testosterone I am calcium or vitamin D deficient I drink two or more ounces of alcohol per day I have a history of falling I am not physically active I have one of the following medical conditions: hyperthyroidism, chronic lung disease, cancer, inflammatory bowel disease, chronic hepatitis or renal disease, hyperparathyroidism, Cushing s disease, multiple sclerosis, or rheumatoid arthritis I have taken one of these medications: oral steroids, aluminum-containing antacids, antiseizure medication, radiation or chemotherapy, thyroid medication, gonadal hormone suppression, or immunosuppressive medication If you answered yes to any of the factors listed above, you could be at increased risk for osteoporosis. It is recommended that you speak with your health care provider about your overall bone health and risks for osteoporosis. A review of your medical history, as well as a physical exam can help your health care provider determine your risks for osteoporosis. A bone mineral density (BMD) test may be recommended and can help diagnose whether you have low bone density (osteopenia) or osteoporosis. Osteopenia is the beginning stage of osteoporosis. Medical History Your health care provider may ask you questions about your health, medicines you take, and the health of your close relatives. Questions may be asked about your diet and exercise habits and whether your smoke or drink. This information helps your health care provider learn if you have risk factors for osteoporosis. Physical Exam Your health care provider may measure your height to determine if you are losing height. Your spine may be evaluated to see if it is curving forward. Losing height and curvature of the spine may indicate that you have already broken bones in the spine, likely due to osteoporosis. Bone Mineral Density (BMD) Test The National Osteoporosis Foundation recommends BMD testing for the following groups: women age 65 years or older, postmenopausal women younger than 65 years who have at least one additional risk factor, all postmenopausal women with a new fracture, and all women who have used estrogen replacement therapy for several years. Your health care provider will determine based on your medical history and physical exam if a BMD is necessary. 4

WHAT IS A BONE MINERAL DENSITY (BMD) TEST? A bone mineral density (BMD) test measures how much calcium and other types of minerals are in an area of your bone using a special X-ray exam or computed tomography (CT) scan. It helps your health care provider detect osteoporosis and predict your risk of fractures. Standard X-rays are not used for BMD testing because they don t show osteoporosis until 25 to 40 percent of bone density has been lost. BMD tests can find the disease earlier. Types of BMD tests include: Central dual energy X-ray absorptiometry (DXA) This uses low-dose X-rays and measures the bone mineral density at the hip, upper thigh bone (femoral neck), and spine. Quantitative computed tomography (QCT) This test is typically done when a DXA machine is not available. It is more expensive and not as reliable at measuring changes in bone density over time. Peripheral screening tests These tests are helpful as a screening tool. They predict the chance of breaking a bone when a DXA test is not available. These tests typically measure bone density in the lower arm, wrist, finger, or heel. They cannot accurately diagnosis osteoporosis, and they should not be used to see how well an osteoporosis medicine is working. Screening tests can help identify people who may benefit from further osteoporosis evaluation. You will commonly find them used at health fairs. BMD tests are safe, accurate, and noninvasive. There are no needles or instruments and are relatively quick (similar to having an X-ray done). In most states, you need to get a prescription from your health care provider to have a BMD test done. Your health care provider can assist in finding an appropriate location for testing. The results of your test are usually reported as a T score and Z score. The T score compares your bone density with that of healthy younger adults of the same gender. The Z score compares your bone density with that of other people your age, gender, and race. The World Health Organization has defined the following categories based on bone density in Caucasian women: Normal bone density T-score greater than -1.0 Osteopenia T-score -1.0 to -2.5 Osteoporosis T-score less than -2.5 5

WHAT TREATMENTS ARE AVAILABLE? The goal of osteoporosis treatment is the prevention of bone fractures. This is done by either reducing bone loss or, preferably, by increasing bone density and strength. There is no cure for osteoporosis so prevention is the key to treatment. Osteoporosis treatment combines lifestyle changes (nutrition, exercise, and safety) and medications, if needed. Lifestyle changes include maintaining a healthy diet rich in calcium and vitamin D, quitting smoking, limiting alcohol, and exercising regularly. Your health care provider may also recommend you take calcium and vitamin D supplements. The Food and Drug Administration (FDA) has approved medicines to reduce the risk of broken bones. These medicines either slow or stop bone loss or rebuild bone. People with osteoporosis (T-scores of -2.5 and below) should consider taking an osteoporosis medicine. People with osteopenia (T-scores between -1 and -2.5) should consider taking medication if they have certain risk factors that may increase their chances for fracture. People with a broken hip or broken bones in the spine should also consider taking osteoporosis medicine. Medications approved for the treatment of osteoporosis include: Class and Drug Brand Name Form Frequency Bisphosphonates Alendronate Generic Alendronate and Fosamax Oral (tablet) daily/weekly Alendronate Fosamax Plus D oral (tablet) weekly (with 2,800 IU or 5,600 IU of Vitamin D3) Ibandronate Boniva oral (tablet) monthly Ibandronate Boniva intravenous (IV) injection four times per year Risedronate Actonel oral (tablet) daily/weekly/twice monthly/ monthly Risedronate Actonel with Calcium oral (tablet) weekly Risedronate Atelvia oral (tablet) weekly Zoledronic Acid Reclast intravenous (IV) infusion one time per year/ once every two years Calcitonin Calcitonin Fortical nasal spray daily Calcitonin Miacalcin nasal spray daily Calcitonin Miacalcin Injection varies 6

Medications approved for the treatment of osteoporosis include (continued): Class and Drug Brand Name Form Frequency Estrogen* Estrogen Multiple brands oral (tablet) daily Estrogen Multiple brands transdermal (skin patch) twice weekly/weekly Estrogen agonists/antagonists Also called Selective Estrogen Receptor Modulators (SERMs) Raloxifene Evista oral (tablet) daily Parathyroid Hormone Teriparatide Forteo injection daily RANK ligand (RANKL) inhibitor Denosumab Prolia injection every six months * estrogen is also available in other preparations including a vaginal ring, as a cream, by injection, and as an oral tablet taken sublingually (under the tongue). The vaginal preparations do not provide as much bone protection as the other forms offered. Reprinted with permission from the National Osteoporosis Foundation, Washington, DC 20036. Treatment with Osteoporosis Medication, October 19, 2012. All rights reserved. 7

OSTEOPOROSIS IN MEN Many people think that osteoporosis only affects women. However, one in four men will develop osteoporosis. It affects nearly half of all people, women and men, over the age of 75. Even though bone loss in men usually occurs later in life compared with women, men can still be at high risk for osteoporosis. By age 65, men catch up to women and lose bone mass at the same rate. Osteoporosis often goes unrecognized in men. Emphasis is typically placed on women and, therefore, men often are undiagnosed until a fracture occurs. This makes it even more important for men to discuss their risk factors for osteoporosis with their health care provider, as well as any changes in height or posture, a fracture, or sudden back pain. Increasing awareness is essential for prevention and early identification is critical as there is no cure, only treatments. Risk factors that have been linked to osteoporosis in men include: Regular use of certain medications, such as steroids, antacids, antiseizure medications, cancer therapy, and thyroid hormones Unhealthy lifestyle habits, such as smoking, excessive alcohol use, low calcium intake, and lack of regular exercise Chronic diseases that affect the kidneys, lungs, stomach, or intestines or alter hormone levels Low testosterone Immobilization or prolonged bed rest following surgery, fracture, or illness that can result in significant bone loss Age the older you are, the greater your risk for osteoporosis Race Caucasian men appear to be at particularly high risk, but all men can develop this disease Family history of osteoporosis or broken bones Consider the following steps to decrease your risk for osteoporosis: Get enough calcium and vitamin D. Exercise include weight bearing and muscle strengthening exercises. Consider quitting smoking and limiting alcohol consumption. Talk to your health care provider about your risk factors and chances for getting osteoporosis. Recommended daily allowances of calcium and vitamin D in men include: Under 50 years... 1,000 mg of calcium and 400 to 800 IU of vitamin D 50 to 69 years... 1,000 mg of calcium and 800 to 1,000 IU of vitamin D 70 years and older... 1,200 mg of calcium and 800 to 1,000 IU of vitamin D Once osteoporosis has been diagnosed, your doctor may prescribe medication. Your treatment plan may also include nutrition, exercise, and lifestyle guidelines to prevent further bone loss. Calcium and vitamin D supplementation may be recommended. If osteoporosis is the result of an underlying condition or medication, your health care provider may plan to address these causes. 8

Penn State Hershey Bone and Joint Institute Bone Health Clinic The Bone Health Clinic at Penn State Hershey Bone and Joint Institute provides treatment for patients with metabolic bone disorders and osteoporosis. Edward J. Fox, M.D., director of the bone health clinic, is a boardcertified orthopaedic surgeon with clinical interests in osteoporosis, edward J. fox, m.d. orthopaedic oncologic surgery/ musculoskeletal oncologic surgery, metabolic bone disease treatment, and orthopaedic trauma surgery. To schedule an appointment with Dr. Fox, please call 717-531-5638. Penn State Hershey Bone and Joint Institute Penn State Milton S. Hershey Medical Center East Health Campus 30 Hope Drive, Entrance B P.O. Box 859 Hershey, PA 17033 PennStateHershey.org/osteoporosis Penn State Milton S. Hershey Medical Center CAMPUS MAP 11 24 10 15 BULLFROG VALLEY RD C A M P U S D R I V E L I F E L I O N D R I V E 26 19 16 20 14 18 17 R E S E A R C H B LV D BULLFROG VALLEY RD East Health Campus 1A 30 Hope Drive, Entrance A 1B 30 Hope Drive, Entrance B 2 Hershey Outpatient Surgery Center (15 Hope Dr.) 3 35 Hope Drive 4 Mohler Senior Center (25 Hope Dr.) 5 Academic Support (Patient Billing Office) 5 7 8 A C A D E M I C D R I V E 9 6 U N I V E R S I T Y D R C A M P U S D R I V E 19 12 22 13 C R E S C E N T D R U N I V E R S I T Y D R 23 C A M P U S D R I V E R O U T E 3 2 2 ( G o v e r n o r R d ) S I P E AV E 25 LUCY AVE To HOPE LODGE S A N D H I L L R D 1B C H E R R Y D R H O P E D R Penn State Milton S. Hershey Medical Center campus map (REV 3/21/13) 2 1A 3 4 H O P E D R R O U T E 3 2 2 ( G o v e r n o r R d ) C E N T E R V I E W D R Ronald McDonald House 21 6 Main Entrance 7 Centerview Parking Garage 8 University Physician Center 9 Children s Hospital 10 NMR Research Facility 11 South Annex 12 Cancer Institute 13 North Entrance 14 College of Medicine Entrance 15 Biomedical Research Main Campus TO R O U T E 4 2 2 PATIENT PARKING 16 University Fitness and Conference Center 17 Hershey Center for Applied Research 18 Life Lion Hangar 19 Student Housing 20 West Campus Health & Wellness Center 21 Medical Group-Briarcrest 22 Emergency Entrance 23 Eastmoor Building 24 Long Lane Building 25 Sipe Avenue Building 26 Support Services Building 9

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