OSTEOPOROSIS REHABILITATION PROGRAM Tricia Orme, R.N. BSc(N) Mary Pack Arthritis Program Victoria i Arthritis i Centre
Objectives Participants will gain an understanding of what Osteoporosis is and how it is treated. There will be a brief review of medications used to treat Osteoporosis. The Victoria Arthritis Centre s Osteoporosis Rehabilitation Program will be discussed. Participants will have an opportunity to ask questions throughout the presentation.
Osteoporosis Means porous bones.. Not a disease of ageing, g, but rather a disease whose symptoms manifest themselves with ageing.. g A silent disease process Effects on Life Quality and Quantity
Risk Factors Genetics Gender Age Peak Bone Mass Prolonged Premenopausal Amenorrhea Physiological Disorders i.e.:arthritis, AS, GI disease Decreased Reproductive hormones in F & M Drug Therapy; Glucocorticoid Drugs Nutrition&Life Style Vitamin i D Deficiency i Low Calcium Intake Caffeine> 5cups/day Alcohol> 2drinks/day Inactivity Smoking
Understanding Bone Density Results- the T-Score 0- normal Bone mass is 10% below normal -1.0 Bone mass is 20% below normal -2.0 and you have osteoporosis -2.5 Below normal
Calcium Supplements Calcium Carbonate and Calcium Citrate Calcium and Cardiac Risk Elemental Ca Consider the source of the Ca Costt Forms: tablets, capsules, chewable, effervescent tablets liquids or candy chews Absorption, side effects and interactions 500mg, max at a time
Nutrients with a Negative Influence on Calcium Metabolism Protein (excess animal Protein) Sodium Caffeine Alcohol ( poor diet deficient in Ca &VitD ) Oxalic Acid, Phytic Acid, Fibre (bind to Ca making it unavailable for absorption ) Phosphorus (excess from soda pop )
Other Nutrients Vitamin D3-800-2000 iu daily fish(fatty), milk, egg yolk, liver, margarine Magnesium Vitamin K
Indications for Treatment - Osteoporosis Medications Osteoporosis- risk of repeat fractures Low BMD- T-score of -2-5 and below To prevent the first fracture Corticosteroid-induced i id i d d osteoporosis FRAX or CARROC
Osteoporosis Medications Bisphosphonates Etidronate (Didrocal or Didronel) Alendronate (Fosamax) Risedronate (Actenel) Zolendronate (Aclasta) Denosumab (Prolia) Calcitonin HRT Raloxifene (Evista) Teripartide Acid (Forteo) synthetic parathyroid hormone
Bisphosphonates p Take on an empty stomach upon arising. Avoid food for 30 minutes. Wash down with large glass of water. Do not lie down until after eating. May not be tolerated in those with upper GI disease.
Pain Management Acute pain related to fractures Chronic Pain related to strain on muscles, tendons and ligaments from postural changes Pain medications RELAXATION STIMULATION DISTRACTION
Achieving Comfort Eat well - ensure adequate Ca++, Vitamin D Get enough sleep Exercise daily Maintain a positive attitude Seek counselling for depression & moodswings Pace yourself and use assistive devices as needed Surround yourself with family and friends
Osteoporosis Rehab Program Nutrition Pain Management and Exercise Knowledge and Improved Quality of Life Medications Fall / Fracture Prevention and Joint Protection of the Spine
Admission to Program (OPRP) Doctor Referral to Arthritis Centre to Osteoporosis Class Osteoporosis Diagnosis or Low Bone Density (Osteopenia) with or without history of fracture Please send BMD results with referral
Practical Information About OPRP Up to 8 clients Held Monthly Seven Sessions Wednesday and Friday from 1:00 to 3:00 1 hour education 1/2 hour exercise Exercises in pool or land based (plinth) Cost $35.00*
The Classes Introduction and pre-class measurements Exercise and Osteoporosis Medication and Nutrition Fall / Fracture Prevention Pain Management Joint Protection of the Spine Community Resources and post class measurements
On-Line Resources http://www.osteoporosis.ca/ http://www.osteoporosis.ca/multimedia/pdf/c AROC.pdf http://www.shef.ac.uk/frax/ http://arthritis.ca/ The Osteoporosis Book, 3 rd Ed, Ellert, G. et al, 2011.
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