OSTEOPOROSIS

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OSTEOPOROSIS OSTEOARTHRITIS You CAN Do
Something About It!

• Lisa Z. Killinger, DC

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REFERENCE FOR THIS PRESENTATIONGleberzon B,
Killinger LZ. Management considerations for
patients with OA and OP A chiropractic
perspective on whats working. TICC
20029(1)48-60.
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What do we know about OP?

• Now affects 25 million Americans
• 1/3 of women gt 75 are osteoporotic
• 94 of women gt 75 have low bone mass
• 1.5 million OP-related fractures/year
• 700,000 vertebral fx/year 2.5
  standard deviations below the mean of a young
  adult reference popul.

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So, what can WE do?
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Primary Prevention(Prevent OP from ever
happening)

• Counsel pts about diet and physical activity at
  all ages, to maximize bone density in the third
  decade of life and slow the rate of bone loss
  after that.
• Most important factor physical activity!!!!
  (National Osteoporosis Foundation and
  Clinicians Handbook of Preventive Services
  HP2010)

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Secondary Prevention (Early detection)

• 1. Screen all patients OP checklist
• 2. Identify preventable risks
• 3. Get baseline bone mineral density test (Dexa
  scan of the hip is the gold standard)
• 4. Design a prevention plan suited to patients
  risk factors

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BMD testing The DEXA Scan

• Recommended for
• Women with risk factors
• Women who have had a fracture (as an adult)
• Those 65 and older
• Those who are considering OP therapies
• Those who have been on or are starting HRT

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But, what does it all mean?!!

• Normal BD within 1 Standard deviation of a
  young healthy adult
• Low Bone Mass BD is 1-2.5 SD below mean
• Osteoporosis BD is gt2.5 SD below mean
• Your Z score compares your BD to people your
  size, age and gender (careful)

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Tertiary Prevention(Minimizing osteoporosis
impact and disability/slowing progression)

• Employ safe chiro. adjusting strategies
• Fall prevention (IMPORTANT!)
• Keep patients physically active
• Monitor lifestyle and behaviors,
• Encouraging healthy dietary choices
• Supplementation!!

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So, what do we tell our patients?

• Physical activity-Weight bearing (axial loading)
  activities are best
• Stair climbing
• Walking
• Step aerobics
• Jazzercise
• 3 times a week for 15-20 minutes
• Find a friend to be active with!

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Pumping Iron

• Free weights work wonders!
• Focus on lifting weights with muscles that tug
  against the spine (traps, rhomboids, lats, etc)
• Start small and work up to more weight
• Can be done while watching TV, etc.
• Lower body? (Jette, Exercise-Its never too
  late AJPH)

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Later years Fall prevention

• Strengthen lower body
• Proprioceptive training
• Balance/gait focus
• Home safety checklist
• Modify unsafe surroundings
• Assess and monitor meds
• Regular chiropractic care-IMPORTANT!

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Risks for hip fractures/falls

• older age
• history of fx
• low weight
• caffeine intake (gt2 cups coffee/day)
• alcohol use
• lack of walking/exercise
• vision impairment
• meds that have dizziness or bone loss as a side
  effect (steroids, anticonvulsives, BP meds)

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What about nutrition?

• Recommendation 1,200-1,500 mg/day of calcium
  (hard to get in diet)
• Vitamin D400 - 800 IU/day
• Other bone helpers magnesium, boron, Vit C
  (collagen), etc.
• Choosing where the calcium deposits through
  focused physical activities
• Watch out for calcium thieves phosphorus,
  caffeine, alcohol, smoking, oxalic acids, etc.

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But what kind of Calcium?

• Calcium citrate-most easily digested (expensive)
  22 usable Ca/big pills
• Calcium carbonate-needs acidic gastric envir (but
  cheaper!) 40 elemental or usable Ca/smaller
  pills)
• Dairy-yogurt and lowfat milk are the gold
  standard calcium sources (all other sources are
  viewed in comparison to these)

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The Acid Test

• Calcium supplement tablet should dissolve
  completely in a small glass of vinegar in 30
  minutes or less
• Beware of coated, compressed supplements with a
  shelf life of a zillion years!
• Dont take more than 500 mg at a time

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Foods for Calcium

• Yogurt/milk
• Ca fortified Juice
• Fortified cereals
• Acidophillus milk
• Fortified soy milk/cheese, etc
• Canned sardines with bones
• Legumes-soak the phylates out first!

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Calcium Interference

• Oxalates and phylates
• High protein diets (esp. meat-based)
• High sodium diets (causes kidneys to dump Ca)
• Wheat bran-phylate
• High iron intake
• High phosphorus intake
• Alcohol, smoking, etc

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Know the medical options...

• HRT, ERT, etc
• Alendronate (bisphosphonate)-Fosomax-decreases
  osteoclastic activity, arrests bone loss, may
  increase bone density, reduces fractures
  (EXPENSIVE 20/pill)
• Calcitonin-oral or nasal spray (hormone)
  increases bone density in postmenopausal women

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Resources related to OP

• National OP foundation 1(800) 624-BONE or
  www.nof.org
• info on prevention, patient pamphlets (free!),
  bone density tests, research, causes, etc.

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Take Home Messages OP...

• Counsel patients on diet/physical activity
• Screen patients for risks
• Assess bone density and risk factors before
  designing intervention
• Develop prevention/health promotion strategies
  based on patients clinical scenario
• Offer good, safe sound chiropractic care

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Osteoarthritis

• Affects about 50 of all people over 65
• Costs 10,000,000 per year in US
• Leading cause of disability in older adults

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Whats working?(Summary of research on OA)

• Physical activity Best strategy ()
• Adjust Bones that are not aligned degenerate
  faster (animal models, human studies of the knee)
• PT TENS 7 trials () Ultrasound (/-)
• Acupuncture-7 clinical trials ()
• Glucosamine-16 clinical trials (effective and
  safe). 1,500 mg/day in 3 doses ()
• Ginger 1 clinical trial ()

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Medical Interventions

• NSIADS first line of therapy, but
• 0.04 fatality rate
• 2,600 -3,200 deaths annually in US
• 20,000 hospitalizations annually
• 2.74 rate of serious adverse events (GI)
• COX-2 inhibitors interrupts bodys perception of
  pain Celebrex, Vioxx - Hypertension, Renal
  failure

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Stay up on the literature!!This is a growing
area of investigation in an aging population.
Patients come in asking informed questions!