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Louise Harder

on 13 October 2015

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Transcript of Osteoporosis

Louise Harder, Ashley Makedonsky,
and Michael Mowbray

Background Information
Osteoporosis - A skeletal disorder characterized by low bone mineral density (BMD) and abnormal bone architecture leading to fractures
Common fracture sites are vertebrae, proximal femur, and distal forearm
Diagnosed as BMD less than or equal to −2.5 or the presence of a fragility fracture
Health Promotion Techniques
Wellness Program
(Golob and Laya, 2015)
Fractures - Vertebral, proximal femur, and distal forearm
Falls are responsible for 90% of hip fractures
Fractures are the 6th leading cause of death in patients >65
(NOF, 2015)
(Madureira, 2006)
Unable to reciprocate the help
Unable to move around in the same way as others
Needing a caregiver for many tasks
Have to give up physically demanding recreational hobbies
Too anxious, sad, or depressed to go out with others
(Gold, 1996)
Fear of fractures
Poor self-esteem
Obsessive-compulsive behaviors
(Gold, 1996)
Limited movement might force a person to quit his or her job
Unable to perform basic housekeeping tasks
(Gold, 1996)
Normal Bone Cycle
Imbalence of osteoblasts and osteoclasts
Changes in trabecular bone mass
Calcium regulating hormones
Decrease in growth hormones (glucocorticoids or thyroid)
Estrogen deficiency
Cytokines and lymphokines
Abnormal collagen
White, Mexican American, and Asian Post-Menopausal Women
In 2011, there were ~ 2 million fractures from osteoporosis in the US
Estimated that 9.9 million Americans currently have osteoporosis
Prevalence is expected to rise
(Golob and Laya, 2015)
(Raisz, 1988)
(Looker et al., 2012)
(Looker et al., 2012)
(Looker et al., 2012)
Risk Factors
(Golob and Laya, 2015)
Does Not Affect
Does Not Affect
American Academy of Orthopeaedic Surgeons (2014, April) Osteoporosis Starts Early. Available at: http://orthoinfo.aaos.org/topic.cfm?topic=a00330 Accessed on October 6, 2015.

Ali, N. S., & Twibell, R. K. (1995). Health promotion and osteoporosis prevention among postmenopausal women. Preventive Medicine, 24(5), 528-534.

Bad news for bones: Calcium supplements don't help in old age (2015, October 5) National Wellness Institute. Available at: http://www.nationalwellness.org/blogpost/921482/228360/Bad-News-for-Bones--Calcium-Supplements-Don-t-Help-in-Old-Age Accessed on October 7, 2015.

Berarducci, A. (2001). Osteoporosis: Clinical issues, detection and treatment strategies. A continuing education self-study program for nurses and nurse practitioners. Tampa, FL: Florida Osteoporosis Board.

Berarducci, A. (2004). Osteoporosis education: a health-promotion mandate for nurses. Orthopaedic nursing, 23(2), 118-120.

Gold, D. T., (1996, March) The clinical impact of vertebral fractures: Quality of life in women with osteoporosis. Bone 18(3), S185–S189. doi: 10.1016/8756-3282(95)00500-5

Golob, A. L. and Laya, M. B. (2015, May 1) Osteoporosis: Screening, prevention, and management. The Medical Clinics of North America 99(3), 587-606. doi: 10.1016/j.mcna.2015.01.010

Howe, T. E et al. (2011, July 6) Exercise for preventing and treating osteoporosis in postmenopausal women. The Cochrane Library. DOI: 10.1002/14651858.CD000333.pub2

Live With Osteoporosis (2015) Managing & treating Osteoporosis. National Osteoporosis Foundation. Available at: http://nof.org/live Accessed on October 6, 2015.

Looker, A. C., Borrud, L. G., Dawson-Hughes, B., Shepherd, J. A. and Wright, N. C. (2012, April) Osteoporosis or low bone mass at the femur neck or
lumbar spine in older adults: United States, 2005–2008. NCHS Data Brief 93, 1-8.

Madureira, M. M., Takayama, L., Gallinaro, A. L., Caparbo, V. F., Costa, R. A. and Pereira R. M. R. (2007, April) Balance training program is highly effective in improving functional status and reducing the risk of falls in elderly women with osteoporosis: A randomized controlled trial. Osteoporosis International 18(4), 419-425. doi: 10.1007/s00198-006-0252-5

Martin, J. T., Coviak, C. P., Gendler, P., Kim, K. K., Cooper, K., & Rodrigues-Fisher, L. (2004). Female adolescents' knowledge of bone health promotion behaviors and osteoporosis risk factors. Orthopaedic Nursing, 23(4), 235-244.

Mayo Clinic (2014, December 13) Diseases and Conditions: Osteoporosis. Available at:
http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/prevention/con-20019924 Accesed on October 6, 2015.

National Osteoporosis Foundation. (1997). Women delay osteoporosis diagnosis because they confuse bone-thinning disease with arthritis. Newsline for Nurse Practitioners, 3, 14-15.

Raisz, L. G., (1988, March 31) Local and systematic factors in the pathogenesis of osteoporosis. The New England Journal of Medicine 318(13), 818-828.
Increase Awareness
Health care professionals must educate those
who may be at risk for developing osteoporosis.


Treatment Options:
Drake, Clarke, & Lewiecki (2015)
Nonpharmocologic interventions
Limiting risks of falls
Proper lifting techniques
Adequate nutrient intake
Weight-bearing physical activity
Improve or maintain balance and posture
Appropriate lifestyle changes
No smoking, moderate alcohol intake, adjusting diet to meet adequate nutrients
Pharmological interventions
61% increase in bone volume
22% in bone wall thickness
Exercise Interventions
Stress or mechanically load bones
Bones are living tissue
Strength training combined with weight-bearing exercises are more beneficial than low impact exercises
Strength training for upper limbs, weight-bearing for back, hips, and spine
Exercise examples: thai chi, walking, aerobics, strength training
Based on postemnopausal women and exercise (Howe et al., 2011):
BMD at the spine:
Exercising: 0.85% less bone loss compared to those not exercising
Combination of exercise types: 3.2% less bone loss, compared to no exercise
BMD at the hip:
strength training 1.03% less bone loss than no exercise
Reveal exercise alone will improve bone density slightly
Starts with mother's diet during pregnancy
American Academy of Orthopeaedic Surgeons (2014) recommendation for calcium intake:
Boys and girls: 1,000mg/day
Not meeting this requirement
Best to start young
Weight bearing to meet maximal bone strength
Female athletes eating too little could cause amenorrhea
Lack of estrogen during teen years could cause bone loss
Adequate calcium, vitamin D, regular exercise: Mayo Clinic (2014)
Calcium sources:
Dark leafy greens, canned salmon, sardines with bones, soy products (tofu), calcium-fortified cereals and orange juice
Vitamin D:
Absorption of calcium
Will always be beneficial, best results when starting younger
Combination of strength training and weight-bearing exercises
Low impact not as helpful
Swimming, cycling
Mineral necessary for life.

Builds and maintains bone structure.

99% is in our bones and teeth.

Calcium is lost through skin, nails, etc.

Body cant produce new calcium.

Can come from certain sources or supplements.
(Berarducci, 2001)
(Berarducci, 2004)
(NOF, 2015)
Vitamin D
Not just milk
Produce Serving Size Estimated Calcium*
Collard greens, frozen 8 oz 360 mg
Broccoli rabe 8 oz 200 mg
Kale, frozen 8 oz 180 mg
Soy Beans, green, boiled 8 oz 175 mg
Bok Choy, cooked, boiled 8 oz 160 mg
Seafood Serving Size Estimated Calcium*
Sardines, canned with bones 3 oz 325 mg
Salmon, canned with bones 3 oz 180 mg
Shrimp, canned 3 oz 125 mg
Dairy Serving Size Estimated Calcium*
Ricotta, part-skim 4 oz 335 mg
Yogurt, plain, low-fat 6 oz 310 mg
Milk, skim, low-fat, whole 8 oz 300 mg
Yogurt with fruit, low-fat 6 oz 260 mg
Mozzarella, part-skim 1 oz 210 mg
Cheddar 1 oz 205 mg
Yogurt, Greek 6 oz 200 mg
Fortified Food Serving Size Estimated Calcium*
Almond milk, rice milk or soy milk, fortified 8 oz 300 mg
Orange juice and other fruit juices, fortified 8 oz 300 mg
Tofu, prepared with calcium 4 oz 205 mg
Waffle, frozen, fortified 2 pieces 200 mg
Other Serving Size Estimated Calcium*
Mac & cheese, frozen 1 package 325 mg
Pizza, cheese, frozen 1 serving 115 mg

(NOF, 2015)
Comes from 3 main sources:
1. Sun
2. food
3. Supplements
How much?
People at risk for low vitamin D
Individuals are unaware of the risks associated.
Individuals are uninformed on preventative measure or strategies.
Individuals don't engage in preventative measures or strategies.
Knowledge based study on osteoporosis risk factors
(Martin et al., 2004)
(NOF, 2015)
How much?
Weight bearing, weightlifting, aerobics.
Osteoporosis preventive behaviors (OPBs) study
(Ali and Twibell, 1995)
High prevelance of osteoporosis and expectations to rise
Expected already have osteoporosis 9.9 million
Behavior changes would easily decrease risk
Diet modification, physical activity, cessation of smoking
Increase awareness and education
Example: prevelance
Example: other sources of calcium, behavior risk factors
Difference between having knowledge compared to utilizing and understanding knowledge
Start teaching at a young age and become and advocate for behavior change throughout life
Knowing prevention techniques and treatment options
Weight bearing versus low impact
Non pharmacological versus drug therapy
Full transcript