Category:EIM Student Project 2

Osteoporosis is a disorder in which bones become increasingly porous and brittle leading to increased risk of fracture. Osteoporosis is a major health threat across the globe. In the United States alone, approximately 10 million individuals are estimated to already have the disease and 34 million at increased risk for osteoporosis. Fifty-five percent of Americans over the age of 50 have the disorder.^[1]

Diagnosis:
Bone Mineral Density (BMD) is measured using a central DXA (dual energy x-ray absorptiometry) scan. In most states, a doctor referral is needed for the scan but Medicare does cover the cost every two years. The DXA scan is usually performed on the lumbar spine and the hips and compares the patient’s BMD to that of a healthy 30 year old adult. The difference in densities is called a T-score. According to the World Health Organization (WHO):
• A T-score between +1 and -1 is normal bone density. Examples are 0.8, 0.2 and -0.5.
• A T-score between -1 and -2.5 indicates low bone density or osteopenia. Examples are T-scores of -1.2, -1.6 and -2.1.
• A T-score of -2.5 or lower is a diagnosis of osteoporosis. Examples are T-scores of -2.8, -3.3 and -3.9.
In the clinic, one can administer a FRACTURE index, which is a seven question survey to determine a patients risk of osteoporotic fracture.

File:Fracture index.gif

Risk Factors:
There are many risk factors for osteoporosis some of which include: age, medications, activity level, previous fractures, low sex hormones, and diet. The most widely known risk factors are over the age of 65 years old and previous fracture.

File:Risk factors.gif

Management:
Effective prevention measures include a holistic approach in which pharmacological and non-pharmacological interventions are combined. There are two primary classes of osteoporosis medications—antiresorptive and anabolic agents. Antiresorptive agents include bisphosphonates, calcitonin, and estrogen therapies. The only anabolic agent that is FDA-approved is Teriparatide (recombinant parathyroid hormone [1-34]).^[2]
Non-pharmacological interventions include: fracture and fall risk education, diet and nutrition counseling, physical activity/ physical therapy, and lifestyle adjustments. Physical activity has been shown to decrease fracture risk. In a study by Feskanich et al, active walking women had 55% lower risk of hip fracture than sedentary women.^[3] In Michaëlsson and colleagues' study, in an estimation of population-attributable risk, 33% of fractures in men could be prevented by participation in recreational sports, heavy gardening, or other activities with similar intensity performed for at least three hours per week.^[4]

References:

www.nof.org

Gronholz MJ. Prevention, diagnosis, and management of osteoporosis-related fracture: a multifactoral osteopathic approach. J Am Osteopath Assoc. 2008 Oct;108(10):575-85.

Feskanich D, Willett W, Colditz G. Walking and leisure-time activity and risk of hip fracture in postmenopausal women. JAMA. 2002;288:2300–2306.

Michaëlsson K, Olofsson H, Jensevik K, Larsson S, Mallmin H, et al. Leisure physical activity and the risk of fracture in men. e199PLoS Med. 2007;4 doi: 10.1371/journal.pmed.0040199.