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OSTEOPOROSIS & OSTEOARTHRITIS You CAN Do Something About It!

OSTEOPOROSIS & OSTEOARTHRITIS You CAN Do Something About It!. Lisa Z. Killinger, DC. REFERENCE FOR THIS PRESENTATION: Gleberzon B, Killinger LZ. “Management considerations for patients with OA and OP: A chiropractic perspective on what’s working.” TICC 2002;9(1):48-60. .

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OSTEOPOROSIS & OSTEOARTHRITIS You CAN Do Something About It!

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  1. OSTEOPOROSIS & OSTEOARTHRITISYou CAN Do Something About It! Lisa Z. Killinger, DC

  2. REFERENCE FOR THIS PRESENTATION:Gleberzon B, Killinger LZ. “Management considerations for patients with OA and OP: A chiropractic perspective on what’s working.” TICC 2002;9(1):48-60.

  3. What do we know about OP? • Now affects 25 million Americans • 1/3 of women > 75 are osteoporotic* • 94% of women > 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.

  4. So, what can WE do?

  5. 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 Clinician’s Handbook of Preventive Services HP2010)

  6. 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 patient’s risk factors

  7. 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

  8. 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 >2.5 SD below mean • Your Z score = compares your BD to people your size, age and gender (careful)

  9. 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!!

  10. 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!

  11. 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-It’s never too late; AJPH)

  12. 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!

  13. Risks for hip fractures/falls • older age • history of fx • low weight • caffeine intake (>2 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)

  14. What about nutrition? • Recommendation =1,200-1,500 mg/day of calcium (hard to get in diet) • Vitamin D=400 - 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.

  15. 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)

  16. 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! • Don’t take more than 500 mg at a time

  17. 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!

  18. 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

  19. 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

  20. 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.

  21. 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 patient’s clinical scenario • Offer good, safe & sound chiropractic care

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

  23. What’s 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 (+)

  24. 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 body’s perception of pain: Celebrex, Vioxx - Hypertension, Renal failure

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

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