Heather Eatson Peterborough & Area Manager Ontario Osteoporosis Strategy Osteoporosis Canada

1. Heather Eatson Peterborough & Area Manager Ontario Osteoporosis Strategy Osteoporosis Canada

2. Ontario Osteoporosis Strategy GOAL: To reduce fractures, morbidity, mortality and costs from osteoporosis… through an integrated and comprehensive approach aimed at health promotion and disease management.

3. Background October 2000: • “A Framework and Strategy for the Prevention and Management of Osteoporosis” May 2002: • “Osteoporosis Action Plan: An Osteoporosis Strategy for Ontario” February 22nd, 2005: • MOHLTC announced the launch of Ontario’s first Osteoporosis Strategy

4. Identification of service gaps • Low public awareness • Inappropriate diagnostic testing • Lack of adequate management • Lack of clinically useful information • Lack of integrated post-fracture care protocols

5. Osteoporosis Strategy: 5 Components Health Promotion 1. Education programs for seniors and children: • Increase seniors knowledge of osteoporosis and improving bone health • Increase bone health education in schools

6. Disease Management 2.Improve the use, and accuracy of bone mineral diagnostic testing (BMD) to increase early diagnosis of osteoporosis 3. Integration of fracture care, rehabilitation and osteoporosis management 4. Improve evidence based practice by Health Professionals 5. Research and evaluation

7. What Is Osteoporosis? “Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.”1 Osteoporosis- (Porous Bone) Normal Bone • 1. Consensus Development Conference, JAMA 2001; 285: 785-95.

8. Osteoporosis is a… potentially crippling disease characterized by low bone mass (density) and deterioration of bone tissue, a condition that can lead to increased bone fragility and risk of fracture- most often at the spine, wrist or hip. Common Fracture Sites

9. Overview on Osteoporosis • Bone loss occurs without symptoms- The Silent Thief • Osteoporosis can result in disfigurement, lowered self-esteem, reduction or loss of mobility, and decreased independence • 1.4 million Canadians live with Osteoporosis • Healthcare costs are estimated to be $1.9 billion each year in Canada

10. Hip fractures Hip fractures related to osteoporosis are a serious problem in older people Approx. 25,000 hip fractures each year in Canada (70% are osteoporosis related) Hip fractures result in death in up to 20% and disability in up to 50% of those who survive

11. Osteoporosis is a major public health issue in Canada • Osteoporosis is diagnosed and treated by a variety of specialists and family physicians • Osteoporotic fracture cases are treated almost exclusively by orthopaedic surgeons

12. The Evidence • The majority of individuals who sustain fragility fractures are not receiving adequate osteoporosis management • Less than 32% of fracture patients are investigated for osteoporosis. Elliot-Gibson et al, 2004

13. Fragility Fractures… “ a fracture caused by injury that would be insufficient to fracture normal bone: the result of reduced compressive and/ or torsional strength of bone ” • Minimal trauma • From standing height, or less WHO, 1998

14. Post- Fracture Care Osteoporosis Screening Coordinators • Increase the rate of referral of fragility fracture patients for assessment and treatment of OP, in order to reduce the risk of re-fracture

15. What does OP Screening Coordinator do? • Identify all men and women 50+ who have suffered a fragility fracture • Assess patient for OP risk factors • Encourage patient to see family physician for further OP assessment • Educate identified patient • Follow up evaluation- 3/6 month

16. Long-Term Outcome Goals • To increase preventive health behaviours in patients who have sustained a fragility fracture. • Lower rates of subsequent fracture in this high-risk patient population, particularly hip fractures. • Lower fragility fracture-related health care costs for the hospital and provincial government.

17. Other Initiatives • Low Volume Fracture Screening • Fracture Fighters – Rehab component • Break Through – Adult Education • Bone Fit – Osteoporosis Fitness Cert.

18. Osteoporosis: An Overview Who Gets Osteoporosis? 1 in 4 women 1 in 8 men

19. How strong are your bones? • Healthy strong bones are critical in preventing fractures. • Bone is renewed through a process in which old bone is removed and replaced by new bone.

20. The Remodeling Process: How Bone Repairs Itself

21. Normal Growth and Development of Bone

22. Four Major Factors that Contribute to Bone Health • Genetics • Hormones • Nutrition • Physical activity

23. Risk Factors • Certain factors appear to play a role in the development of Osteoporosis • These are called “risk factors” • There are both minor and major risk factors

24. Age  65 Vertebral compression fracture Fragility fracture after age 40 Family history of osteoporotic fracture Systemic glucocorticoid use > 3 months Malabsorption syndrome Primary Hyperparathyroidism Propensity to fall Osteopenia apparent on x-ray Hypogonadism Early menopause (before age 45) Diagnosis of Osteoporosis Assessing Your Risk Factors: Major Risk Factors

25. Excess alcohol Excess caffeine Low body weight (<57 kg or 125 lbs) Weight loss > 10% of weight at age 25 Chronic heparin therapy Diagnosis of Osteoporosis Assessing Your Risk Factors: Minor Risk Factors • Rheumatoid Arthritis • History of clinical hyperthyroidism • Chronic anticonvulsant therapy • Low dietary calcium intake • Smoker

26. Review Your Risk Factors with Your Physician • Everyone over the age of 50 should assess their risk factors with their physician. • Those individuals with at least one major or two minor risk factors should have a bone mineral density (BMD) test. • Everyone age 65 and over should have a bone mineral density (BMD) test.

27. Diagnosis of Osteoporosis Bone Densitometry

28. Determining Your 10-year Absolute Fracture Risk • Factors that influence this are: • BMD results • Age • Gender • Fracture history • Family history • Glucocorticoid (steroid) use

29. Goals of Osteoporosis Management • bone loss • Maintain and/or increase bone density • Reduce the risk of fracture(s)

30. Slow bone erosion Bisphosphonates include: Etidronate (Didrocal ) Alendronate (Fosamax, Fosavance ) Risedronate(Actonel ) Zoledronic Acid (Aclasta) SERMs-Raloxifene( Evista) Calcitonin (Miacalcin) Speed up bone building Parathyroid hormone (PTH ) Teriparatide (Forteo) a daily subcutaneous injection for 18 months Drug Therapies

31. Calcium: OC’s Daily Recommended Intake

32. Dairy sources- whole and skim milk products, cheese, yogurt Fortified beverages Fish bones-salmon, sardines Vegs- broccoli, bok choy, kale Eat foods high in Calcium

33. Calcium Content of Some Foods Milk – all 1cup 300mg Yogurt ¾ cup 295mg Cheese-hard 245mg Ice cream ½ cup 80mg Salmon/bones ½ can 240mg Beans,baked ½ cup 75mg Broccoli,cooked ¾ cup 50mg Orange 1 med 50mg

34. Osteoporosis Prevention Calcium Supplements: Questions & Answers • What are they made of? • How do I choose one? • What is the best way to take them? • Which types are recommended?

35. Osteoporosis Prevention Vitamin D: OSC’s Daily Recommended Intake

36. Where to find Vitamin D? • Foods that are a natural source of Vit D – fish oils, eggs, chicken livers, salmon and sardines • Foods fortified with Vit D - milk, margarine, some yogurts, some soy beverages (check labels) • Vit D supplement, Multi vitamin, calcium supplement with Vit D

37. Physical Activity • Regular weight bearing activity • Resistance exercise

38. Weight Bearing Exercise Some examples of weight-bearing physical activities are… • Walking, running, stair climbing, dancing • Games and sports such as badminton, tennis, basketball, volleyball etc

39. Resistance Exercises These involve moving objects or your own weight to create resistance • Common forms of resistance exercise include: • Weight – training with barbells, dumbbells, household objects or wrist weights • Strength training with equipment in a gym or health club

40. Exercise with Caution Check with a physician before starting any exercise program • Don’t do exercise that causes pain • Warm up before exercise and stretch well after exercising • Choose a facility, leader or trainer who knows the exercise restrictions associated with osteoporosis • Choose an activity or program that is enjoyable

41. Living with Osteoporosis Some Movements Should be Avoided

42. Osteoporosis Prevention The Benefits of Being Physically Active • Healthier bones - works with calcium & vitamin D to build strong bones • Better coordination and balance • Improved muscle strength and flexibility • Increased endurance for daily activities • Improved posture

43. Balance & Falls Prevention • 1 in 3 seniors 65+ falls each year • 1 in 2 seniors 80+ falls each year • The fall-related injury is 9x greater in seniors than among those under 65 • Vitamin D has been shown to reduce falls • Exercise has been shown to decrease falls as well as the risk of falls if exercise includes activities aimed at improving balance.

44. Personal costs after a Fall • Pain and suffering • Loss of independence • Increased risk of falling- fall cycle • Falls cause 90% of all hip fractures in seniors • Almost half of all falls occur in/around home

45. The Key Messages for Osteoporosis • Knowing/Assessing your risks • Bone Mineral Density Testing • Medication • Diet – Calcium and Vitamin D • Exercise – Wt Bearing and Resistance Training • Falls and Safety Prevention

46. Osteoporosis Canada • 1-800-463-6842 (English) • 1-800-977-1778 (French) • www.osteoporosis.ca • COPN (Canadian Osteoporosis Patient Network)