Osteoporosis and its Prevention-Osteoporosis is defined as a decrease in bone mass, disruption of bone architecture, and resultant increased risk of fracture. It is common and has significant population impact; osteoporosis leads to more than 1.4 million fractures in the United States each year.
Approximately 800,000 of these fractures occur in the spine and result in pain and immobility. Only 20% to 30% of individuals with fragility fractures (nontraumatic and due to very thin bone) receive appropriate evaluation and treatment. This lack of appropriate detection was the subject of a public health initiative in the 2004Bone Health and Osteoporosis: A Report of the Surgeon General. As with many disease processes, osteoporosis is best managed by prevention. Prevention not only is cost-effective in this disease but also reduces the incidence of pain and suffering due to fracture.
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Approximately 20% of men and women die within 1 year after a hip fracture. The Surgeon General's 2004 report outlined four specific components to guide individuals to better bone health: good nutrition with vitamin supplementation, physical activity, safe environment, and appropriate medical evaluation. Risk factors for osteoporosis include female gender, older age, loss of female hormones (e.g., menopause), Caucasian or Asian race, personal history of fracture, and current smoking. Other contributions to a higher risk of osteoporosis include maternal history of fracture, low body weight (< 127 pounds), and a calcium-deficient diet.
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Calcium and Vitamin D play an important role in bone health. Calcium helps bones to maintain strength, and the average American consumes an insufficient amount of calcium. Three 8-ounce glasses of low-fat milk are recommended daily with a well-balanced diet. Highprotein diets might not provide enough calcium to reach a goal of 1,200 milligrams (mg) per day for the average adult over 50 years of age. There has been no evidence that coral calcium (derived from coral reefs) provides easier absorption than other forms of calcium supplements. Most experts in the field recommend brand-name over-the-counter supplements that can be easily found in most pharmacies. Vitamin D not only is present in the diet but also must be metabolized in the skin into an active form. With age, the ability of skin to synthesize active Vitamin D decreases. Adequate sunlight is necessary for Vitamin D metabolism in the skin. Older persons in long-term care facilities are at increased risk for
Vitamin D deficiency, in part due to low sunlight exposure combined with aging effects on the skin. For most patients, 400 international units (IU) per day of Vitamin D supplement can be used for prevention. Patients with established osteoporosis should take 800 IU/day.
Physical activity has a clear role in fracture prevention. Exercise preserves bone mass and also reduces the risk of falling, helping to prevent fractures. Exercise should focus on muscle strengthening and balance. Evaluation and treatment of balance problems, including therapeutic exercise, is an important component of fracture prevention.
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Screening for osteoporosis helps detect disease before serious problems develop. The diagnosis of osteoporosis is often overlooked in clinical practice. Only a quarter of patients receive bone mineral density tests after hip fractures, and less than a quarter receive any type of treatment. Bone density tests should be performed in women over 65 years of age, women who have lost ovarian function due to surgery or medical conditions, people who take medications that increase the risk of osteoporosis (e.g., corticosteroids, some seizure prevention medications), and anyone who has had a previous fracture not due to trauma. Bone density can be tested using several methods, but the most common approach in practice today is dual energy X-ray absorptiometry (DEXA), which measures bone mass at several important sites, including the spine, wrist, and hip. DEXA is used both for initial detection and for follow-up testing of the effect of treatment. Because DEXA machines vary, it is important to use the same type of machine for follow-up so as to assess changes in bone
density accurately. Osteoporosis can also be seen in men. Men who have a history of fracture, have a history of hypogonadism (low testosterone), or are taking steroids are at increased risk for future fracture.
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