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Prevention and risk factors of osteoporosis

Prevention and risk factors of osteoporosis. Prof.Dr.Selma KARABEY. Osteoporosis is defined as a systemic skeletal disease characterised by low bone mass m icroarchitectural deterioration of bone tissue with a consequent increase in bone fragility susceptibility to fracture.

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Prevention and risk factors of osteoporosis

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  1. Prevention and risk factors of osteoporosis Prof.Dr.Selma KARABEY

  2. Osteoporosisis defined as a systemic skeletal diseasecharacterised by • low bone mass • microarchitecturaldeterioration of bone tissue • with a consequent increasein bone fragility • susceptibility to fracture

  3. Fractures of the hip, vertebrae, and distal radiusare particularly common. • The WHO has defined osteoporosis as bone mineral density more than 2.5 standart deviationsbelow the mean value of peak bone mass in young adults of the same sex.

  4. Scope of the Problem • More than 8.9 million Americans have osteoporosis and an additional42.5 million have low bone density of the hip • About one out ofevery two Caucasian women will experiencean osteoporosis-related fracture at some point in her lifetime, as will approximately one in five men. • Althoughosteoporosis is less frequent in African Americans, those with osteoporosis have the same elevated fracturerisk as Caucasians. National Health and Nutrition Examination Survey III(NHANES III) Wright NC, Looker A, Saag K, Curtis JR, Delzell ES, Randall S, Dawson-Hughes B. The recent prevalenceof osteoporosis and low bone mass based on bone mineral density at the femoral neck or lumbar spinein the United States. Submitted manuscript, 2013. National

  5. Distribution of bone mineral densityin differentagedwomenandtheprevalance of osteoporosis (blue) Kaniset al. J Bone MinerRes 1994; 9:1137-41

  6. Scope of the Problem • Hipfractureincidenceratesarehighestamongwhites in northernEuropeand North America • LoweramongAsiansliving in developedareassuch as Hong Kong andthe United States • StillloweramongHispanicsandBlacks in the United Statesand in South America • Lowest in lessdevelopedareas of Asia (China), as well as in Africa

  7. Age-adjustedincidenceratesper 100 000 of hipfractureamongfemalesandmalesaged 50 yearsandolder in selectedlocalities İnternationalvariation in theincidenceof hipfactures:cross-nationalproject on osteoporosisforthe WHO Program forResearch on Aging, Osteoporosisİnternational , Schwartz A.V.,Kelsey J.L., Maggi S et al.1999,9,242-253

  8. Scope of the Problem • The remaining lifetimeprobability in women, at menopause, of a fracture atany one of these sites the spine, hip, distal forearm proximal humerus exceeds that of breast cancer (approximately12 %), • the likelihood of a fracture at any ofthese sites is 40 % or more inWestern Europe,a figure close to the probability of coronary heart disease

  9. European guidance for the diagnosis and managementof osteoporosis in postmenopausal women, J. A. Kanis & E. V. McCloskey & H. Johansson, Osteoporos Int (2013) 24:23–57

  10. Medical Impact • Hip fractures are associated with a 8.4 to 36 percent excess mortality within one year, with a higher mortalityin men than in women; • hip fractures are followed by a 2.5-fold increased risk of futurefractures.(1) • Approximately 20 percent of hip fracture patients require long-term nursing home care, • only 40percent fully regain their pre-fracture level of independence.(2) • 1)B. Abrahamsen, vanStaa T, ArielyR, Olson M, Cooper C. Excessmortalityfollowinghipfracture: a systematicepidemiologicalreview. OsteoporosInt. 2009; 20:(10):1633–1650. • 2)Colón-Emeric C, Kuchibhatla M, Pieper C, et al. Thecontribution of hipfractureto risk of subsequentfracture: Data fromtwolongitudinalstudies. OsteoporosInt. 2003;(14):879-883.

  11. Medical Impact Vertebral fractures, whether clinically apparent orsilent, are major predictors of future fracture risk, • up to 5-fold for subsequent vertebral fracture • 2- to 3-fold for fractures at other sites. • 1)US Department of Health and Human Services. Bone Health and Osteoporosis: A Report of the SurgeonGeneral. Rockville, MD: 2004.US Department of Health and Human Services, Office of the SurgeonGeneral; 2004.

  12. Ten year probability of a hip fracture inwomen fromdifferent Europeancountries. BMI set to 24 kg/m2

  13. In Turkey, osteopenia has been identified in the half of the adults. • Osteoporosis has been identified one in fourof adults. • In Turkey, the rate of hip fractures has increased over the years. MEDOS (1995) 3.3/10000 FRACTURK(2012) 13.24/10000 • Hip fractures are more common in urban areas. • Hip fractures are lower in physically active individuals.

  14. Economic Toll • Collectively,all osteoporotic fractures account for 2.7 millionfractures in men and women in Europe at a direct cost(2006) of €36 billion. • A more recent estimate (for2010) calculated the direct costs at €29 billion in the fivelargest EU countries (France, Germany, Italy, Spain andUK) and • €38.7 billion in the 27 EU countries • European guidance for the diagnosis and management of osteoporosis in postmenopausal women, J. A. Kanis & E. V. McCloskey & H. Johansson, Osteoporos Int (2013) 24:23–57

  15. BASIC PATHOPHYSIOLOGY

  16. Risk Factors

  17. PREVENTION AND MANAGEMENTOFOSTEOPOROSIS,Report of aWHO Scientific Group, 2003

  18. European guidance for the diagnosis and management of osteoporosis in postmenopausal women, J. A. Kanis & E. V. McCloskey & H. Johansson, Osteoporos Int (2013) 24:23–57

  19. Uncontrollable Risk Factors •Being over age 50. •Being female. (White andAsian) •Menopause. •Family history of osteoporosis. •Low body weight/being small and thin. •Broken bones or height loss.

  20. Controllable Risk Factors •Not getting enough calcium and vitamin D. •Not eating enough fruits and vegetables. •Getting too much protein, sodium and caffeine. •Having an inactive lifestyle. •Smoking. •Drinking too much alcohol. •Loosing weight.

  21. Types of osteoporosis

  22. Type 1 or postmenopausal osteoporosis • Occurs in 5% to 20% of women, • affecting those within 15 to 20 years of menopause, • with a peak incidence in the 60s and early 70s. • The incidence in women is eight times higher than that in men. • The frequency of postmenopausal osteoporosis accounts for the overall female-male ratio of 2:1 to 3:1.

  23. Type 1 or postmenopausal osteoporosis • Estrogen deficiency is thought to underlie this form of osteoporosis, • rendering the skeleton more sensitive to parathyroid hormone (PTH), • resulting in increased calcium resorption from bone • This in turn decreases PTH secretion, 1,25-dihydroxyvitamin D production, and calcium absorption • ultimately causes loss of trabecular bone, • leading to vertebral crush fractures and Colles' fractures.

  24. Type 2 or senile osteoporosis • Occurs in women or men more than 70 years of age • usually is associated with decreased bone formation along with decreased ability of the kidney to produce 1,25(OH)2D3.

  25. Type 2 or senile osteoporosis • The vitamin D deficiency results in decreased calcium absorption, • which increases the PTH level and therefore bone resorption. • In type 2 osteoporosis, cortical and trabecular bone is lost, • primarily leading to increased risk of hip, long bone, and vertebral fractures

  26. Type 3 or secondary osteoporosis • Occurs equally in men and women and at any age. • In men, most cases are due to disease or to drug therapy, • but in 30% to 45% of affected individuals no cause can be identified • Secondary osteoporosis accounts for about 40% of the total number of osteoporotic fractures seen by a physician

  27. Diagnosis

  28. The diagnosis of osteoporosis is established • bymeasurement of BMD or • by the occurrence of adulthoodhip or • vertebral fracture in the absence of major trauma (such as a motor vehicle accident or multiplestory fall).

  29. Prevention • an adequate intake of calcium and vitamin D, • lifelong participation in regular weight-bearing andmuscle-strengthening exercise, • cessation of tobacco use, identification and treatment of alcoholism, and • treatment of other risk factors for fracture such as impaired vision.

  30. Calcium Supplementation • The recommended daily calcium intake is 1,500 mg for postmenopausal women and 1,000 mg for pre-menopausal women. • However, recent study has shown that supplementation of 800 mg of calcium daily may prevent bone loss in post-menopausal women

  31. Calcium Supplementation • the results of clinical trials also suggest that such supplementation may prevent hip and vertebral fractures in the elderly • The combination of calcium (1.2 g/day) with vitamin D3 (800 IU/day) has been reported to prevent fractures in elderly women.

  32. World Osteoporosis Day • World Osteoporosis Day was launched on 20 October 1996 by the United Kingdom's National Osteoporosis Society and supported by European Commission. • Since 1997, the day has been organized by IOF⃰. • In 1998 and 1999, the World Health Organization acted as co-sponsor of World Osteoporosis Day.

  33. Since 1999, World Osteoporosis Day campaigns have featured a specific theme: • 1999 Early Detection • 2000 Building Bone Health • 2001 Bone Development in Youth • 2002 Osteoporosis in the Workplace • 2003 Quality of Life • 2004 Osteoporosis in Men • 2005 Exercise • 2006 Nutrition • 2007 Risk Factors • 2008 Advocate for Policy Change • 2009 Advocate for Policy Change • 2010 Signs and Symptoms of Spinal Fractures • 2011 3 Steps to Unbreakable Bones: Vitamin D, Calcium and Exercise • 2012 Stop at One: Make Your First Break Your Last • 2013 Postmenopausal women and their bone health

  34. ‘School Milk’ Programs in the World • In more than 80 countries around the worldthe School Milk project was implemented, in different periods. • Netherlands, Denmark, Czech Republic, China, Portugal and Sweden are the most successful of them.

  35. ‘School Milk’ Programs in the World • EU:26 countries - except Greece and Croatia- joined the program conducted by the European Dairy Association, between the years 2011-12 in EU. • 312 thousand 700 tons of milk consumed by 20 million 358 thousand children. • China:School Milk Programme launched by the government in 2000. • 18 million students drank milk every day at school in 2012. Program has beenextendedto28 states, 660 cities and 60 thousand schools.

  36. ‘School Milk’ Programs in Turkey • 7 million 200 thousand 144 million cans of milk were distributed to students32 thousand 500 schools in Turkey ,in 2011-2012 Academic Year. • 296 million cans of milk were distributed to 6 million 172 thousand 692 master classes and elementary school studentsin Turkey, in 2012-2013 Acedemic Year. • From 10 February 2014, 303 million boxes,in reliable, 200 mL healthy packaging, fat, plain UHT milk will be distributed to 6 million 330 thousand 215 students,3 days a week (Monday, Wednesday, Friday)

  37. References and Web Sources • Clinician’s Guideto Preventionand TreatmentofOsteoporosis, 2013 Issue, Version 3Released February 25, 2014,National Osteoporosis Foundation (NOF). • http://nof.org/files/nof/public/content/file/2237/upload/878.pdf • Oxford Textbook of Public Health, Musculoskeletal Diseases,Roger Detels, Robert Beaglehole, Mary Ann Lnsang, Martin Gulliford,2009, vol 3, • Ostoporozun Kontrolü ve Önlenmesi için Yapılan Uygulamalar,Yrd. Doç. Dr. Nurcan Yabancı • http://www.beslenme.gov.tr/content/files/yayinlar/sunumlar/sut_ve_osteoporoz/osteorozunkontrolu_nurcan.pdf • European guidance for the diagnosis and management of osteoporosis in postmenopausal women, J. A. Kanis & E. V. McCloskey & H. Johansson, Osteoporos Int (2013) 24:23–57 • PREVENTION AND MANAGEMENT OF OSTEOPOROSIS,Report of a WHO Scientific Group, 2003 • http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf

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