Advertisement

Advertisement

osteoporosis

After the Fall: The ABCs of Fracture Prevention

After the Fall: The ABCs of Fracture Prevention

Teaser: 

Susan B. Jaglal, PhD, Toronto Rehabilitation Institute Chair, Associate Professor, Faculty of Medicine, Department of Physical Therapy, University of Toronto, Toronto, ON.

A wrist fracture is associated with an increased risk of another fracture and should prompt investigation for osteoporosis in both men and women. If the fracture was caused by low trauma (a fall from a standing height or less), a bone density test should be ordered. If the T score is <–1.5, pharmacological treatment with a bisphosphonate and calcium (1,500 mg/d) and vitamin D3 (≥800 IU/d) is recommended. Management should also include balance, posture, and muscle-strengthening exercises and walking, as well as a review of fall-prevention strategies.
Key words: wrist fracture, osteoporosis, diagnosis, treatment, exercise, falls.

Vertebral Compression Fractures Among Older Adults

Vertebral Compression Fractures Among Older Adults

Teaser: 

Simona Abid, MD, FRCP(C), Geriatric Medicine Fellow, McMaster University, Hamilton, ON.
Alexandra Papaioannou, MD, FRCP(C) MSc, Professor, Department of Medicine, Division of Geriatric Medicine, McMaster University, Hamilton, ON.

Vertebral compression fractures (VCF) are the hallmark of osteoporosis, yet two-thirds of all VCF remain undiagnosed and untreated. Both symptomatic and occult VCF are associated with considerable increases in morbidity and mortality, hospitalization rates, admissions to long-term care, and health care-related costs. These fractures increase the risk of future osteoporotic fractures, both vertebral and nonvertebral, independent of bone mineral density. Older adults have lower rates of diagnosis and treatment compared with younger patients, although clinical studies have shown the efficacy and safety of currently available therapies for osteoporosis in older adults are comparable with those in younger individuals.
Key words: vertebral compression fractures, osteoporosis, bone mineral density, antiresorptive therapy, anabolic agents.

New Pharmacotherapy for Osteoporosis

New Pharmacotherapy for Osteoporosis

Teaser: 

Savannah Cardew, MD, FRCP(C), Osteoporosis Program, University Health Network and Mount Sinai Hospital, University of Toronto, Toronto, ON.

Successful management of osteoporosis includes nonpharmacologic and pharmacologic strategies, aimed at fracture prevention. First-line therapies include oral bisphosphonates, an intravenous bisphosphonate (zoledronic acid) that is administered once yearly, the selective estrogen receptor modulator raloxifene and parathyroid hormone. Other selective estrogen receptor modulators are being investigated as potential therapies. Strontium ranelate and denosumab each have a unique mechanism of action and may eventually be available in Canada for the management of osteoporosis. In this article the aforementioned therapies will be reviewed with an emphasis on their efficacy in preventing fractures.
Key words: osteoporosis, osteoporotic fractures, zoledronic acid, parathyroid hormone, raloxifene.

Osteoporosis Screening and Assessment of Fracture Risk

Osteoporosis Screening and Assessment of Fracture Risk

Teaser: 


Mohammed O. Rahman, BHSc student, McMaster University, Hamilton, ON.
Aliya Khan, MD, FRCPC, FACP, FACE, Professor of Clinical Medicine, McMaster University, Hamilton, ON, Director, Calcium Disorders Clinic, St. Joseph’s Healthcare, Hamilton; Director, Oakville Bone Center, Oakville, ON.

Osteoporosis is a skeletal disease characterized by impaired bone strength and an increased risk of fragility fracture. Effective screening should be aimed at evaluating risk factors for osteoporosis with identification of individuals at risk, allowing for intervention prior to fragility fracture. This article presents an overview of the risk factors for fracture in men and women and the integration of these factors in various models, enabling an assessment of the 10-year fracture risk. Through effective screening, early identification, and early intervention with pharmacological therapy of osteoporosis, significant impact can be made on reducing fragility fracture incidence, thereby alleviating the economic and clinical costs to our health care system.
Key words: osteoporosis, screening, risk factors, diagnosis, FRAX.

Osteoporosis Fracture Prevention in Long-Term Care

Osteoporosis Fracture Prevention in Long-Term Care

Teaser: 


Cathy R. Kessenich, DSN, ARNP, Professor of Nursing, University of Tampa, Tampa, FL, USA.
Darlene A. Higgs, RN, BSN, Nurse Practitioner Student, University of Tampa, Tampa, FL, USA.

Osteoporosis is a major cause of health problems in residents of long-term care facilities. It often results in bone fracture, causing poor quality of life and a national financial burden. As the population ages, the incidence of osteoporosis and its consequences increase. It is essential to employ fracture-prevention strategies that have proven most beneficial in long-term care settings and those tailored to promote adherence among older adults. This article reviews osteoporotic treatment appropriate for individuals in long-term care, including treatment through pharmacology, nutritional support, fall prevention, and hip fracture prevention.
Key words: osteoporosis, long-term care, hip protectors, fall prevention, vitamin D.

Continuing the Effort to Improve Outcomes||in Osteoporosis among Aging Adults

Continuing the Effort to Improve Outcomes||in Osteoporosis among Aging Adults

Teaser: 

Since our last issue focusing on osteoporosis, much has changed and yet much stays the same. We have new Canadian guidelines on the detection and management of osteoporosis, several new treatment modalities, and a better understanding of osteoporosis in men. However, many people with osteoporotic fractures are not identified and managed, many people do not stay on effective treatment, and falls prevention programs are rarely available for appropriate older adults. In other words, we have a long way to go before we can say we are dramatically ameliorating the morbidity that osteoporosis causes. Hopefully, this edition of Geriatrics & Aging will do its part to promote the effective diagnosis and management of this important disorder.

Two articles tackle the important issue of diagnosing osteoporosis and determining who is at particular risk for complications. Dr. Angela Juby and Dr. David Hanley review “Diagnostic Tools for Osteoporosis in Older Adults” while Dr. Aliya Khan and Mohammed Rahman discuss one of the key issues in their article “Osteoporosis Screening and Assessment of Fracture Risk.” In our CME article, Dr. Savannah Cardew reviews “New Pharmacotherapy for Osteoporosis.” Our final focus article concentrates on a group at high risk of having osteoporosis and not being treated. Cathy Kessenich and Darlene Higgs review “Osteoporosis Fracture Prevention in Long Term Care.”

We also have our usual collection of key geriatric topics. My colleague, Dr. M. Bachir Tazkarji reviews the important area of “Blood Pressure and Cardiovascular Risk among Older Adults.” Dr. Ekaterina Rogaeva reviews an area of intense research scrutiny in her article on “The Genetic Profile of Alzheimer’s Disease: Updates and Considerations.” Dr. Sophie Robichaud and Dr. Joseph Blondeau address a common problem in their article “Urinary Tract Infections in Older Adults: Current Issues.” Educating students, residents, and even ourselves in proper medical care of the older adult has been a tremendous challenge so any improvements offered via technology are much appreciated. In their article, Drs. Anita Bagri, Bernard Roos, and Jorge Ruiz discuss “Simulation Technology in Geriatric Education.” And our Sexual Health column, written by Drs. Irwin Kuzmarov and Jerald Bain of our partner organization the Canadian Society for the Study of the Aging Male, looks at the important matter of "Sexuality and the Aging Couple, Part I: The Aging Woman."

Enjoy this issue,
Barry Goldlist

POWER in Osteoporosis: Descriptive Review of a Multidisciplinary Community-Based Prevention and Management Program

POWER in Osteoporosis: Descriptive Review of a Multidisciplinary Community-Based Prevention and Management Program

Teaser: 


Michael Gordon, MD, MSc, FRCPC, FRCP Edin, Medical Program Director, Palliative Care Baycrest Geriatric Health Care System; Professor of Medicine, University of Toronto, Toronto, ON.
Kayi Li, BHSc, medical student, University of Toronto, Toronto, ON.

Osteoporosis is a systemic disease resulting in bone fragility and increased risk of fractures. For optimal prevention, the literature increasingly supports the combined use of education on nutrition, lifestyle, and exercise. Currently, multidisciplinary, multimodal initiatives are rarely implemented in the community. The POWER (Promoting Osteoporosis Wellness through Education, Exercise and Resources) program in Toronto, Ontario, strives to empower individuals with osteoporosis with diverse cultural backgrounds to sustain healthy behaviours for self-management of their condition. This article provides a description of the POWER program philosophy, as well as a preliminary evaluation to assess its benefits and potential for further expansion and adaptation.
Key words: osteoporosis, management program, cultural differences, education, health beliefs.

Bone Densitometry among Older Men: Indications and Interpretation

Bone Densitometry among Older Men: Indications and Interpretation

Teaser: 

John T. Schousboe, MD, MS, Park Nicollet Osteoporosis Center, Park Nicollet Health Services, Division of Health Policy and Management, School of Public Health, University of Minnesota, Minneapolis, MN, USA.

Fractures related to osteoporosis are increasingly recognized as a serious public health problem among older men. As in women, bone densitometry has substantial utility to aid in the identification of older men at high risk of fracture and for whom fracture prevention therapies are indicated. This article briefly reviews the epidemiology of osteoporosis and associated fractures in men, the association of bone mineral density with fractures in men, indications for bone densitometry among older men, and the interpretation of bone mineral density test results in men.
Key words: osteoporosis, bone mineral density, densitometry, men, fractures.

Use of Calcium or Calcium in Combination with Vitamin D Supplementation to Prevent Fractures and Bone Loss in People Aged 50 Years and Older

Use of Calcium or Calcium in Combination with Vitamin D Supplementation to Prevent Fractures and Bone Loss in People Aged 50 Years and Older

Teaser: 

With osteoporosis fractures increasing in prevalence worldwide, the prevention of fractures has become a major economic and social burden. In addition, nations with poorer health care systems in Asia, Africa, and Latin America are facing aging populations, making the development of affordable preventative therapy especially important.

Supplemental calcium, either alone or in combination with Vitamin D, has been suggested as an inexpensive treatment for the prevention of osteoporotic bone loss and fractures. Data from clinical trials have resulted in inconsistent results regarding the efficacy of this treatment in preventing bone loss and fracture. Tang et al. have synthesized a meta-analysis of randomized trials in which calcium, or calcium in combination with vitamin D, was used to prevent osteoporotic fracture and bone loss in adults over 50 years of age in an effort to offer a comprehensive review of all the relevant evidence.1

Their findings supported the use of calcium and vitamin D supplementation. When data were pooled, it was revealed that supplementation had resulted in a reduction of 12% in bone fractures of all types (risk ratio 0.88, 95% CI 0.83-0.95; p=0.0004), and a 0.54% decrease in bone mineral density loss (0.35-0.73; p<0.0001) at the hip and 1.19% (0.76-1.61%; p<0.0001) in the spine.

The authors conclude that the evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, as preventative therapy for osteoporosis in adults over 50 years of age. In addition, they suggest a minimum dosage of 1200 mg for calcium and 800 IU of vitamin D for optimal therapeutic effect.

Reference

  1. Tang BM, Eslick GD, Nowson C, et al. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet 2007;370:657-66.

Care of the Menopausal Woman: Beyond Symptom Relief

Care of the Menopausal Woman: Beyond Symptom Relief

Teaser: 

Lynne T. Shuster, MD, Women’s Health Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Sharonne N. Hayes, MD, Women’s Heart Clinic, Department of Internal Medicine, Mayo Clinic College of Medicine, Rochester, MN, USA.
Mary L. Marnach, MD, Women’s Heart Clinic, Department of Gynecology, Mayo Clinic College of Medicine, Rochester, MN, USA.
Virginia M. Miller, PhD, Departments of Surgery and Physiology and Biomedical Enginering and Office of Women’s Health, Mayo Clinic College of Medicine, Rochester,MN,USA.

Women in the Western world may expect to spend a significant portion of their lives in postmenopause. After menopause, women are at increasing risk for several conditions associated with aging that may or may not be related to declining hormone levels. Caring for women seeking advice and treatment for menopausal concerns presents a golden opportunity to not only identify individuals at risk for early intervention but also to address prevention and screening strategies important to sustaining health.
Keywords: cancer, cardiovascular disease, menopause, osteoporosis, screening.