Osteoporosis |
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Risk Factors |
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Race (caucasian has greater risk
than African American/Asian), family history, small stature/weight, anorexia,
decreased estrogen levels (I.e. post-menopausal), increased age, female,
smoking, decreased physical activity, low calcium intake, high phosphate diet
(i.e. cola), caffeine use, hyperthyroidism, Cushing's syndrome, rheumatoid
arthritis, medications (aluminum antacids, corticosteroids, furosemide,
phenytoin, synthroid) |
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Diagnosis of Osteoporosis |
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Done by DEXA
(bone) scan: 1-2.5 standard deviations from average - osteopenia |
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2.5 or greater
standard deviations from average - osteoporosis |
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Prevention Guidelines |
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1. Maintain
adequate intake of dietary calcium (from daiy products, etc.) |
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2. Increase
intake of vitamin D (from fortified daily products, cod, or fatty fish) |
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3.
Weight-bearing exercise (walking, etc.) three-five times per week |
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4. Calcium supplementation: 1000-1500mg elemental calcium daily (divided into 500mg per dose). Amount of calcium needed based on patient
demographics: adults over 51 - 1200mg/day, post-menopausal women on estrogen
- 1000mg/day, post-menopausal women or men over 55 - 1500mg/day |
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5. Bisphosphonates (alendronate 5mg/day or 35mg/week;
risidronate 5mg/day or 35mg/week) |
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6. Selective estrogen receptor modulators (SERMs) - can be used
in patients where hormone replacement therapy is contraindicated (ex. Evista
60mg daily) |
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7. Estrogens - not considered first line therapy for prevention
of osteoporosis because of increased risk of breast cancer, heart disease,
stroke, and DVT (premarin 0.625mg/day +/- provera 2.5mg/day (only use provera
if patient has intact uterus)) |
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8. Vitamin D supplementation if
dietary intake inaqequate: 400-800 units/day and/or 15 minutes exposure to
direct sunlight |
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Treatment Guidelines |
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1. Calcium,
vitamin D, and exercise as listed in prevention guidelines above |
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2. Estrogen
therapy as listed above if tolerated |
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3. Bisphosphonates are considered first line agents in the
treatment of osteoporosis (alendronate 10mg/day or 70mg/week; risidronate
5mg/day or 35mg/week) |
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3. Calcitonin is often used as an adjunct treatment for
hypercalcemia or in cases where estrogens or bisphosphonates are
contraindicated (100u/day IM or 200u/day intranasal for osteoporosis; 4-8u/kg
every 12 hours for hypercalcemia).
Adequate vitamin D intake is essential. |
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4. Selective estrogen receptor modulators (SERMs) can be used in
patients who cannot tolerate estrogen therapy or it is contraindicated (ex.
Evista 60mg daily) |
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5. Fall prevention - BP
monitoring for orthostasis, diuretics given in the morning, minimization of
sedating medications (I.e. benadryl) |
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Types of calcium and percent of elemental calcium
contained |
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Type of
calcium |
Percent elemental Ca |
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Acetate |
25% |
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Carbonate |
40% |
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Citrate |
21% |
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Glubionate |
6.50% |
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Gluconate |
9% |
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Lactate |
13% |
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Phosphate
tribasic |
39% |
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Return
to Main Index |
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