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A "Lunch and Learn Seminar" highlighting osteoporosis was held at noon on Monday, May 21, 2012 at Rolling Plains Memorial Hospital, with orthopedic surgeon Dr. Mark Seibel leading the discussion and answering questions of those in attendance.
Osteoporosis is a silent disease which increases in incidence as the population ages. The cost of treatment is increased and while significant long term functional consequences can occur, mortality rates can be increased as well.
Peak bone mass typically occurs by the late 20s and is related to activity and diet in children. Bone mass begins to decrease after the late twenties and significantly drops after menopause. In men, a slow but gradual loss of bone mass has been reported.
Secondary causes that lead to osteoporosis include the thyroid, smoking, alcohol, steroids, kidney disease, diabetes, calcium metabolism and bowel absorptive problems, among others.
Different methods can be used to evaluate the disease, such as bone densitometry, vitamin D levels, general health and the secondary causes of osteoporosis. Treatment can include the addition of Vitamin D, calcium, bisphosphonates, estrogen and calcitonin. The best treatment, however, is prevention.
Vitamin D increases the absorption of calcium in the gut and kidney and is typically available over the counter. Vitamin D-2 is derived from plants, while vitamin D-3 is animal derived. A debate arises when discussing dose, which is determined if dosage will help maintain or catch up.
Those in sunny climates can have Vitamin D deficiency; however, Vitamin D offers other possible benefits toward immunity, cancer, the heart and muscles.
To monitor vitamin D treatment, a blood test is useful. Higher doses are well tolerated over long periods of time, and it is rare to see an overdose or toxicity with the supplement.
Calcium should be taken at the daily dose of 1200 or 1500 milligrams, with the maximum daily dose of 2500 mg. Calcium comes in either the citrate or carbonate form--citrate is better if stomach acid does not pose a problem; carbonate tends to be less expensive. Both are available over the counter.
Bisphosphonates can also be used to treat osteoporosis, such as Actonel, Fosamax, Boniva and Reclast. They can be taken orally by tablet or through an intravenous (IV) injection--which tends to be a more convenient but costlier alternative. Each medicine varies with cost and side effects.
Hormones can also be taken, such as estrogen, calcitonin and a parathyroid hormone.
Dr. Seibel also shared some of the "hidden tolls" regarding osteoporosis, including that the mortality rate following a hip fracture is 20-25% for women and 30-35% for men. Following a hip fracture, men and women will lose around 80% of one level of function.
A vertebral fracture will result in pain or a deformity known as kyphosis, or the curvature of the spine. As a result, a decrease in appetite, pulmonary function and self image could occur.
Other fractures frequently require surgery. Patients who are older or sicker tend to have be greater risk from surgery or anesthesia. Even with a successful surgery, those affected by the disease may still have pain or loss of function.
Though the disease is scary, Dr. Seibel stressed the importance of physical activity--like tai chi for balance--to help ward off problems while still taking calcium or vitamin D medications for osteoporosis.
Door prizes were also given during the lunch, such as free bone density screenings, year-long memberships to the hospital's fitness center and t-shirts.
For more information on osteoporosis, visit the National Osteoporosis Foundation's website at www.nof.org or aaos.org--the website for the American Academy of Orthopedic Surgeons.