OsteoporosisOsteoporosis

Dr. Lauren PhillipsDr. Lauren Phillips

Sugar Land Women’s HealthSugar Land Women’s Health

Osteoporosis- What is Osteoporosis- What is it?it? A common disorder resulting A common disorder resulting

in low bone mass, skeletal in low bone mass, skeletal fragility, and an increased risk fragility, and an increased risk of fractureof fracture

15% of women over 50 have 15% of women over 50 have osteoporosisosteoporosis

1.3 million fractures per year 1.3 million fractures per year in the USin the US

Bone RemodelingBone Remodeling

OsteoblastsOsteoblasts- bone forming cells- bone forming cells OsteoclastsOsteoclasts- bone destroying cells- bone destroying cells These cells must cooperate to These cells must cooperate to

maintain adequate bone metabolismmaintain adequate bone metabolism Regulated by calcium, vitamin D, Regulated by calcium, vitamin D,

estrogen, calcitonin, PTH, and estrogen, calcitonin, PTH, and inflammatory markers called inflammatory markers called cytokinescytokines

Who is at risk?Who is at risk?

Postmenopausal women Postmenopausal women Previous fracture Previous fracture Long-term steroid therapy Long-term steroid therapy Low body weight (less than 58 kg [127 lb]) Low body weight (less than 58 kg [127 lb]) Family historyFamily history Cigarette smoking Cigarette smoking Excess alcohol intakeExcess alcohol intake Premature or surgical menopause, Premature or surgical menopause,

malabsorption, chronic liver disease, malabsorption, chronic liver disease, inflammatory bowel disease inflammatory bowel disease

Caucasian or Asian ethnicityCaucasian or Asian ethnicity

Screening for Screening for osteoporosisosteoporosis Bone density testing: Bone density testing:

Dual energy x ray absorpiometry (DXA)-Dual energy x ray absorpiometry (DXA)- most useful and reliable test for measuring most useful and reliable test for measuring BMD (bone mineral density). It’s a special BMD (bone mineral density). It’s a special type of x ray that gives off little radiationtype of x ray that gives off little radiation. .

Who should get Who should get screened?screened? All women age greater than 65All women age greater than 65 Postmenopausal women with one or Postmenopausal women with one or

more risk factorsmore risk factors No consensus regarding frequency of No consensus regarding frequency of

screening; most practitioners make screening; most practitioners make individual recommendations for individual recommendations for patients based on age and risk factorspatients based on age and risk factors

Typically every 2-5 years after Typically every 2-5 years after menopause or yearly if severely menopause or yearly if severely osteopenic or osteoporoticosteopenic or osteoporotic

Measuring bone Measuring bone mineral densitymineral density T score:T score: the standard deviation (SD) the standard deviation (SD)

difference between a patient's BMD difference between a patient's BMD and that of a young-adult reference and that of a young-adult reference population population

Z score:Z score: a comparison of the patient's a comparison of the patient's BMD to an age-matched population BMD to an age-matched population (less than -2.0 is abnormal)(less than -2.0 is abnormal)

Diagnosing osteopenia Diagnosing osteopenia and osteoporosisand osteoporosis Measure T scores at spine and hipMeasure T scores at spine and hip

T score values:T score values:- +1 to -1: normal bone density+1 to -1: normal bone density- -1 to -2.5: -1 to -2.5: osteopeniaosteopenia- -2.5 and lower: -2.5 and lower: osteoporosisosteoporosis

TreatmentTreatment

All postmenopausal women with a history of All postmenopausal women with a history of vertebral or hip fracturevertebral or hip fracture

Women with a T score of less than -2.5 Women with a T score of less than -2.5 (osteoporosis)(osteoporosis)

T-score between -1.0 and -2.5 T-score between -1.0 and -2.5 (osteopenia)(osteopenia) with high risk of fracture such as with high risk of fracture such as glucocorticoid use or total immobilization.glucocorticoid use or total immobilization.

Osteopenia plus a 10-year probability of hip Osteopenia plus a 10-year probability of hip fracture ≥3 % or a 10-year probability of any fracture ≥3 % or a 10-year probability of any major osteoporosis-related fracture ≥20% major osteoporosis-related fracture ≥20% based upon the WHO algorithm.based upon the WHO algorithm.

www.shef.ac.uk/www.shef.ac.uk/FRAXFRAX

Non pharmacologic Non pharmacologic treatmenttreatment Calcium and vitamin D intake: Calcium and vitamin D intake:

1200 mg/ day calcium and 1200 mg/ day calcium and 800 mg vit D per day800 mg vit D per day

ExerciseExercise: weight bearing : weight bearing exercise for at least 30 min 3 exercise for at least 30 min 3 times a week. times a week.

Smoking cessation Smoking cessation

Non Pharmacalogic Non Pharmacalogic TherapyTherapy Osteostrong.me- a wellness Osteostrong.me- a wellness

center uses a BioDensity device center uses a BioDensity device to build bone mass and promote to build bone mass and promote muscle growthmuscle growth

Weekly visits with improvement Weekly visits with improvement each weekeach week

4-7% increase in BMD after 12 4-7% increase in BMD after 12 monthsmonths

Pharmacologic therapyPharmacologic therapy

Bisphosphates:Bisphosphates: Fosamax, Actonel (taken Fosamax, Actonel (taken weekly) Boniva (taken monthly), Reclast (IV weekly) Boniva (taken monthly), Reclast (IV once yearly) once yearly)

Causes Causes osteclastsosteclasts to undergo apoptosis to undergo apoptosis (cell death)(cell death)

First line therapy- can use safely 5-10 yearsFirst line therapy- can use safely 5-10 years Must take on empty stomach and stay Must take on empty stomach and stay

sitting up for 30 minsitting up for 30 min Side effects typically mild and include GI Side effects typically mild and include GI

upset, flu like symptomsupset, flu like symptoms Osteonecrosis of jaw approx 1/10,000Osteonecrosis of jaw approx 1/10,000

Pharmacolgic therapyPharmacolgic therapy

Raloxifene (Evista):Raloxifene (Evista): a selective a selective estrogen receptor modulator. estrogen receptor modulator.

Increases estrogen absorption in the Increases estrogen absorption in the spine but not other organs. Also spine but not other organs. Also decreases risk of breast cancer and decreases risk of breast cancer and LDL cholesterol, but increases risk of LDL cholesterol, but increases risk of DVT slightlyDVT slightly

Not as efficatious as bisphosphonates Not as efficatious as bisphosphonates or HRT. or HRT.

May increase hot flashesMay increase hot flashes

Pharmacologic Pharmacologic TherapyTherapy HRTHRT- estrogen alone or estrogen plus - estrogen alone or estrogen plus

progesteroneprogesterone EffectiveEffective Due to WHI study in 2002, no longer Due to WHI study in 2002, no longer

used solely for the prevention or used solely for the prevention or treatment of osteoporosis. Exceptions treatment of osteoporosis. Exceptions include women with persistent include women with persistent menopausal symptoms and those who menopausal symptoms and those who cannot tolerate the other drugs. cannot tolerate the other drugs.

Pharmacologic Pharmacologic TherapyTherapy Prolia-Prolia- stops the production of osteoclasts stops the production of osteoclasts Injection twice a yearInjection twice a year Not first lineNot first line Side effects related to injection, Side effects related to injection,

hypocalcemia, infectionshypocalcemia, infections Not for people who have hypocalcemia, Not for people who have hypocalcemia,

malabsorption, kidney problems, have malabsorption, kidney problems, have had thyroid or parathyroid surgeryhad thyroid or parathyroid surgery

Goals of TherapyGoals of Therapy

Introduce/ continue healthy Introduce/ continue healthy lifestyle habitslifestyle habits

Prevent fractures!Prevent fractures! Slow or stop progression of Slow or stop progression of

bone lossbone loss Improve T scoresImprove T scores Re-evaluate every 1-2 yearsRe-evaluate every 1-2 years

Contact informationContact information

Dr. Lauren Phillips Dr. Lauren Phillips

17510 West Grand Parkway South 17510 West Grand Parkway South

Suite 430Suite 430

Sugar Land, TX 77479Sugar Land, TX 77479

713-578-3823713-578-3823

www.obgynassociates.comwww.obgynassociates.com

www.mysugarlandobyn.comwww.mysugarlandobyn.com