Osteoporosis Treatment - " Mary a 60-year-old woman"

Case study ( 17806 views as of February 25, 2017 )

Mary, a 60-year-old woman, was seen in the office for Osteoporosis treatment. She had a recent bone density test as she was concerned about having stopped HRT and the risk to her bones. Her BMD was lower than normal and according to Osteoporosis Guidelines; she was assessed as being at moderate risk. Since at that level, she may or may not be treated; further history was needed.

Had she fallen more than twice in the last year? Did she fracture any bones (other than face and fingers) since age 40 from a less than traumatic incident? What drugs, if any, is she taking on a regular basis? Has she lost height? These are important issues to discuss with her doctor for osteoporosis treatment . Your pharmacist can review your medication and alert you to any drugs that affect bone. Your dietitian can help you increase your calcium-containing foods. And your physiotherapist or trainer can help you focus on the correct exercise to maintain good posture and decrease the risk of falling. Whether or not specific medication is needed depends on many variables and you need to control the lifestyle options to prevent deterioration.

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Conversation based on: Osteoporosis Treatment - " Mary a 60-year-old woman"

Osteoporosis Treatment - " Mary a 60-year-old woman"

  • Thanks Dr. Miller for pointing out how pharmacists can be of help to people with osteoporosis or interested in prevention of fracture (who are not diagnosed) with osteoporosis. Besides helping with drug related concerns, pharmacists can assist in determining the need and best choice of over the counter supplements and vitamins. There are many different types of calcium and vitamin D on the market now. Depending on what patients are also taking with respect to medications and other conditions, a particular calcium salt may be preferred and would be absorbed better. People who do not take 1200mg of elemental calcium per day from their diet (usually requires multiple servings of dairy products daily and/or calcium fortified foods), a calcium supplement to provide sufficient calcium to the body to keep bones health and help minimize the risk of fractures is needed. Vitamin D is necessary to help the calcium get from the digestive system to the circulation and bones. With the current weather in winter, it may not always be possible to get enough sun exposure to produce the amount of Vitamin D needed and Vitamin D supplements are necessary. A reasonable approach is to take 800IU to 1000IU of Vitamin D all year round to ensure sufficient levels of Vitamin D in the body, speak to your pharmacist or dietician about these essential elements and what is right for you.
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  • A pharmacists can review your medications and osteoporosis treatment to ensure they are optimal and identify if any drug related concerns exist as well as help with any over the counter vitamin supplements to identify a calcium supplement (if it is needed) that is a good fit with your preferences and needs.
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  • It is important to maintain a regular exercise program which is tailored to your abilities and needs. To help prevent fractures with osteoporosis, a person should optimize their stability to avoid falls.
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  • The important thing to think about in regards to Osteoporosis is that movement and conversations with your doctor are key.
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    • A physiotherapist or physical therapist can help with advice and recommendations on optimal exercises.
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    • This can include exercise which strengthen the body as well as those which help improve balance.
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    • As mentioned, it is important to maintain a regular exercise program which is tailored to your abilities and needs. To help prevent fractures with osteoporosis, a person should optimize their stability to avoid falls. This can include exercise which strengthen the body as well as those which help improve balance. Ensure there is enough building block to allow the body to be stronger and improve balance also means that a good balanced diet should also be part of the care plan to prevent fractures due to osteoporosis. Speaking with your team of healthcare providers, identifying which ones can help with what aspect of prevention of fractures and treatment of osteoporosis is useful. For example, a dietician can assist with your diet, making a meal plan to ensure that you not only get enough of all the nutrients you need to help reduce the risk of fractures (eg. getting enough calcium in your diet as well as vitamin D from diet and/or sun exposure), but also enjoy what you eat. A physiotherapist or physical therapist can help with advice and recommendations on optimal exercises. A pharmacists can review your medications and osteoporosis treatment to ensure they are optimal and identify if any drug related concerns exist as well as help with any over the counter vitamin supplements to identify a calcium supplement (if it is needed) that is a good fit with your preferences and needs. Your physician can monitor your overall progress and regularly assess the improvement or progression of the condition over time. Alan Low
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  • As we age, various parts of the body begin to show their signs of wear and tear. The heart and blood vessels often have atherosclerosis or hardening of the arteries. This may not cause symptoms but they exist in almost everyone once they reach the age of 50. These changes may not cause disease in all of us but almost all of us have some effects. Also, the muscles are often weaker, balance is poorer, blood pressure goes up and it is much easier to put on weight. As we age, the risk of specific diseases increases - heart attack and stroke (related to atherosclerosis and calcification), diabetes (due to insulin resistance and obesity), cancer and dementia become more common. Some of us will not be able to avoid these but we can reduce the risk. In fact, reducing the risk of is the key. Is it really possible to reduce the risk? One thing is to exercise. The benefits of exercise are important and diverse. In fact, some experts argue that a sedentary life style is as great a risk factor for heart disease or stroke as is smoking and we know how bad it is in increasing the risk of many age related diseases including cancer, heart disease, stroke and dementia. Exercise is known to help. Exercise has many benefits: it can Strengthen heart and improve your circulation Lower blood pressure Increase energy levels and endurance Improve muscle strength Improve balance and flexibility Strengthen bones Help reduce body fat and help you reach a healthy weight Help reduce stress and anxiety Improve sleep These improvements can make changes in two ways - decreasing the risk of disease and increasing the quality of life while you are alive. Being more flexible, having better balance, reducing life's stresses, having more energy or improving sleep all contribute to quality of life. Quality of life is for many seniors more important than living longer. It is very difficult to when one is weak and frail - difficult for you as well as your family. It is estimated that 20-25% of indls over 65 are in only fair or poor health. So exercise is an important ingredient, one that we have considerable control over, that contributes to both longevity and quality of life.
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    • Speaking with your team of healthcare providers, identifying which ones can help with what aspect of prevention of fractures and treatment of osteoporosis is usefu
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    • My Mother has gotten more unstable after turning 80. Is suspect she should be doing more balance work and seeing a physiotherapist.
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  • The case study mentions increasing calcium-rich foods, which is definitely an important consideration for Mary. It's also important to understand calcium's role in someone Mary's age so her treatment plan can be tailored effectively. Mary's bone mass will have peaked when she was a young adult, and now her bone is naturally broken down more than it is built up. This means that, generally, it's difficult for adults to improve their bone density. Rather, calcium is crucial for bone mass maintenance and preventing further loss. Increasing her intake will no doubt be key for treating Mary's osteoporosis but it should be part of a more comprehensive treatment plan, as others have been discussing.
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  • I am particularly interested in the connection between family history and my own risk for osteoporosis once I reach menopause. My grandmother did end up having osteoporosis and had a very humped back later in life. She did have falls and I remember her breaking her arm quite badly. However, my mother does not seem to be at risk of osteoporosis. Could I still be at risk? Is Osteoporosis genetically linked? Should I consider going for bone density scan at some point when I'm older to get a base line?
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    • @ChantalSayers these are all very good questions and I have similar concerns. I am unable to have dairy and my mother had osteoporosis later in life. I have a number of questions and I find that the answers my doctor gives me change annually.
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  • The use of Hormone Therapy (HT) in the treatment and prevention of osteoporosis remains somewhat controversial. Results from the WHI (Women's Health Initiative) Study show benefits to bone by preventing fractures as well as reducing colorectal cancer, but at an increased risk of cardiovascular events, breast cancer and some blood clots. Many of the negative effects did not occur more frequently in the first 4 to 5 years of HT in the WHI study. HT does help reduce peri-menopausal symptoms and may be used short-term (less than 5 years) with most experts agreeing this is a good situation to use such a therapy. The controversy is around the benefits vs. the risks of HT to prevent and treat osteoporosis when other therapies exist. This is a very personal decision (to take HT or not) and should be a shared-informed decision made with the patient and a healthcare provider well-informed about the evidence and can explain the risks and benefits to a patients so they can make a well-informed choice which respects their personal preferences and concerns. There is data from studies that demonstrate the benefit of HT in both preventing the development of osteoporosis as well as treating osteoporosis to prevent fractures. Some experts may suggest to use HT around the perimenopausal time for women for up to 5 years and then switch to another osteoporosis therapy for people at moderate to high risk of osteoporotic fractures. There are many choices for osteoporosis treatment as well as a range in costs of the therapy and differences in coverage by government payers and private payers. Speak to a well-informed healthcare provider about the choices and which one to start first since the sequence of treatment has been shown to have an impact how beneficial these agents are on the bone.
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    • The results of that study in to the effects of HT on osteoporosis are very interesting. My mother had osteoporosis but there is a very high risk of cancer in my family so I wouldn't think that treatment would be the best choice for me should it be warrented
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    • Thanks for weighing in @Dr. Alan Low! This is a very interesting perspective as I assumed HRT was used as a 'blanket treatment' for menopausal women. It definitely sounds as though an open dialogue with your family doctor or healthcare professional is a good starting point to weigh all of the evidence and determine if it's the right course of treatment given your particular condition.
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  • I would like to hear more about the connection between hormone replacement therapy and osteoporosis. Is this a case where women are given HRT as a preventative measure against osteoporosis, or are they prescribed HRT once they have been diagnosed with osteoporosis as a treatment measure?
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    • Ensure there is enough building block to allow the body to be stronger and improve balance also means that a good balanced diet should also be part of the care plan to prevent fractures due to osteoporosis.
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  • I had a patient with osteoporosis when I was a personal trainer and it was always a challenge to balance progress with pain management. Exercise is a great toll to maintain strength and increase range of motion in the muscle but must always should be balanced with slow steady progress.
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    • With chronic conditions, there is often a need to understand whether the pain a patient is feeling is actually causing damage or if it isn't. Sometimes, people with conditions such as osteoporosis can learn how to safely exercise with proper education about pain management.
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    • I've learned over the years, while recovering from a number of injuries, that sometimes pain isn't a sign to stop exercising. Mild pain can be a good thing because it shows the area is getting strong
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  • @HealthyMama: Undenatured whey protein is pure whey protein that is not processed or modified.
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    • What is the benefit of undenatured whey over denatured whey? Denatured whey seems like it would be absorbed more quickly since it doesn't need to be broken down as extensively.
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  • Thank you Mr. Lieon Kit, gentle pilates offers many health benefits.
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    • There are various moves in pilates that may not be appropriate for someone with osteoporosis. Certain exercises that involve rolling on the spine or rotation of the spine may place too much strain on weakened bones. Also, some of the moves that include extension of the neck or place too much strain on the wrists can be modified for people with osteoporosis. I would strongly encourage anyone with osteoporosis trying pilates to inform the instructor of their condition so the exercises can be modified for them.
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    • You mention gentle pilates. I know that pilates can differ depending on the instructor but are there specific variations for people with medical conditions like osteoporosis ?
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  • Gentle Pilates classes can offer postural support, strengthening, stretching and elongating of core, back and hip muscles, which can be beneficial for those who have osteopenia or osteoporosis. Yoga can also offer these benefits.
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    • Would pilates be a recommended exercise for anyone?
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    • Its a simply as lying on your back and pulling your leg into you chest to loosen you hips and low back. The key if you are suffering from Osteoporosis is to as remain as active as you can and see a qualified physiotherapist for example to keep you motivated and to keep introducing new motions and parameters you can reach for achieving.
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    • Many community centres now have therapy pools where the water is warmer. They run gentle aquarobics programs with people with conditions like osteoporosis
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    • what are some simple stretches / yoga exercises that may help ?
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  • Thank you Dr Leith. Healthy weight loss would certainly help with her joints and overall health.
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  • Poor alignment can be improved with exercises that target muscles important for posture. Muscles that support the upper back include the lat's and low back muscles. Stomach muscle are also important to help with the treatment of Osteoporosis
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    • What sort of exercises would be recommended ?
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    • I think its great that family physicians are looking at things like posture in relation to osteoporosis treatment. posture can have such a good impact on conditions like osteoporosis.
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    • Strength training is very important at all ages and certainly for people suffering Osteoporosis. Seeing a good personal trainer or a physiotherapist is great place to start to getting good information for the treatment of osteoporosis.
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  • The fear of falling is legitimate though, it can be the beginning of the end for some folks.
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