Osteoporosis: Prevention and Assessment


Article Categories: Patient Care & Diseases and Conditions

Chances are that every day in your practice, you will encounter several of the more than 54 million Americans that have--or at risk for--osteoporosis. The National Osteoporosis Foundation states that 1 in 2 women and 1 in 4 men over the age of 50 years will break a bone due to osteoporosis....about 2 million broken bones a year!



Osteoporosis is one of the “silent” diseases that can affect anyone. It is more common among white women and elderly people, but there are many other risk factors:

• Autoimmune disorders, including Rheumatoid Arthritis, Lupus, and Multiple Sclerosis
• Digestive conditions, such as Celiac Disease and Crohn’s Disease
• Diabetes
• Premature menopause and missing periods in women
• Low testosterone levels in men
• Eating disorders, malnutrition, weight loss, and gastric bypass surgery
• Cancer, including Leukemia, Lymphoma, Multiple Myeloma, breast, and prostate
• COPD
• Kidney and liver disease
• AIDS/HIV
• Cultural and race disorders, such as Sickle Cell Anemia and Thalassemia

PREVENTION:

The best way to deal with the possibility of osteoporosis is prevention. When talking with patients, discuss how much calcium they are taking in. Food is the best source of calcium, but supplements may be necessary to meet daily requirements. Women under age 50 need 1,000 mg a day; after age 50 they need 1,200 mg a day. Men under age 70 require 1,000 mg a day; after age 70, they need 1,200 mg a day. Two things to remind your patients:

1. Taking calcium with food increases absorption.

2. Take in amounts of 500-600 mg at a time.

The human body needs Vitamin D to absorb calcium. Everyone under age 50 should aim for 400-800 International Units (IU) a day; after age 50, the requirement is 800-1,000 IU daily. Despite the bad rap, sunlight is an excellent source of Vitamin D. Just 10 minutes a few times a week will help the body produce its own Vitamin D.

A balanced diet with dairy or enriched non-dairy foods, fatty fish (salmon, mackerel, tuna, and sardines), and dark green vegetables will support healthy bones. Limits should be placed on alcohol, colas, and caffeine.

Weight-bearing exercises build and maintain bones. Unless they are at risk for a broken bone, encourage your patients to include activities that move the body against gravity, while remaining upright. Examples are:

• High-Impact: Running, hiking, tennis, dancing
• Low-Impact: Elliptical trainers, step machines, walking
• Muscle-Strengthening: Lifting weights, rubber exercise bands, push-ups

Other types of exercise can also improve balance and flexibility. Pilates, yoga, and Tai-Chi can help decrease the chance of falling. Patients with osteoporosis should check with their provider before proceeding, to determine the risk.

ASSESSMENT:

Determining if patients have, or are at risk for, osteoporosis depends on the entire healthcare team. A Medical Assistant can:

• Ensure an accurate height (without shoes) is done every year after age 50
• Assist with ordering and drawing blood tests for calcium levels, thyroid function, parathyroid hormone levels, and 25-hydroxyvitamin D. Men may need a testosterone level.
• Assist with a 24-hour urine calcium measurement by providing instructions
• Educate patients on risk factors such as smoking and alcohol intake
• Schedule bone mineral density scans, x-rays or other diagnostic assessments

While osteoporosis can progress without symptoms, being alert to the risk factors and performing appropriate diagnostic testing can keep patients healthy and independent for many years.

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