Primary Prevention

of Osteoporosis and
Bone Health

Michael Zanovec, CDT

Research Associate
LSU School of Human Ecology
 Overview

 Osteoporosis is a skeletal disorder

characterized by:
 Compromised bone strength
 Reflects bone density and bone quality

 Increased susceptibility to fractures

 Overview
Normal bone

Osteoporosis causes
weak bones.

In this common
disease, bones lose Osteoporotic bone
minerals like calcium.

They become fragile

and break easily.

3
Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:
What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
 Risk Factors

 Female
 White/Caucasian
 Post menopausal woman
 Older adult
 Small body size
 Eating a diet low in calcium/vitamin D
 Physically inactive
 Female athlete triad
 Osteoporosis Prevalence

 44 million Americans are at risk

 10 million Americans have the disease
 ~ 80% are women
 ~ 20% of Caucasians
 ~ 5% of African Americans

Bone Health and Osteoporosis: A Report of the Surgeon

General, 2004
Osteoporosis can strike at any age!

It is a myth that
osteoporosis is only
a problem for older
women.
 The “Silent Disease”

 Bone loss occurs

without symptoms.

 A fracture may be
the first sign.

 Collapsed vertebrae
may cause pain,
loss of height, or
spinal deformities.
 The 3 most
common breaks in
weak bones are in
the:
1. hip
2. spine
3. wrist

Source: The 2004 Surgeon General’s Report on Bone Health and8 Osteoporosis:
What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
Hip fractures
account for
300,000
hospitalizations
annually.
People who break a hip
might not recover for
months or even years.

Source: The 2004 Surgeon General’s Report on Bone Health and9 Osteoporosis:
What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
1 in 5 people with
a hip fracture end
up in a nursing
home within a
year.

Some people never walk again.

Source: The 2004 Surgeon General’s Report on Bone Health and Osteoporosis:
10
What It Means to You at http://www.surgeongeneral.gov/library/bonehealth
 A woman’s hip
fracture risk
equals her
combined risk of
breast, uterine
and ovarian
cancer.

11
Source: National Osteoporosis Foundation Web site; retrieved July 2005 at http://www.nof.org
 Burden of Bone Disease

Economic cost - Estimated direct expenditures

(hospitals and nursing homes) for osteoporotic
and associated fractures:
 $17 billion in 2001
 $47 million each day

Cost to the individual – osteoporosis causes

frailty and reduced functional capacity
Bones are living organs
 Calcium is deposited and
withdrawn from bones daily.

 Bones build to about age 30.

 We need to build up a
healthy bone account while
young and continue to
make deposits with age.
 Types of Bone

 Cortical bone
 Lining or “bark”

 Trabecular bone
 Structure
 “trab
trab”” meaning beams
or timber
 Spongy
 Bone composition

 Cortical bone accounts for 80% of

skeletal body mass
 1/3 radius region of forearm: 100%
 Femoral neck: 75%

 Cancellous bone accounts for 20% of

skeletal body mass
 Spine: 66%
 Os calcis (heel): 95%
 Healthy Bones

“Bone strength reflects the

integration of two main features:
bone density and bone quality.”
quality.”
NIH Consensus Development Panel. JAMA 2001:285:785
2001:285:785--795.
 Evaluation of Bone Health

 Bone Density
Dual-Energy X-
Dual- X-ray Absorptiometry (DXA) –
“gold standard” for detecting osteoporosis

 Bone Quality
Quantitative Ultrasound (QUS) – measures
physical properties of bone
 Bone Density

DXA Apparatus
 Full-Size Table Models
Full-
 Peripheral DXA Devices
DXA BMD Reports
BMD T-score Risk Assessment
The World Health Organization
classifications for white women
 Normal
T-score greater than –1.0

 Osteopenia
T-score between –1 and –2.5

 Osteoporosis
T-score below –2.5
 24

Fracture Risk Doubles

With Every SD Decrease in BMD
35
30
25
Relative
Risk 20

for 15
Fracture 10
5
0
-5.0 -4.0 -3.0 -2.0 -1.0 0.0 1.0
Bone Density (T-score)
 Quantitative Ultrasound
 Peripheral site (usually the
calcaneus; ~95% trabecular bone)
 Assesses without ionizing radiation
 Portable
 Less expensive
 Relatively new technology in the
US
 Approved by the FDA Center for Devices
and Radiological Health (Achilles Express)
in 1999.
 DOES NOT MEASURE BONE DENSITY!
 Why the heel?

 Considered the best peripheral

site for fracture risk
assessment
 Easily accessible
 Metabolically active bone
 High trabecular content (~90%)
 Weight--bearing like the spine &
Weight
femur
 Allows early detection and
intervention
 Bone Characteristics in Terms of
Ultrasound Velocity and Attenuation

 Measurements of Bone
Quality:
1. Speed of Sound (SOS)
 Bone elasticity and density

2. Broadband Ultrasound
Attenuation (BUA)
 Trabecular density, spacing,
and orientation
 Stiffness Index

Stiffness Index = BUA + SOS

SI = (0.67*BUA + 0.28*SOS)-
0.28*SOS)- 420)

Clinical measure with a lower precision

error than either variable alone
 Stiffness Index T-score
QUS printout
DXA printout

What’s this person’s T-score?

Comparison of DXA and QUS

BUA and DXA measurements

are significant and independent
predictors of hip fracture

Fracture Risk/1000 women

+ DXA & + BUA = 2.7

+ DXA & - BUA = 6.2
- DXA & + BUA = 11.8
- DXA & - BUA = 19.6

+ = score above the mean

- = score below the mean

Hans et al, Lancet, 1996

 Conclusions

 Bone health is a product of both bone

density and bone quality.

 Quantitative ultrasound appears to be a

effective bone quality screening tool.

 Quantitative ultrasound appears to be a

better screening tool for African
American women than for Caucasian
females.
Nutrition and Osteoporosis
 Build Your Bones!
 The amount of bone tissue
can continue to grow until
approximately 30 years of
age.

 At that point, bones reach

their maximum strength and
density, known as peak bone
mass.

 Attainment of peak bone mass

is one of the most important
strategies for preventing
osteoporosis.
 3 Keys to Bone Health

1. Weight bearing physical

activity

2. Calcium

3. Vitamin D
 Exercise for Bone Health

 Weight bearing physical activity

 Make your bones and muscles work
against gravity with jogging, walking, stair
climbing, dancing, and soccer.

 Resistance
 Build your muscular strength with weight
lifting
 Exercise for Bone Health

 Moderate intensity exercise at least 30

minutes most days of the week to
maintain health.

 Moderate intensity activity 60 minutes most

days of the week to maintain weight and
prevent future weight gain.

U. S. Dietary Guidelines 2005

 Eat Right for Bone Health
 Calcium – DRI Adequate Intake (AI)
 1,000 mg/day for men and women 19-
19-50 yrs of age
 1,200 mg/day for men and women 51 and older

 Vitamin D
 200 IU/day for men and women 19-
19-50 yrs of age
 (Sunshine 10-
10-15 min/day during the summer months)
 400 IU/day for men and women 51
51--70 yrs of age
 600 IU/day for men and women > 70 years of age

 Fruits and vegetables (U. S. Dietary Guidelines, 2005)

 2 cups/day (4 servings) of fruits
 2.5 cups/day (5 servings) of vegetables
 Keys to Bone Health

 Be physically active
 Eat a well-
well-balanced diet rich in calcium
and vitamin D
 Get plenty of sunshine
 Don’t smoke
 If you drink alcohol do so in
moderation