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Osteoporosis Treatment

Case study ( 30234 views as of November 17, 2024 )

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

Osteoporosis Treatment

  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 28 April 2023
    The risk of fracture is the serious event in osteoporosis, because fractures cause tremendous disability for patients. For example, if a women has a hip fracture, she has a one in five, or approximately 23% chance, of dying within the next couple of years.
    Reply to: Osteoporosis Treatment
    • Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh
      Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh Pharmacist, Vancouver, BC 07 June 2023 BioPro Biologics Pharmacy Vancouver
      If we are looking at what's happening in our population, in Canada, 1 in 3 women will suffer an osteoporotic fracture in their lifetime and it is only a little less in men at 1 in 5. Those who survive a hip fracture, 17% will go to a long-term care facility because they cannot return to living at home. The best thing to do is to discuss with your healthcare provider and identify your risk of fracture. If it is deemed to be high, you should take actions to reduce your risk, this may include ensuring an adequate calcium intake, vitamin D, regular weight-bearing exercise, and in higher risk situations or if you have had an osteoporotic fracture already, to begin prescription medications which help to preserve and strengthen bone to reduce the fracture risk.
  • Dr. Duncan Miller MD
    Dr. Duncan Miller MD Family Doctor, Vancouver, BC 13 December 2019 Broadway Plaza Family Practice Vancouver
    A fracture or “bone attack” is similar to a heart attack in that it is a serious event which could mean future complications from osteoporosis. A Fragility Fracture occurs when a fall from standing height or less results in a fracture. Our bodies should be able to sustain a fall from this height without a fracture unless there is an underlying cause that makes the bones fragile. You should talk to your doctor about other tests or treatments after a fragility fracture
    Reply to: Osteoporosis Treatment
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 14 April 2022
      Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 14 April 2022
      Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 14 April 2022
      Back pain causes include injury or activity, arthritis, back strain, sciatica, poor posture, aging and scoliosis.
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
      Symptoms of rheumatoid arthritis include joint pain, swelling and stiffness. At first, rheumatoid arthritis usually only attacks a few joints, but over time it affects more.
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 06 December 2019
    Osteoporosis is a bone disease that occurs when the body loses too much bone, makes too little bone, or both. As a result, bones become weak and may break from a fall or, in serious cases, from sneezing or minor bumps. Osteoporosis means “porous bone.” Viewed under a microscope, healthy bone looks like a honeycomb.
    Reply to: Osteoporosis Treatment
  • Dr. Richard Bebb MD, ABIM, FRCPC
    Dr. Richard Bebb MD, ABIM, FRCPC Endocrinologist, Victoria, BC 14 May 2019
    Repeated muscle contractions (tightening) until the muscle becomes tired. Strengthening exercises for the upper body are especially helpful for people with COPD, as they help increase the strength of your respiratory muscles.
    Reply to: Osteoporosis Treatment
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 14 April 2022
      In most cases, back pain will resolve on its own with treatment at home and over-the-counter medications. Some patients benefit from spinal traction, a physiotherapy technique that applies a longitudinal stretch to the reachable joints and soft tissues that is commonly used on the cervical, lumbar spine and thoracic spine. Surgery is not usually recommended.
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
      Unlike some other types of arthritis, the chronic swelling from rheumatoid arthritis can cause permanent damage to the joints.
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 25 April 2019
    Talking to your doctor about Osteoporosis is a great start to getting control of the disease.
    Reply to: Osteoporosis Treatment
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 09 January 2019
    If you have sleep apnea, you're much more likely to have high blood pressure, diabetes, a heart attack, stroke or an irregular heart beat. This can effect your osteoporosis
    Reply to: Osteoporosis Treatment
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 03 December 2018
    Lots of good questions and answers
    Reply to: Osteoporosis Treatment
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 13 April 2022
      Rheumatoid arthritis treatments include disease modifying anti-rheumatic drugs (DMARDs) and biologics (medications produced from living organisms or components of living organisms). Other medication options include nonsteroidal anti-inflammatory medications (NSAIDs) and analgesics (painkillers).
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 03 May 2018
    Doctors understand that taking medications on a regular basis can be very challenging and a fact of life. Simply speaking to your doctor, getting advice can be really important as a first step to reducing the risk of complications from osteoporosis.
    Reply to: Osteoporosis Treatment
  • stephaniebarron
    stephaniebarron 06 February 2018
    My mother is Alzheimer patient, she is also suffering from Osteoporosis. My sister while looking for medical treatment concluded that such patients need extra care for health. As we both are working we are thinking to take help from senior care professionals ( http://jchcorp.org/memory-care-morris-county-nj ) suggested by our relative. What will be your suggestion for our mother's health.
    Reply to: Osteoporosis Treatment
  • Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh
    Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh Pharmacist, Vancouver, BC 21 February 2017 BioPro Biologics Pharmacy Vancouver
    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.
    Reply to: Osteoporosis Treatment
  • Dr. Duncan Miller MD
    Dr. Duncan Miller MD Family Doctor, Vancouver, BC 20 February 2017 Broadway Plaza Family Practice Vancouver
    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.
    Reply to: Osteoporosis Treatment
  • Dr. John Wade MD, FRCPC
    Dr. John Wade MD, FRCPC Rheumatologist, Vancouver, BC 20 February 2017 Artus Health Centre
    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.
    Reply to: Osteoporosis Treatment
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 09 September 2016
    The important thing to think about in regards to Osteoporosis is that movement and conversations with your doctor are key.
    Reply to: Osteoporosis Treatment
    • Dr. Grant Lum MD, CCFP, Dip Sport Med
      Dr. Grant Lum MD, CCFP, Dip Sport Med Sports Medicine Physician, Richmond Hill, ON 20 February 2017 Athletic Edge Sports Medicine
      A physiotherapist or physical therapist can help with advice and recommendations on optimal exercises.
    • Dr. John Wade MD, FRCPC
      Dr. John Wade MD, FRCPC Rheumatologist, Vancouver, BC 20 February 2017 Artus Health Centre
      This can include exercise which strengthen the body as well as those which help improve balance.
    • Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh
      Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh Pharmacist, Vancouver, BC 12 September 2016 BioPro Biologics Pharmacy Vancouver
      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
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 30 June 2016
    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.
    Reply to: Osteoporosis Treatment
    • Dr. Grant Lum MD, CCFP, Dip Sport Med
      Dr. Grant Lum MD, CCFP, Dip Sport Med Sports Medicine Physician, Richmond Hill, ON 20 February 2017 Athletic Edge Sports Medicine
      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
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 24 November 2016
      My Mother has gotten more unstable after turning 80. Is suspect she should be doing more balance work and seeing a physiotherapist.
  • AllieS
    AllieS 04 June 2016
    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.
    Reply to: Osteoporosis Treatment
  • Chantal Sayers
    Chantal Sayers Vancouver, BC 22 December 2015
    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?
    Reply to: Osteoporosis Treatment
    • K. Michael
      K. Michael 08 March 2016
      @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.
  • Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh
    Dr. Alan Low BSC (Pharm), PharmD, ACPR, FCSHP, CCD, RPh Pharmacist, Vancouver, BC 20 October 2015 BioPro Biologics Pharmacy Vancouver
    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.
    Reply to: Osteoporosis Treatment
    • K. Michael
      K. Michael 11 January 2016
      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
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 21 October 2015
      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.
  • Michelle Kaarto, BScK, CSEP CEP
    Michelle Kaarto, BScK, CSEP CEP 20 October 2015
    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?
    Reply to: Osteoporosis Treatment
    • Dr. John Wade MD, FRCPC
      Dr. John Wade MD, FRCPC Rheumatologist, Vancouver, BC 20 February 2017 Artus Health Centre
      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.
  • Mr. Jackson Sayers BSc.,
    Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 06 October 2015
    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.
    Reply to: Osteoporosis Treatment
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 12 November 2015
      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.
    • K. Michael
      K. Michael 09 November 2015
      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
  • Lisa Cantkier BA, BEd, CHN
    Lisa Cantkier BA, BEd, CHN Holistic Nutritional Consultant, Toronto, ON 22 September 2015
    @HealthyMama: Undenatured whey protein is pure whey protein that is not processed or modified.
    Reply to: Osteoporosis Treatment
    • AllieS
      AllieS 13 February 2016
      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.
  • Lisa Cantkier BA, BEd, CHN
    Lisa Cantkier BA, BEd, CHN Holistic Nutritional Consultant, Toronto, ON 18 September 2015
    Thank you Mr. Lieon Kit, gentle pilates offers many health benefits.
    Reply to: Osteoporosis Treatment
    • Michelle Kaarto, BScK, CSEP CEP
      Michelle Kaarto, BScK, CSEP CEP 20 October 2015
      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.
    • K. Michael
      K. Michael 14 October 2015
      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 ?
  • Lisa Cantkier BA, BEd, CHN
    Lisa Cantkier BA, BEd, CHN Holistic Nutritional Consultant, Toronto, ON 25 June 2015
    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.
    Reply to: Osteoporosis Treatment
    • Healthymama
      Healthymama 22 September 2015
      Would pilates be a recommended exercise for anyone?
    • Mr. Jackson Sayers BSc.,
      Mr. Jackson Sayers BSc., Kinesiologist, Vancouver, BC 26 August 2015
      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.
    • K. Michael
      K. Michael 26 August 2015
      Many community centres now have therapy pools where the water is warmer. They run gentle aquarobics programs with people with conditions like osteoporosis
    • ShirleyG
      ShirleyG 23 August 2015
      what are some simple stretches / yoga exercises that may help ?

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