From a presentation by: Eric Willoughby, DNP
McLeod Orthopaedics Cheraw
In the 20 years that I’ve been doing orthopedics, I’ve had the opportunity to see thousands of fractures. One of the things that I have not seen consistently is adequate attention toward fracture prevention by focusing on osteoporosis.
Osteoporosis affects about 200 million women worldwide and the most common fractures associated with osteoporosis are fractures of the wrist, of the hip, and of the spine. The biggest concern and the area where we have the most room for improvement in patient morbidity and mortality is in the prevention of hip fractures.
The hip fractures are the real killers. Most people do not realize that one in five people, who sustain a hip fracture will not be alive in a year’s time.
SCREENING
We regularly screen for hypertension, high cholesterol, and diabetes. However, we’re not doing a very good job of screening for osteoporosis. It’s a very easy condition to screen for, using DEXA bone densitometry.
In the years after DEXA bone density studies became reimbursable by Medicare, studies found only about 18% of eligible women underwent screening. While there has been some improvement in screening rates, there is tremendous room for further improvement.
TREATMENTS
Three major treatments for osteoporosis include use of bisphosphonates, available as oral, injectable, or IV treatments to reduce bone resorption and anabolic types of medications that work to build bone.
Bisphosphonate medications are very easy to take. Many formulations are now generic, not very expensive and many types may be taken once a week. They are extremely effective in reducing fracture risk, particularly in the hip and spine. These medications stay in the system for a long time. So, after taking the medications for about five years, patients can go on a drug holiday, and still receive protection.
There are two additional options for the use of bisphosphonate medication. One is an injectable type of a delivery system, which is done every six months, and the other is once a year IV treatment. The injectable option can be given in the Orthopedic/Family Practice clinics and the IV option can be performed through the infusion center and McLeod hospital in Cheraw.
The anabolic or bone building type of medication to treat osteoporosis carries some additional risk including a higher risk of osteosarcoma (bone cancer) and are used in certain cases but much less frequently.
THE ROLE OF CALCIUM
Calcium plays a major role in bone health. 99% of a person’s calcium is stored in their bones and teeth.
When calcium levels in your bloodstream drop, the body starts to steal calcium from your bones, weakening the skeleton and can further weaken bones and lead to decreased bone mineral density. It’s important to maintain calcium supplementation to maintain adequate calcium levels to prevent the leeching calcium from the bones in order to meet your body’s metabolic needs.
In general, women need about 1200 milligrams of calcium supplement a day. If a woman goes into the drug store and picks up their 600 milligram calcium supplementation tablets and takes two of them at a time and think they’re fine they are wrong.
It is important to understand that the body can only absorb 600 milligrams of calcium at a time. So, take one 600 milligram pill in the morning and another in later in the day.
ACTION YOU CAN TAKE
If you’re concerned that osteoporosis or serious fractures may be in your future, see an Orthopedic Specialist, who can conduct appropriate screening and discuss fracture risk reduction strategies.