Transcript

Things that come to mind when I say osteoporosis.

What do you think of arthritis?

Hollow bones.

What was it?

Brittle bones, fracture, Risk for fracture, fall, rest online.

What do you got?

What comes to mind?

Females, females.

Calcium.

Calcium hormones.

Old ones.

Old ones.

Old ones, Females.

Old females.

Not wrong.

Hormones.

Yes, yes.

Postmenopausal.

Angie.

Fractures.

Fractures, Yep.

High risk for falls.

Yeah, I'm hearing it.

This is, this is, this is what we, this is what we see, all of these things.

So let's, let's bring it all together into a nice little package that you can help confirm your knowledge.

So the pathophysiology, right?

This is a chronic problem.

It's a chronic disease that has to do with the cellular regulation of the bones.

And we will not make it go away again.

That's the chronicity of it.

But we can do interventions to slow it, the process.

We'll talk about that.

When we say osteoporosis, the bone loss is significant, right?

These are significant changes that we're seeing in individuals.

Hollow bones.

I mean, I think you said that.

Yeah, I tend to think of like.

Swiss cheese, right?

Swiss cheese.

If you don't know what I'm talking about when I say Swiss cheese.

Right.

Made in Swiss.

It's got all the little holes in it, right?

Similar, this is similar.

The structure of the bone, it gives it its structure strength is gone, deteriorated.

So as a result, that's how we ended with the fractures, right.

We see what we call fragility fractures, meaning or pathologic fractures is another or silent fractures.

Those are all terms that are used.

And it is such that like we might not even know the person, might not.

Didn't do anything significant.

They bent over to get something below and they heard a pop in their back and they can't, you know, they're just having significant pain.

Sometimes the silent fractures happen.

Well, how about just have like some back pain, but it's not terrible.

And then they go for something else and they get some imaging done and it's like, oh, look here, it looks like you have an old fracture of your spine.

So we tend to see these fractures along the spinal column and the hips, right femur, the head of the femur oftentimes.

Right.

And this is where we come into contact a lot of times with these patients.

For those of us that are working in acute care, long term care in facilities is the result of a fracture.

They fell, they have a fracture and they either have a need of surgery if they're a candidate, or, and, or just needing some Rehab some PT and then they get sent along to the long term care facilities, oftentimes for more rehabbing osteomalacia.

Is bone loss related to lack of vitamin D?

What is the role of vitamin D when we talk about bone health?

Helps to control some healing.

It helps to, it helps the body to use the calcium, absorb the calcium.

Right.

Calcium without vitamin D is not as effective as calcium with vitamin D. Osteopenia is loss of bone mass.

So here we just have some terms and I will, we're going to talk about in a minute the diagnostics for osteoporosis.

And these terms come into play.

Basically tells us about the significance of the disease process.

How bad, if you will, is the echo process.

A bmd, bone mineral density is a key diagnostic marker.

So when we start talking about osteoporosis, preventative measures for osteoporosis, BMD would be something.

It's a great baseline marker.

Just like we say, you know, let's get a CBC on our patients, let's do some kidney functions, some liver functions before we start them on a statin, for example.

Right.

This is very similar to that.

We want a baseline, a bmv, bone mineral density.

And then we're going to start our interventions and we're going to use that as a marker because otherwise there's no way for us to know.

Unless they have a fracture.

Right.

A low BMD means that a patient's at increased risk for fractures.

So we may do some different, offer different types of pharmaceuticals.

We probably are going to do some education around preventative measures.

Falling, pick up the rugs around your house, right?

All that good stuff.

Look at this picture, people, you know, women in particular.

We're gonna lose some height here.

Six inches.

They say up to six inches.

I can say it's my mom.

I said I hug her and I'm like, what happened?

She was big, tall, strong, right.

And now she's this.

So it's true.

It's very true.

Image right to the right show.

Build a normal spine.

Here we are today, work on your posture, be strong, all these things.

At age 40 we start to see changes moving into the six years, 60 and 70 in particular.

Again, like I said there, the six inches in height can result in a so called Gallagher's hump.

You can see that in the back, right?

Can you see that?

Have you seen this in people?

People, yeah.

So strength, conditioning, stretching, right?

All of these things are important for good bone health.

We'll talk about specifically when we're talking about protecting our Bones, we need to make sure our muscles are intact, right.

We have to have strong muscles to protect our bones as they age.

Because this is a.

This is a natural process.

We've talked in this class through all the systems, right.

As the systems.

As we age, the system starts to decline.

This is a natural process.

But if we can start to do some intervention by supporting that system in particular muscles here, that is most helpful.

Okay, so etiology, genetic risk.

We touched on this.

See what we miss.

It is a multifactorial situation.

It's not just one thing that plays a role in regard to osteoporosis.

We think about genetics, right?

If we have people in our.

In our life who are osteoporotic, we are also more likely to become osteoporotic.

Light style.

Are you exercise?

Right.

They say we learned in cardiac.

How.

How much should we be exercising?

At least what we Learned in cardiac, 150 minutes a week.

Right.

Also, that helps our bone health.

It helps us because of our muscles helping with my bone and environmental influences.

So we think about, you know, are we living in a place where there's good clean comb air.

Happen to live in a space where we have pollutants, Right.

Sometimes we can change that and sometimes we can't.

We just need to know that.

And we have to work around that.

And then I'll get to lifestyle in a minute, I guess.

Genetics, we talked about that.

Family history.

Genes affect bone density and metabolism, lifestyle, environmental factors, more there.

Nutrition, calcium and vitamin D. We just talked about that.

We're going to have those additive.

Components.

So we're going to make sure our people are getting that.

And postmenopausal.

This is something that we did talk about women, the loss of estrogen.

Estrogen.

When women go through menopause, we are not producing estrogen anymore.

And as a result, there's so many things in our body that are impacted by that change, that hormone loss.

And one of them is the bone really take a hit.

So if you are a woman who goes to annual wellness checks, you're going to see as you age, there comes a point where they really start taking you to the heart at your provider's office.

You know, you need to be doing this, you need to be doing this.

And then there's.

Then they get to the point where they're saying, how many milligrams are you taking?

Like that?

You're not even messing around anymore.

So be paying attention to this.

We can include it in our diet.

But even that, as we age, the loss can be so significant and rapid that we need to be supplementing as well.

Protein again, bone strength, muscle strength, lots of stuff right now.

Lots of studies coming out about the importance of protein in our diet.

Right.

30 milligrams is day.

30 grams a day, that's it.

No, not a day, a meal.

Often times they're saying for postmenopausal women, 30, 60, 90, same around 100.

Right.

Of protein, which can you.

Yeah, because I mean we learned a lot about other system.

Like we can't just be eating T bone steak every night, it turns out, because that's our heart doesn't like that.

So, you know, we have to face a little adjustment.

We have to learn some new ways to eat healthy things.

And then of course, lifestyle.

We want to think about the sedentary lifestyle.

We talked about how being active is super helpful for lots of things, but we have to continue that.

And smoking.

Smoking increases bone loss.

We know that there are studies that support that.

So we encourage our people to not smoke.

But we recognize if they are continuing to smoke, they are higher risk as a result of that.

And again, so our prevention primarily circles around what can we add.

So the calcium, the vitamin D, the protein and then early screening for people who are at risk.

And this is that.

BMD bone mineral density studies incidence and prevalence 50, 54 million Americans.

The number are increasing as baby boomers age.

Right.

We talked about this in clinical, I think.

What did we identify?

What was our age for baby boomers?

64.

Was that the average.

64 to 80 is the age right now of baby boomers.

Baby boomers for people who don't know, was this influx.

Right.

The large birth rate that happened started in 191964 to 19.

I wrote it down.

191946 to 64.

He was like, wait a minute.

Yeah, so 46 to 64, ages 62 to 80 are the boomers right now.

So this is going to be a bread and butter.

These people, these are going to be there.

Are you think you're going to be trusting, taking care of them?

Yeah, you are taking care of them.

We're gonna see more and more.

So let's start with promotion.

So without looking at this, what do you think?

What are some things you're gonna help tell people about promotion?

Exercise, weight bearing, exercise to build up like or not lose muscle.

Weight bearing, exercise, super important online.

Who can give me some health promotion?

Did someone say diet?

I heard exercise.

Exercise.

We didn't get to diet yet.

Tell me more.

Tell me specifically about diet.

What are you going to say?

To them.

Amanda.

More vitamin D and calcium.

Love it.

More vitamin D and calcium.

Beautiful.

And protein.

And protein, yes.

Let's get that going too.

For building our muscles.

We don't.

The body has to do something to fuel itself.

Right.

And what happens is it starts to eat away the muscle.

We see a lot of muscle advocacy at the age.

Angie, were you going to say something?

We need smoking.

Yes.

Hormones, like monitor their estrogen and their hormones, especially if they're in menopause or in per.

Menopause.

Yes, yes.

Monitoring the hormone levels.

This is a whole to do kind of a hot button topic.

And.

Right.

The history of hormone replacement is such that women used to be.

In the 70s, early 80s, we were giving more estrogen.

Right.

To women because we know the loss of estrogen was so significant to cardiac health, to bone health.

The signs or the symptoms that people have as they go through menopause.

This could help with that.

Right.

Then we learned that when we gave this.

There seems to be some study.

There's some studies that were done that showed an increased incidence of breast cancer in these individuals.

So we put a halt on all of that.

And for years and years and years, we have not done estrogen replacement therapy.

There is some thought now providers going back and doing some studies on this and thinking, you know, maybe we need to look at this a little bit more.

So there's some conflicting evidence as to if hormone replacement therapy is safe or not.

The risk benefit analysis, if you will.

But to Angie's point.

Well, estrogen replacement, there is question about that right now.

It used to be that we used to think that this was really great and every woman who went through menopause needed this.

And when you hit that mark, you got your pills and away you went.

Okay.

Then there were studies that were done that showed that there was a correlation between women taking estrogen and certain kinds of breast cancers.

So off the table, it was removed.

No one was using it anymore.

And now the question.

There's some question about the validity of the study that was done at the time and the reviewing of the data.

And is that really true?

Is it not true?

The risk benefit analysis that I'm talking about?

Because we know, we talked about cardiac.

Right.

The highest risk time for women to have mi, a cardiac event is postmenopausal because they don't have the protection event, estrogen.

So the answer is it's being studied.

We're continuing.

You will see there are some providers that are dabbling back in this market a little bit and trying to see so as Angie is saying, monitoring the levels, that is helpful for us because we know how serious we have to get.

Not that we're necessarily going to add the estrogen back, but we know what's going on with the physiology of the individual.

So we can, you know, there's times when, you know, just adding oral calcium, vitamin D might not be as helpful as there's other products.

We can do different infusions.

We can do injections, things like that to support the bones.

We have medications that mimic the estrogen.

The synthetic product that we'll talk about.

Go ahead.

I was gonna say the bioidentical hormones.

And then like, then there's like other hormones that can help balance your estrogen.

You know, we have other hormones in our body.

Progesterone.

We even have testosterone and stuff like that.

Yeah.

So there's other options to help with our bone density.

It's not just the estrogen is what I'm trying to say.

There's other hormones too.

Yes, agreed.

I agree.

So promotion.

What did we hit?

I'm just trying to see if we missed anything.

So we've got nutrition, right?

The vitamin D, calcium, stopping smoking.

We're going to stop that because this does not help our estrogen levels.

And we know that, we talked about that.

So we're going to try to encourage that, giving support around that.

We are going to suggest weight loss if people are overweight.

Just thinking about the load that the bones and muscles have to take.

And if we have weak bones, we want to try to support that as much as possible.

Avoiding alcohol.

Couple reasons why avoiding alcohol is important.

It can impact how the body uses the calcium that is taken in.

And also it can cause people.

It's a higher risk for fresh.

Can make people a little unsteady sometimes.

Right.

And then we have weak bones and that's not a great mixture.

Carbonated beverages.

Did you know about this?

Phosphoric acid.

So if you're drinking your carbonated beverages, enjoy it.

Now, drink up.

Because there will be a time when it will not be recommended only.

And we suggest that they replace it with something else versus just taking something away.

Again with the weight bearing, exercise.

I mean, I think you mentioned that.

Right.

To help strengthen the muscles.

And 150 minutes a week or more is what is recommended.

All right, so how do we know?

We kind of touched on this a little bit.

Right.

But let's get a little bit deeper in regards to the assessment for osteoporosis.

Things that you are thinking about, looking at, you want to be thinking about for your people, the fall risk factors.

So just watching people walk, right, Ambulating, but also thinking about other sensory pieces.

So thinking about how well are people seeing, how well are they hearing.

We know that hearing impacts our balance.

So as people age, you know, this is a population that we were working with in clinical.

Right.

And it sometimes is like, oh man, I gotta really talk loud.

It's not just about the hearing loss.

We know that what that can do for the brain too.

But it also impacts balance.

Does the individual have need cognitive issues that we need to consider.

Right.

We spent last week talking about dementia.

Cognition can play a role in people's ability to be out, be moving, that sort of thing.

Blood pressure, lower blood pressure.

We think about again, this population starting like page 18, 60s, 70s and so on.

A couple things can happen.

One, they may have be on a blood pressure pill that they've been on since they were 40.

But now we have this process happening as we age where we're losing bone and muscle and we need people are losing weight.

That impact, you may not need that anymore, right?

They don't need that blood pressure that anymore.

And as a result they are at risk for fall to see orthostatic hypotension sometimes, right.

The body's ability to compensate when we shift and change position.

We rely on our vascular system to clamp things up when we start moving, get our heart moving to be able to react to those position changes.

And you might not see that happening.

As a result, we see fall.

We know about the use of sedatives.

Right.

In our older population, this isn't really a.

No, no, we don't.

We really try.

There's a thing called the beers list.

Did you learn about that in karma?

I'll look it up sometime.

This is a whole list of medications that they say, I don't know what the age cut off is, but the whole list of medications that they recommend that we are not giving, like B I E R. Let me know when you figure it out.

So again, as people like right now, we're learning, right, A lot of meds, right.

We're giving a lot of meds to these people.

Just as a nurse, a provider who's actually administering these, taking a look sometimes because there's a risk benefit analysis.

You know, there's a population that really can benefit from something to help them chill.

But that doesn't come without issues.

Sometimes physical assessment, what do we see?

We see loss of height.

We talked about that.

Up to 6, 6 inches.

Back pain, chronic back pain.

Why do people have chronic back pain with osteoporosis?

So the muscles are not supporting the bone structure.

Posture, Poor posture.

See how that's.

Huh.

Yeah.

The kyphosis where that's a thoracic curvature right the middle of the spine.

How about fractures?

The chronicity of these fractures that people have, we tend to see them happening along the vertebral column because that's what's bearing the most of our load.

And sometimes again, it's very obvious and they're in a lot of pain.

And other times it's just like this dull, aching chronic thing that goes on and on.

Imaging you can see that they have some fractures.

We don't do anything for these fractures.

Honestly.

There are some procedures today.

I think today we talked about bacteria, but we do.

There's like some cementing sort of things where they'll put cement in between the vertebrae.

They can do.

The problem is with the, with this population, this.

Because we'll talk about surgical intervention in the bit with fessing, but with this population it's not really, doesn't really fix it because you have a whole column that is like, you know, is deteriorating.

And when you cement an area, it puts more pressure on the lungs above and below, which can cause problems.

So it's really.

Is not a great solution for this situation.

How do Albert young people who are brittle.

Well, this is when I'm Dr. D about.

So I'll talk about back pain and surgical intervention later this morning when we talk about just a problem of low back pain that could be anyone.

Right.

But when we're talking about osteoporosis and back pain, it's not, it's really not our recommended intervention for these people because it doesn't, it's not.

That doesn't fix the problem.

Yeah.

Okay, so loss of height, reduce reduced mobility.

We see the stooped posture, we see fractures.

This is what I was saying.

We come in counter with these people in our care, in our care system when they've had a fall, so maybe just a minor fall and it ends up in a hip fracture that says something to you like, oh, wow.

You know, we're, we're not having very strong bones here.

Spine tenderness, body image change, people, they look different.

You know, I used my mother as an example before.

Like she looks different than she did before.

You know, she's lost a lot of weight.

Her stature is very different.

It could impact in individuals.

You know, especially when you, you haven't seen people fo