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Osteoporosis Osteoporosis (meaning “porous bones”) is a common bone disease that leads to an increased risk of fracture. One in three women and one in five men over the age of 50 are affected by osteoporosis. Bone is a living tissue made up of proteins and minerals, such as calcium and phosphorus. Throughout life, bone is constantly being broken down and renewed. Bone density – the amount of bone tissue in a certain volume of bone – reaches a peak between 18 and 25 years of age. Higher peak bone masses are associated with a lower risk of fracture or osteoporosis later in life. Women lose bone density more quickly after menopause due to a decrease in oestrogen levels. Regular weight-bearing exercise and an adequate dietary intake of calcium and other minerals is also needed to maintain good bone density in addition to oestrogen in women and testosterone in men. Osteoporosis occurs when bone breaks down faster than it rebuilds. Although bones remain the same size, they become thinner and more brittle. Osteoporosis CALCIUM CONTENT OF SOME FOODS CALCIUM CONTENT (MG) 1 cup cooked broccoli 59 ½ cup cooked spinach 45 ½ can baked beans 90 1 glass lite-blue top or trim milk, 250ml 310 1 cube Edam cheese, 8g 75 1 pottle yoghurt, 150g 195 1 cup ice cream, 157g 196 ½ cup sour cream, 112g 124 tofu cubes, 100g 105 Soy drink, calcium fortified, 250ml 286 10 almonds 30 Sesame seeds, 1 tablespoon, 9g 88 6 mussels 136 ½ cup salmon 110 1 sardine 66 Reference: Calcium Content of Foods. NZ Nutrition Foundation can cause significant disability and affect quality of life. Risk factors for osteoporosis include: • age (older than 50 years) • being underweight • coeliac disease, Crohn's disease or Rheumatoid arthritis • early menopause or low testosterone levels • excessive alcohol intake (more than 2 glasses wine/day) • family history of osteoporosis and fractures • female gender • low dietary intakes of calcium • physical inactivity (particularly lack of weight-bearing exercise) • previous fracture as a result of a minor fall or bump • smoking • some medicines (eg, antiandrogens, aromatase inhibitors, corticosteroids) • vitamin D deficiency. Symptoms of osteoporosis The condition is usually asymptomatic – it is not painful until there is a fracture. Fractures usually occur in the spine, wrist or hip. Hip fractures can have a dramatic effect on a person’s quality of life, with up to 50% of people unable to return to a fully independent lifestyle after a hip fracture and requiring long-term ongoing care. Bone mineral density (BMD) BMD is a measure of the amount of bone in a particular part of the body and can be calculated using a special type of x-ray, called DEXA. The World Health Organization (WHO) defines osteoporosis in women as a BMD 2.5 standard deviations below peak bone mass (20-year-old healthy female average) as measured by DEXA. Initial assessment Customers who are more likely to have osteoporosis include those who look frail or older adults with a current fracture. But all customers should be encouraged to eat enough calcium in their diet while they are still young, with the aim of TREATMENT OPTIONS Category Examples Comments Calcium +/- vitamin D Vitamin D preparations [GENERAL SALE] eg, calcium (Caltrate, GO Calcium) calcium + vitamin D (Swisse Ultiboost) calcium + other vitamins (Caltrate Plus) [SUPPLEMENTS] eg, vitamin D3 (Blackmores, Ethical Nutrients Daily D, Swisse Ultiboost) eg, vitamin D3 + other vitamins (Mvite, Vitabdeck) Milk and dairy products are the most readily available sources of dietary calcium and have the added advantage of being high in protein and other micronutrients important for bone health. Dietary calcium is preferred over supplements. Customers should talk with the pharmacist or their doctor before taking calcium supplements. The D3 form of vitamin D is most effective at maintaining body stores of vitamin D. This form is available as supplements and also manufactured in specialised cells in the skin on exposure to sunlight. Vitamin D2 found in foods and some supplements is not as well utilised. Certain groups of people (eg, elderly, dark skinned) may require supplements (see also Vitamins and Dietary Supplements). There is no evidence that vitamin D improves bone health in people who are not deficient. Usual supplemental dosage is 400–800IU/day. PharmacyToday A part of your everyday Page 116 HEALTHCARE HANDBOOK 2017-2018 Common Disorders

CONTINUING OTC EDUCATION preventing osteoporosis. Continued calcium intake is also important to maintain bone mass once people are over the age of 50. Suggest ways to reduce falls in those with a high risk of fracture (see Reducing the risk of falls opposite) and encourage safe weight-bearing exercise to help with muscle tone and balance. Encourage smokers to stop smoking (see Smoking cessation) and those who drink to limit their alcohol intake. Prevention and treatment Calcium is an important component of bone, so adequate dietary calcium is needed in order to maintain good bone health. However, the actual recommended daily intake is controversial (ranges from 500–1000mg). Calcium from dietary sources is preferred over supplemental calcium. Research suggests there is no added benefit in taking more calcium (in the form of supplements) than needed, and in fact, too much calcium can be detrimental. Vitamin D is made in the skin as a result of sunlight exposure. Supplements may be beneficial in people who never go outside (eg, frail elderly), or with reduced exposure to the sun (eg, veiled women, dark-skinned individuals). There is no evidence that vitamin D supplements improve bone health in people who are not deficient. Most people with osteoporosis will need to see their doctor to establish a medication regimen that ensures adequate bone protection. Prescription medicines used for the treatment and prevention of osteoporosis include cholecalciferol (vitamin D3), calcitriol (active vitamin D), bisphosphonates (eg, alendronate, etidronate, pamidronate, risedronate, zoledronic acid), oestrogen modulators (eg, raloxifene), and other hormones (eg, teriparatide). Reducing the risk of falls In people who have already had a fall, offer suggestions on how to reduce the risk of further falls. Advise customers to: • ask for a thorough medication review by a pharmacist or doctor to identify medicines that may be detrimentally lowering their blood pressure or interfering with balance, increasing their risk of falls • review their furniture placement and use of rugs in their home or workplace to lessen the risk of falls (see • consider t’ai chi, which research shows can improve balance and prevent falls • book in a comprehensive eye examination to check both their vision and eye health; good eyesight is needed to avoid tripping over or bumping into objects • wear shoes with non-slip soles and advise women to avoid high heels • partake in regular weight-bearing exercise, to improve muscle strength and balance • consider a walking stick to help improve balance if falling remains a problem • consider an alarm/alert system, worn around their neck or wrist, which could be easily activated if a person has fallen and cannot move. Ensure customers are getting enough vitamin D to help with the absorption of calcium. Encourage some sun exposure without sunscreen in the early morning or late afternoon every day in order to maintain adequate vitamin D levels. Refer to PHARMACIST The following questions aim to identify customers who would benefit from further input from a pharmacist. Your initial assessment may have already provided some answers. Decide if any further questions still need to be asked and refer any “yes” answers to a pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Has the person had a previous fracture? • Has the person been having frequent falls? • Is the person elderly, or taking medicines that might cause dizziness or drowsiness eg, benzodiazepines or blood pressure-lowering agents, which may increase the risk of falls? • Is the person unsure about what they should be taking for their osteoporosis? • Does the person have any allergies to medicines? Supplements may be more suitable for some people (such as resthome residents). Also see the Osteoporosis NZ website ( SUBSCRIBE • Latest pharmacy headlines • Online learning • Hot retail tips • Prizes & giveaways • Healthcare Handbook 09 488 4286 Page 117

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