May 2018

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HEALTH No bones about it Osteoporosis is a risk by Nancy M. Ouhib, MBA, RD, LD/N Osteoporosis leads to increased bone weakness, which increases the risk of a broken bone. Osteoporosis is a thinning of the bone or a reduction in bone mass due to the depletion of calcium and bone protein. It takes much less stress on compromised bone to cause it to break than it would a strong, healthy bone and it is the most common reason for a broken bone in the elderly. Osteoporosis is a silent disease until it is complicated by fractures. These fractures occur with minimal or no trauma. Fractures are common and cause an enormous medical and personal burden on the elderly who suffer from them. Osteoporosis can be prevented, diagnosed, and treated before fractures occur. Prevention, diagnosis, and treatment are the responsibility of primary care practitioners. Since the National Osteoporosis Foundation first published its guidelines, it has been noted that many adults are not being given appropriate information about prevention and many are not getting appropriate testing to diagnose osteoporosis or establish their level of risk. More importantly, adults who have osteoporosis related fractures are not being diagnosed with osteoporosis and are not receiving any of the FDA approved, effective therapies. Bone Mass Density testing and measurements can predict both site specific and overall fracture risk. Several interventions to preserve bone strength can be recommended. These include an adequate intake of calcium and vitamin D, lifelong participation in weight-bearing and muscle-strengthening exercise, cessation of tobacco use, identification and treatment of alcoholism, and treatment of risk factors for falling. Having an adequate daily calcium and vitamin D intake is a safe and inexpensive way to help reduce fracture risk. A dietitian can assess your intake of calcium and vitamin D and counsel you on how to meet the recommendations for your age and specific needs. A balanced diet rich in low-fat dairy products, fruits, and vegetables provides calcium, as well as, many nutrients needed for good health. If adequate dietary calcium cannot be consumed, dietary supplementation may be indicated. Calcium intake through diet should always be the first-line approach. Women age 51 and older and men age 71 and older should consume 1200 mg/day of calcium. Men age 50-70 should consume 1000 mg/day of calcium. There is no evidence to support additional bone strength from calcium intake in excess of the above recommendations. Intakes in excess of 1200 to 1500 mg/day may increase the risk of developing kidney stones, cardiovascular disease, or stroke. Vitamin D plays a major role in calcium absorption, bone health, muscle performance, balance, and risk of falling. An intake of 800 to 1000 international units (IU) of vitamin D per day for adults 50 and older is recommended. Supplementation with vitamin D3 (cholecalciferol) may be used. Vitamin D2 (ergocalciferol) is derived from plant sources and may be used by individuals that follow a strict vegetarian diet. Many elderly people are at high risk for vitamin D deficiency due to limited sun exposure (a source of vitamin D), intestinal diseases, chronic renal insufficiency, medication that breaks down vitamin D, obesity, or dark skin. Many elderly people with osteoporosis have a high prevalence of vitamin D deficiency. Adults who are deficient can be treated with 50,000 IU of vitamin D3 or D2 once a week, or the equivalent daily dose for 8-12 weeks, and then a maintenance therapy of 1000 IU/day. Regular weight-bearing and muscle-strengthening exercises reduce the risk of falls and fractures and are beneficial for osteoporosis prevention. Before initiating a new exercise program, a physical therapist’s evaluation is appropriate. Risk factors for falling should be assessed by an occupational therapist. Strategies can be implemented to reduce the risk of falls. When you go to your annual wellness visit with your primary care physician, make sure you discuss your risk level for osteoporosis, have the appropriate testing done, and proper intervention initiated if required. P 114 MAY <strong>2018</strong>
Gustava Zimmer, CNM,MSN, ARNP FOR YOUNG WOMEN OF ALL AGES COMPLETE WOMEN’S HEALTHCARE GYNECOLOGY OBSTETRICS | INFERTILITY MENOPAUSAL MEDICINE ADOLESCENT GYNECOLOGY MINIMALLY INVASIVE GYNECOLOGICAL SURGERY Bruce M. Zafran, M.D. F.A.C.O.G. Tim Puckett, M.D. F.A.C.O.G. Hala Bunni, M.D. F.A.C.O.G. Jose Luis Terrazas, M.D. F.A.C.O.G. Sandra Edmee, M.D. F.A.C.O.G. Charlene Hylton, MD Nicole Navarrete, CNM, MSN, ARNP Christina Fallacaro CNM, MSN, ARNP Shaina Federman CNM, MSN, ARNP Katrina Colbourne CNM, MSN, ARNP, MPH Maricel Perez ARNP, CNM Jennifer D. Quider MSN, WHNP-BC, AGPCNP LOCATED AT THE CENTER FOR THE MEDICAL ARTS 8110 ROYAL PALM BLVD. SUITE 108 CORAL SPRINGS, FL. 33065 954.341.8288 / 954.341.5165 FAX ROYALPALMWOMENSHEALTH.COM Early morning, evening, and Saturday appointments available. Hablamos Español, Nous Parlons Francais Royal Palm OB/GYN is pleased to welcome to our practice, Dr. Jose Luis Terrazas the PARKLANDER 115
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May 2018

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