Abstract
Osteoporosis poses a significant public health issue, causing significant morbidity and mortality. Calcium and vitamin D utilization in the optimization of bone health is often overlooked by patients and health care providers. In addition, the optimal standard of care for osteoporosis should encompass adequate calcium and vitamin D intake. Dietary intake or supplementation with calcium and vitamin D will be reviewed, including recent recommendations for increased vitamin D intake. Compliance to calcium and vitamin D therapy is paramount for effective prevention of osteoporotic fractures. A recently released algorithm (FRAX) estimating absolute fracture risk allows the health care provider to decide when pharmacologic therapy is warranted in addition to calcium and vitamin D. When pharmacologic therapy is advised, continued use of calcium and vitamin D is recommended for optimal fracture risk reduction. A ‘bricks and mortar’ analogy is often helpful when counseling patients and this analogy will be explained. This manuscript reviews relevant data related to calcium and vitamin D use for patients at risk for fracture due to bone loss.
Osteoporosis overview
The skeletal disease of bone thinning and compromised bone strength, osteoporosis, continues to be a major public health issue as the population ages. This disease is characterized by bone fragility and an increased susceptibility to fractures, especially of the spine and hip, although any bone can be affected. It is estimated that over 10 million Americans over the age of 50 have osteoporosis. Risk for osteoporosis has been reported in people of all ethnic backgrounds. An additional 34 million have reduced bone mass, called osteopenia, which puts them at higher risk for fractures later in life. The risk of fracture from osteoporosis increases with age. There are approximately 1.5 million osteoporotic fractures per year reported in women and men in the US, including over 300,000 hip fractures. As the population ages, this number will probably increase. The US Surgeon General estimates that one out of every two women over the age of 50 will have an osteoporosis-related fracture in their lifetime. In addition, 20% of those affected by osteoporosis are men with 6% of white males over the age of 50 suffering a hip fracture. It is estimated that the national direct care costs for osteoporotic fractures is US$12.2 to 17.9 billion per year in 2002 dollars, with costs rising. This cost is comparable to the Medicare expense for coronary heart disease.
Since bone loss occurs without symptoms, osteoporosis is often considered a ‘silent disease’. As deterioration of bone tissue mounts and disruption of bone architecture occurs, the bone becomes so weak that a relatively minor bump or fall causes a fracture or vertebrae to collapse. The resulting fracture may lead to loss of mobility and independence, with 25% requiring long term care. Fractures caused by either osteoporosis or low bone mass can lead to chronic pain, disability, as well as psychological symptoms, including depression. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer). Unfortunately, approximately 24% of patients with hip fractures over the age of 50 will die in the year following the fracture.
Fortunately, the importance of this debilitating bone disease is being recognized. President Bush has declared 2002–2011 as the Decade of the Bone and Joint. Important advances have been made to understand the disease process and help create therapies to treat the condition. Bone health is optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout life and prevention of bone loss with aging. Health care providers are vital to identify patients at risk for bone loss and diagnose bone thinning so that prevention and treatment strategies are effective.
The US Surgeon General has outlined a ‘pyramid approach’ to treating bone diseases. Prevention of falls with maintenance of bone health through adequate calcium, vitamin D, and physical activity represent the base of the pyramid for all individuals, including those with bone disease. The second tier of this pyramid relates to identifying and treating secondary causes of osteoporosis. Lastly, the third tier revolves around pharmacotherapy.
Calcium and vitamin D have long been recognized as important and required nutrients for bone health and maintenance. The continuation of calcium and vitamin D in a patient with bone loss is critical for optimal care. Unfortunately, 90% of women may not be getting enough calcium and over 50% of women treated for bone loss have inadequate vitamin D levels. Currently, there are a number of pharmacologic treatments for osteoporosis which provide improvements in bone mass and reduction in fracture risk. These treatments have been studied where adequate calcium and vitamin D supplementation had been achieved. Therefore, their use is predicated on proper calcium and vitamin D therapy. The goal of this manuscript is to review data related to calcium and vitamin D in the management of osteoporosis.
Resource: http://www.ncbi.nlm.nih.gov
Resource: http://www.nutritionforest.com/
Osteoporosis poses a significant public health issue, causing significant morbidity and mortality. Calcium and vitamin D utilization in the optimization of bone health is often overlooked by patients and health care providers. In addition, the optimal standard of care for osteoporosis should encompass adequate calcium and vitamin D intake. Dietary intake or supplementation with calcium and vitamin D will be reviewed, including recent recommendations for increased vitamin D intake. Compliance to calcium and vitamin D therapy is paramount for effective prevention of osteoporotic fractures. A recently released algorithm (FRAX) estimating absolute fracture risk allows the health care provider to decide when pharmacologic therapy is warranted in addition to calcium and vitamin D. When pharmacologic therapy is advised, continued use of calcium and vitamin D is recommended for optimal fracture risk reduction. A ‘bricks and mortar’ analogy is often helpful when counseling patients and this analogy will be explained. This manuscript reviews relevant data related to calcium and vitamin D use for patients at risk for fracture due to bone loss.
Osteoporosis overview
The skeletal disease of bone thinning and compromised bone strength, osteoporosis, continues to be a major public health issue as the population ages. This disease is characterized by bone fragility and an increased susceptibility to fractures, especially of the spine and hip, although any bone can be affected. It is estimated that over 10 million Americans over the age of 50 have osteoporosis. Risk for osteoporosis has been reported in people of all ethnic backgrounds. An additional 34 million have reduced bone mass, called osteopenia, which puts them at higher risk for fractures later in life. The risk of fracture from osteoporosis increases with age. There are approximately 1.5 million osteoporotic fractures per year reported in women and men in the US, including over 300,000 hip fractures. As the population ages, this number will probably increase. The US Surgeon General estimates that one out of every two women over the age of 50 will have an osteoporosis-related fracture in their lifetime. In addition, 20% of those affected by osteoporosis are men with 6% of white males over the age of 50 suffering a hip fracture. It is estimated that the national direct care costs for osteoporotic fractures is US$12.2 to 17.9 billion per year in 2002 dollars, with costs rising. This cost is comparable to the Medicare expense for coronary heart disease.
Since bone loss occurs without symptoms, osteoporosis is often considered a ‘silent disease’. As deterioration of bone tissue mounts and disruption of bone architecture occurs, the bone becomes so weak that a relatively minor bump or fall causes a fracture or vertebrae to collapse. The resulting fracture may lead to loss of mobility and independence, with 25% requiring long term care. Fractures caused by either osteoporosis or low bone mass can lead to chronic pain, disability, as well as psychological symptoms, including depression. A woman’s risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer). Unfortunately, approximately 24% of patients with hip fractures over the age of 50 will die in the year following the fracture.
Fortunately, the importance of this debilitating bone disease is being recognized. President Bush has declared 2002–2011 as the Decade of the Bone and Joint. Important advances have been made to understand the disease process and help create therapies to treat the condition. Bone health is optimized by creating an environment to achieve peak bone mass during adolescence, maintenance of healthy bone throughout life and prevention of bone loss with aging. Health care providers are vital to identify patients at risk for bone loss and diagnose bone thinning so that prevention and treatment strategies are effective.
The US Surgeon General has outlined a ‘pyramid approach’ to treating bone diseases. Prevention of falls with maintenance of bone health through adequate calcium, vitamin D, and physical activity represent the base of the pyramid for all individuals, including those with bone disease. The second tier of this pyramid relates to identifying and treating secondary causes of osteoporosis. Lastly, the third tier revolves around pharmacotherapy.
Calcium and vitamin D have long been recognized as important and required nutrients for bone health and maintenance. The continuation of calcium and vitamin D in a patient with bone loss is critical for optimal care. Unfortunately, 90% of women may not be getting enough calcium and over 50% of women treated for bone loss have inadequate vitamin D levels. Currently, there are a number of pharmacologic treatments for osteoporosis which provide improvements in bone mass and reduction in fracture risk. These treatments have been studied where adequate calcium and vitamin D supplementation had been achieved. Therefore, their use is predicated on proper calcium and vitamin D therapy. The goal of this manuscript is to review data related to calcium and vitamin D in the management of osteoporosis.
Resource: http://www.ncbi.nlm.nih.gov
Resource: http://www.nutritionforest.com/
No comments:
Post a Comment