Aging Gracefully: Bone Health and Diabetes

Aging Gracefully

Christina Mitchell, MD

Penn Medicine Valley ForgeDivision of Endocrinology, Diabetes and MetabolismJune 8, 2016

Learning Objectives• Learn what you can do to prevent

osteoporosis• Discover what treatment options are

available for you if osteoporosis is diagnosed

• Recognize the manifestations of diabetes• Identify ways to take control of your blood

sugar

BONE HEALTH

Why is bone health important?

• Osteoporosis is COMMON.

• Osteoporosis is SERIOUS.

• Osteoporosis is COSTLY.

• Osteoporosis can SNEAK UP ON YOU!

Osteoporosis is COMMON• Osteoporosis is a condition

in which the bones become weak and can break more easily.

• 10 million Americans already have the disease.

• 34 million are at risk. • Estimates suggest that

about half of all women older than 50 will break a bone because of osteoporosis.

• Up to one in four men will too.

Effects of Osteoporosis on Bone Health

Osteoporosis is decreased bone quantity and quality leading to weak bones

Normal Osteoporotic

NIAMS. Osteoporosis overview. 2009; NOF. Clinician’s Guide to Prevention and Treatment of Osteoporosis. 2008; US Surgeon General’s Report. 2004.

Osteoporosis is SERIOUS• Broken bones due to osteoporosis

are most likely to occur in the hip, spine and wrist, but other bones can break too.

• Broken bones can cause severe pain that may not go away.

• Some people lose height and become shorter.

• Osteoporosis may even keep you from getting around easily and doing the things you enjoy.

• 20% of seniors who break a hip die within one year from problems related to the broken bone itself or surgery to repair it. Many of those who survive need long-term nursing home care.

Osteoporosis is COSTLY• In 2005, osteoporosis

was responsible for an estimated two million fractures and $19 billion in costs.

• By 2025, experts predict that osteoporosis will be responsible for approximately three million fractures and $25.3 billion in costs each year.

Osteoporosis canSNEAK UP ON YOU!!!

• You can’t feel your bones becoming weaker.

• You could have osteoporosis now or be at risk for it without realizing it.

• Often, breaking a bone is the first clue that you have osteoporosis.

• A bone mineral density test can tell if you have osteoporosis before you have these symptoms.

When should I be thinking about osteoporosis?

In Your 30’s• No DXA yet• Exercise• Stop smoking• Restrict your alcohol

intake to fewer than 7 drinks/week

• Avoid excessive weight loss

• Calcium 1000 mg/day• Vitamin D 400 IU/day

In Your 40’s

• Consider baseline DXA

• Exercise• Stop smoking• Restrict alcohol• Calcium 1000 mg/day• Vitamin D 400 IU/day

In Your 50’s• Consider baseline DXA• DXA if you break a bone• If you have risk factors

– Family history– Low body weight– Cigarette smoking– Early menopause– Thyroid– Celiac disease– Depo-Provera– SSRI’s

• Calcium 1200 mg/day• Vitamin D 800-1000 IU/day

In Your 60’s• DXA after age 65• Under age 65 with risk

factors• X-ray showing break or

bone loss• Height loss of ½ inch or

more in 1 year• Total height loss of 1.5

inches from your original height

• Calcium 1200 mg/day• Vitamin D 800-1000 IU/day

In Your 70’s and Beyond

• DXA if you are a man older than 70

• Screening DXA for all women

• No data on when to stop DXA screening

• Calcium 1200 mg/day• Vitamin D 800-1000

IU/day

Calcium and Vitamin D

When a serving of milk

says it contains 30% calcium, how

do I know how much calcium

is in that serving?

Treatment

Factors to Consider When Choosing Treatment

• Your sex. • Your age. • If you have not reached menopause. • How severe your osteoporosis is. • Other health problems you may have.• Personal preference.

Treatment Options

• Bisphosphonates– Alendronate

(Fosamax®)– Risedronate (Actonel®)– Zoledronate (Reclast®)– Ibandronate (Boniva®)

• Teriparatide (Forteo®)• Denosumab (Prolia®)

• Calcitonin nasal spray (Miacalcin®)

• Raloxifene (Evista®)• Estrogen

DIABETES

Diabetes is COMMON

• In 2012, 9.3% of the population had diabetes.

• Among Americans age 65 and older, the prevalence was 25.9%.

Diabetes is SERIOUS

• 7th leading cause of death in the US

• Can lead to many complications

Diabetes is COSTLY

• Total costs of diagnosed diabetes: $245 billon/year

• Medical expenditures are 2.3 times higher in people diagnosed with diabetes

Early Diabetes is ASYMPTOMATIC

• Later symptoms include:– Fatigue– Increased thirst– Increased hunger– Increased urination– Blurry vision– Slow healing– Depression

Risk Factors

• Gestational diabetes• Overweight• High blood pressure• Unhealthy cholesterol• Physical inactivity• Smoking• Unhealthy eating• Age, race, gender and family history

Healthy Eating

• NOT ‘One size fits all’• Plate method:

Vegetables 50%!• Watch portions• Lean meats• Whole Grains• Start with a salad or soup• Water, Water, Water

Physical Activity

• Aim for 30 minutes/day, 5 days/week– Activity tracker (10,000

steps/day)– Brisk walk– Dancing– Swimming or water aerobics– Indoor or outdoor bike– Light weights or resistance

bands

Losing Weight

• Eat breakfast every day• Track your food intake (My Fitness Pal)• Weigh yourself regularly• Increase physical activity• Medication may be helpful

Resources

• http://www.diabetes.org (ADA website)• http://www.shef.ac.uk/FRAX/• Bisphosphonates in the management of osteoporosis in postmenopausal

women. Uptodate.com.• National Institute of Arthritis and Musculoskeletal and Skin Diseases.

Osteoporosis overview. Reviewed May 2009. www.niams.nigh.gov/Health_Info/Bone/Osteoporosis/overview.pdf.

• National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation. 2008.

• US Surgeon General. Bone Health and Osteoporosis: A Report of the Surgeon General. October 14, 2004. Accessed July 6, 2009 at www.surgeongeneral.gov/library/bonehealth/.