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Aging Gracefully Christina Mitchell, MD Penn Medicine Valley Forge Division of Endocrinology, Diabetes and Metabolism June 8, 2016
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Aging Gracefully: Bone Health and Diabetes

Apr 11, 2017

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Page 1: Aging Gracefully: Bone Health and Diabetes

Aging Gracefully

Christina Mitchell, MD

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

Page 2: Aging Gracefully: Bone Health and Diabetes

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

Page 3: Aging Gracefully: Bone Health and Diabetes

BONE HEALTH

Page 4: Aging Gracefully: Bone Health and Diabetes

Why is bone health important?

• Osteoporosis is COMMON.

• Osteoporosis is SERIOUS.

• Osteoporosis is COSTLY.

• Osteoporosis can SNEAK UP ON YOU!

Page 5: Aging Gracefully: Bone Health and Diabetes

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.

Page 6: Aging Gracefully: Bone Health and Diabetes

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.

Page 7: Aging Gracefully: Bone Health and Diabetes

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.

Page 8: Aging Gracefully: Bone Health and Diabetes

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.

Page 9: Aging Gracefully: Bone Health and Diabetes

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.

Page 10: Aging Gracefully: Bone Health and Diabetes
Page 11: Aging Gracefully: Bone Health and Diabetes

When should I be thinking about osteoporosis?

Page 12: Aging Gracefully: Bone Health and Diabetes

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

Page 13: Aging Gracefully: Bone Health and Diabetes

In Your 40’s

• Consider baseline DXA

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

Page 14: Aging Gracefully: Bone Health and Diabetes

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

Page 15: Aging Gracefully: Bone Health and Diabetes

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

Page 16: Aging Gracefully: Bone Health and Diabetes

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

Page 17: Aging Gracefully: Bone Health and Diabetes

Calcium and Vitamin D

Page 18: Aging Gracefully: Bone Health and Diabetes

When a serving of milk

says it contains 30% calcium, how

do I know how much calcium

is in that serving?

Page 19: Aging Gracefully: Bone Health and Diabetes

Treatment

Page 20: Aging Gracefully: Bone Health and Diabetes

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.

Page 21: Aging Gracefully: Bone Health and Diabetes

Treatment Options

• Bisphosphonates– Alendronate

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

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

• Calcitonin nasal spray (Miacalcin®)

• Raloxifene (Evista®)• Estrogen

Page 22: Aging Gracefully: Bone Health and Diabetes

DIABETES

Page 23: Aging Gracefully: Bone Health and Diabetes

Diabetes is COMMON

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

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

Page 24: Aging Gracefully: Bone Health and Diabetes

Diabetes is SERIOUS

• 7th leading cause of death in the US

• Can lead to many complications

Page 25: Aging Gracefully: Bone Health and Diabetes

Diabetes is COSTLY

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

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

Page 26: Aging Gracefully: Bone Health and Diabetes

Early Diabetes is ASYMPTOMATIC

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

Page 27: Aging Gracefully: Bone Health and Diabetes

Risk Factors

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

Page 28: Aging Gracefully: Bone Health and Diabetes

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

Page 29: Aging Gracefully: Bone Health and Diabetes

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

Page 30: Aging Gracefully: Bone Health and Diabetes

Losing Weight

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

Page 31: Aging Gracefully: Bone Health and Diabetes

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/.