Emerytom pękają kości bo piją filtrowaną wodę bez wapnia = osteoporoza

Breaking Bones Signals Need for Screening
https://assets.clevelandclinic.org/transform/LargeFeatureImage/fb8c70ce-4f9d-4723-b0a1-d5954c9911c5/bone-structure-osteoporosis-667380856
Zdjęcia osteoporozy
=========================
Falling from standing height should not break bones
Illustration of porous bones
Cleveland Clinic endocrinologist Leila Khan, MD, has a family story that
illustrates a common misperception about bone fragility.
In 1990, Dr. Khan’s 70-year-old grandmother fell after being pushed by
her cousin, a toddler, while babysitting. Her grandmother, who
previously was active, broke her hip and spent months recovering. While
she ended up doing her rehab at home and was lucky to return to her
prior level of functioning, the explanation was that Dr. Khan’s cousin
“caused” the break. In reality, the fall likely would not have happened
if Dr. Khan’s grandmother had strong, healthy bones. Instead, she had
osteoporosis.
“In 1990, there were no available medications for osteoporosis. There
was not much to offer,” says Dr. Khan, Co-Director of the
Calcium/Parathyroid Center at Cleveland Clinic’s Endocrinology, Diabetes
and Metabolism Institute. “Now we have much better treatment options.”
While treatment for bone fragility has improved, there is still a lag in
understanding of the significance of osteoporosis bone breaks in adults.
Raising awareness is crucial to timely diagnosis, and treatment can mean
the difference between living a healthy, active life or suffering with
fracture that can reduce quality of life and even result in premature
death.
The most important message, says Dr. Khan, is that adults don’t
typically break bones from falling from a standing height. A broken bone
is a sign to take action.
“Even if it's icy, even if the floor was wet, it is really abnormal to
fracture,” says Dr. Khan. A fracture from standing height “results in a
diagnosis of osteoporosis.”
Primary care doctors and clinicians who treat patients with such
fractures should be referring them for further screening, but that does
not always happen.
“What's common is that the patient goes to Orthopaedics, gets their bone
fixed, and then their underlying bone fragility is not evaluated,” says
Dr. Khan. “We would like these patients to come to Endocrinology or
colleagues in Rheumatology, Women’s Health or Internal Medicine for an
evaluation.”
Patients are unlikely to ask for additional testing. “They're tired.
They may not know the importance of getting this done,” says Dr. Khan.
“They may think, well, it’s just a fracture. But they have other bones
that they could also fracture.”
In 2010, an estimated 158 million individuals were at high fracture
risk. This figure is expected to double by 2040 because of demographic
shifts.1 It is estimated that worldwide, one in three women and one in
five men over age 50 will experience osteoporosis fractures in their
remaining lifetimes.2
“Understanding family history is critical, because there are genetic
risk factors,” says Dr. Khan.
The CDC recommends dual energy X-ray absorptiometry (DEXA) bone density
testing for women 65 and older or who are 50 to 65 and have certain
health conditions that put them at higher risk. Men age 70 years and
older also need testing.
Bone mineral density is measured in grams per centimeter squared.
Results for people over 50 are translated into T score, which helps
stratify risk. T scores run from 0 into negative numbers; 0 to -1 is
normal; -1 to -2.5 confers osteopenia; scores of -2.5 or lower are
considered osteoporosis. Understanding the risks allows pharmaceutical
treatment and lifestyle changes to begin. That puts patients in a better
position to avoid additional fractures and the risks that come with
them.
Medical and lifestyle interventions
Once bone fragility has been diagnosed, it can be successfully treated
with medication and lifestyle changes.
“Patients can take a bisphosphonate tablet, which is an antiresorptive,
or they can receive a yearly IV infusion of zoledronic acid or a shot
every six months called denosumab,” says Dr. Khan. “Or they can start a
medication to build up their bone with a daily shot called teriparatide
or abaloparatide, or a monthly shot of romosozumab.”
Medical interventions reduce fracture risk between 30% and 60%,
depending on the medication. When Dr. Khan works with patients, she
gathers family history information and also emphasizes the importance of
fall prevention and exercise.
“Exercise, such as walking or weight lifting, is absolutely critical,”
she says. ”The bone is a living organism and when we exercise, we
significantly improve bone density. It can make a huge difference in
preventing the breakdown of bone.”
Reminders for providers
Increasing awareness among clinicians is also essential. A quality
improvement initiative was recentlystarted to increase bone-density
screenings among primary care post-menopausal women who should be having
them. Dania Salih Bacha, MD, a Cleveland Clinic internal medicine
fellow, worked with colleagues to expand understanding of when and how
often to order bone mineral density tests.
Despite the CDC’s age- and risk-dependent screening recommendations, in
outpatient settings, DEXA test orders are often overlooked. Unlike
mammograms and colonoscopies, timely reminders for repeat bone density
screenings were not programmed into patients’ electronic medical
records, so Dr. Salih Bacha and her teamintroduced several
interventions. They created a flow chart to remind physicians when a
patient would be due for a repeat bone scan and created an educational
podcast on osteoporosis diagnosis and treatment.
The most effective change, however, was adding a reminder to the health
maintenance tab in the EMR.
“For every woman older than 65 years who either did not have a bone scan
or was due for a repeat scan, a reminder will pop up that this patient
needs a DEXA scan,” says Dr. Salih Bacha. “If osteoporosis is added to
her medical history, then by default an alert should come up every two
years that she needs a new scan. If the physician believes a patient is
at lower risk or higher risk, they can manually adjust that interval.”
Reminders that yield high rates of testing can make a real difference
for those who are unaware of their risk.
“This is a silent disease,” says Dr. Khan. “People have no symptoms
until they fracture, and when they start fracturing, there could be a
cascade of fractures that can really alter the course of their life.”
With medication and lifestyle interventions, patients with low bone
density can protect themselves and preserve their good health for years
to come.