Multilingual Support:

Concerns

What is your underlying cause of osteoporosis?

What is your bone mineral density?

What signs and symptoms have you experienced associated with osteoporosis?

Do you consume ≥3 daily servings of dairy products?

What medications are you taking?

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What is your underlying cause of osteoporosis?

There are several identified risk factors for osteoporosis: family history, history of bone fracture secondary to mild/moderate trauma, loss of height (kyphosis), gender, age, early menopause, small-framed body, race, hereditary, low bone mass, body mass index BMI <19, low calcium intake (see question on dairy products below), lack of exercise, smoking, alcohol consumption, underlying disease (e.g., hyperthyroidism, multiple myeloma, hyperparathyroidism), systemic medications (e.g., long-term use of glucocorticosteroids), low testoterone levels in men.

What is your bone mineral density?

Bone mineral density (BMD) is measured by dual energy x-ray absorption (DEXA) scans in g/cm2. A DEXA report will compare a person’s values with those of a same-gender person, aged 20-80 years.

Normal – BMD no more than 1 SD below young normal.

Osteopenia – BMD between 1 and <2.5 SD below young normal.

Osteoporosis – BMD >2.5 SD below young normal.
Z-score – (Patient’s BMD – expected BMD)/SD of normal population.
T-score – (Patient’s BMD – reference BMD)/SD of normal population.

What signs and symptoms have you experienced associated with osteoporosis?

Hip fractures are strongly associated with low BMD. Vertebral fractures result in an increased risk of death due to cardiovascular and pulmonary disease. These fractures also impact on physical disability, self-esteem, body image, and behavior.

Osteoporosis and consequent fractures are associated with significant pain, loss of mobility, and diminished ability for independent living.

Do you consume ≥3 daily servings of dairy products?

Recommended daily value for calcium intake (external link) -

Adults:

- age 18 – 50 years

1,000 mg calcium (100% DV) and 200 IU vitamin D

- age 51 – 70 years

1,200 mg calcium (120% DV)and 400 IU vitamin D

Food sources:

- dairy products (300-400 mg/serv) ideal source combining Ca + vit D

- fortified foods and fluids(+/- 300 mg/serv) orange juice, cereals

- tofu (400 mg/serv) in calcium sulfate bath (hard is best)

- vegetables (100-200 mg/serv) low oxalate sources

What medications are you taking?

One of the more controversial medications for osteoporosis is oral bisphosphonate. This medication has been associated with antiresorptive agent-induced osteonecrosis of the jaw (ARONJ), also known as bisphosphonate-related osteonecrosis of the jaws (BRONJ). Although the risk is extremely low – possibly less than 1 case per 100,000 person/year – risk factors may include palatal tori, long-term use of the medication, glucocorticosteroid therapy, periodontal and dental diseases, older age, female gender, and traumatic dental procedures.

Classifications and treatment strategies have been developed to assess and provide dental care for patients with ARONJ.

Other nonbisphosphonate-type medications used to treat osteoporosis, including denosumab (Prolia), an injectable human monoclonal antibody, have also been associated with osteonecrosis of the jaws.

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