General Medical Issues
General Medical Issues
People with DLB and PDD tend to be middle-aged and older. In this age group, selected general health issues deserve discussion. Comprehensive medical care is beyond the scope of this book, but several general medical topics should be addressed here. People with Lewy disorders commonly experience walking difficulties. The risk of falling may surface early or later in the condition. Fracture risk is also a concern, and preemptive action is wise. Falls can be tolerated if bones are strong; witness athletes who fall on a football field. Over the course of a lifetime, bones tend to lose their strength and become more prone to fractures. When the loss of bone integrity is substantial we categorize this as osteoporosis. There are specific criteria that doctors use to define osteoporosis. While bone integrity is measured in several ways, the most common and accepted measurement is by imaging with a nuclear medicine technique. A quick scan after injection of a radioisotope that is taken up by bones generates a picture and numeric data; these can be compared to those of normal subjects. This analysis is termed a nuclear medicine bone density study and sometimes is called a DEXA scan. Using the numeric measures from a bone density scan, reductions of bone integrity fall into two classes. We have already mentioned that substantial loss of bone strength is termed osteoporosis. A less severe reduction of bone integrity has been defined and termed osteopenia. Restated, mild bone weakening is osteopenia, and marked loss of bone integrity is osteoporosis. Conventionally, osteoporosis is treated with prescription medications, whereas the lesser problem of osteopenia is not. However, if there is a substantial fall risk, some clinicians would advise treating osteopenia with a prescription drug (see below). Who is at risk for osteoporosis? In the general population, advancing age is the major risk factor. Women over age 60 and men over age 70 fall into these risk categories, as well as those with very sedentary lives. In the context of DLB or PDD, osteoporosis is especially important to consider.
Keywords: Actonel (risedronate), Boniva (ibandronate), Evista (raloxifene), Forteo (teriparatide), Fosamax (alendronate), Reclast (zoledronic acid), alendronate (Fosamax), bisphosphonate drugs, gait problems, ibandronate (Boniva), leukoaraiosis, osteopenia, stroke, teriparatide (Forteo), walking difficulties
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