OSTEOPOROSIS

Widya Arsa

Introduction

Become major health problem Canada: 1 of 4, 1 0f 8 USA: > 1 million fragility fracture cost US$ 10 billion In 2041, elderly people > 25% Preventable disease

Bone lining cells

Bone Remodeling Cycle

Bone Osteoclasts

Resorption by osteoclasts

Osteoblasts

Bone remodelling

Sincere thanks to Dr. Susan Ott from the University of Washington for permission to use the above images

Normal Bone

Osteoporosis

Bone loss associated with sex and etnis

Bone Regulation

Low bone mass + micro structure damaged

Decreased bone quality Decreased bone strength

Fragile Increased # risk

Definition

Consensus Development Conference

(1993) a systemic skeletal disease

characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk

Definition

United States National Institutes of Health (2000) a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of 2 main features: bone density and bone quality.

Osteoporosis according World Health Organization (WHO)

Normal
Cortical

Osteopenia

Osteoporosis

Severe Osteoporosis

Trabecular

Sincere thanks to Dr. Susan Ott for permission to use the above images

Classification

Primary Osteoporosis Type 1 high turnover Type 2 low turnover Secondary Osteoporosis (type 3)

Classification
Type I (high turnover) Early menopause 10 yrs after

Estrogen osteoclast activity

Losses 3% annualy fast bone depletion

Classification
Type 2 low turnover th or 8th Decade 7 Osteoblast activity due to aging, nutritional insufficiency Losses 0,5% annually # at minor trauma

Classification
Type 3 Careful : < 50 yo, rapid bone loss Underlying disease

Risk Factors

Clinical signs and symptoms

"silent disease"

Back pain Decreased in height Kyposis Fracture caused by minor trauma (Pathological fracture)

Bone fracture in osteoporosis

Osteoporosis

Fracture locations

Osteoporosis detection

Radiographic findings BMD (Bone Mineral Density) measurement Biochemical markers

BMD (Bone Mineral Density) measurement

Indication: Assess degree & progressivity bone metabolic disease Screening high risk Follow up

BMD (Bone Mineral Density) measurement

1.

2.

3. 4.

5.

Dual-energy x-ray absorptiometry (DEXA) Calcaneal quantitative ultrasonometry (QUS) Quantitative CT Radiographic absorptiometry Single-energy x-ray absoprtiometry

Singh Index

Osteoporosis detection

DXA (Dual Energy X-ray Absorptiometry)

Prevention & Treatment

Aim: early intervention to ensure retention of bone mass, preserve structural integrity, prevent fragility fracture

Prevention & Treatment

Consist of: Non-pharmacological intervention Pharmacological intervention Operative therapy

Non-pharmacological intervention

Adequate Ca & Vit D intake RDA for Ca:

4 8 yo: 800 mg 9 18 yo: 1300 mg Premenopause: 1000 mg Male < 50 yo : 1000 mg Menopause & male > 50 yo: 1500 mg Pregnant & lactating: 1000 mg

Non-pharmacological intervention

RDA for Vit D:

< 50 yo: 400 IU > 50yo: 800 IU

Vit D3 more potent than D2 Maintain adequate protein intake Physical activity imapct type Prevention of fall

Osteoporosis prevention

Vitamin D

Vitamin D meningkatkan penyerapan kalsium

Exercise

Fall Prevention

Tranqualizer Visus problem Gait abnormality

Pharmacological intervention
1.

2. 3. 4.

5.

Estrogen (hormone replacement therapy/HRT) Biphosphonate Calcitonin Selective estrogen-receptor modulator (SERM) Iprivlafone

Pharmacological intervention

Operative treatment

If theres any fracture Vertebrae vertebropalsty, kyphoplasty Hip ORIF, hemiarthroplasty Wrist ORIF

Surgery