Osteoporosis

Dr. Femi Syahriani, Sp.PD.

Departement of Internal Medicine
University of Hasanuddin
 Intoduction
• Osteoporosis (OP): a reduction in the strength of
bone leading to an increased risk of fractures.
Loss of bone tissue is associated with
deterioration in skeletal microarchitecture.
• The World Health Organization (WHO): OP as a
bone density that falls -2.5 standard deviations
(SD) below the mean for young healthy adults of
the same gender—also referred to as a T-score of
–2.5
• OP  “silent thief” and “silent disease”
 Intoduction
• Age is not the only risk factor for osteoporosis.
Lifestyle choices, certain diseases and even
medications can lead to this condition.
• A simple test known as a bone density scan can
give important information about your bone
health.
• Newer medications can slow and even stop the
progression of bones getting weaker, and can
help decrease fracture risk.
 Intoduction
• More than 1.5 million osteoporosis-related
fractures occur each year in the United States.
• Osteoporotic fractures  the femoral neck,
the vertebral bodies, or the wrist.
• Ninety percent (90%) of all hip and spinal
fractures are related to osteoporosis.
 Intoduction
• In Surabaya (1997) 26% pasca menapause
women had OP
• OP  OP primer and OP secunder
 Pathology and Pathophysiology
• The pathophysiology of OP  genetic,
hormonal, nutritional, and environmental
influences. Some risk factors for this condition
are well defined.
• The bone mass of an individual in later life is a
consequence of the peak bone mass accrued
in utero and during childhood and puberty, as
well as the subsequent rate of bone loss
 Pathology and Pathophysiology
• Bones are an extremely dense form of
connective tissue made up principally of the
fibrous protein collagen, impregnated with a
mineral phase of calcium phosphate crystals
as well as other components such as water.
• Although they are one of the hardest
structures in the body, bones maintain a
degree of elasticity due to their structure and
material properties.
 Pathology and Pathophysiology
• During development and growth, bone is
produced by two main processes:
intramembranous ossification, as occurs in
skull bones; and endochondral ossification
involving the growth plate, as occurs in limb
bones.
• Modeling is the process that results in the
achievement of bones’ characteristic shape
and overall structure
Pathology and Pathophysiology
 Pathology and Pathophysiology
• Tulang mengalami 2 macam pertumbuhan :
Modelling dan Remodelling.
• Kedua proses ini selalu berpasangan dan
dalam keadaan normal selalu seimbang
sehingga tidak akan terjadi defisit massa
tulang.
• The principal cell types within bone are the
osteoclasts, osteoblasts, and osteocytes.
 Pathology and Pathophysiology
⁺
Osteoclastic Bone Resorption
Disbalance

⁻
-
Osteoblastic Bone Formation

Loss of bone mass

Decrease in total bone volume
Change in bone architecture
Risk for fragility & fractures
Deformities
 Diagnosis

Normal Bone Osteoporotic Bone

 Common factors predictive of OP
Peak bone mass at maturation :
• Genetic
• Nutrition
• Physical activity or exercise
• Life style
• Chronic disease
• Iatrogenic (drug induced)
Common factors predictive of OP

Loss of bone mass pasca menopause

Loss of bone massa due to aging
Other risk factor.
 How to diagnosis OP
• The clinical evaluation of OP is dedicated to identifying
lifestyle risk factors for fracture, pertinent physical
findings, and secondary causes of metabolic bone
disease.
• Evaluation of a person with or at risk for op : family
history of metabolic bone disease, changes in height
and weight, the quantity and frequency of weight-
bearing exercise, level of sun exposure, previous
fractures, reproductive history, endocrine disorders,
dietary factors, tobacco smoking, alcohol intake,
exercise, renal or hepatic failure, and past and current
medications and supplements.
 How to diagnosis OP
• Factors that increase the risk of falls :
neuromuscular disease, gait instability, and
unsafe living conditions.
• History of bone pain is potentially useful if
present, osteoporosis is not painful until the
time of fracture (if then).
 How to diagnosis OP
Physical Examination:
• Accurate height measurement using an
instrument known as a stadiometer is a vital part
of the OP physical examination
• Comparison of a patient’s current height and
maximum height obtained in young adulthood
(e.g., through reference to the patient’s driver’s
license) is helpful in identifying height loss.
• The loss of 2 inches (5 cm) in height is a fairly
sensitive indicator of vertebral compression.
 How to diagnosis OP
Physical Examination:
• The number of missing teeth has been
correlated with losses in BMD.
• The neurological examination highlights
muscular weakness or neurological
compromise that could predispose to falls
• Observation of the patient’s gait is a critical
part of the examination.
 How to diagnosis OP
Skeletal Imaging :
• Conventional Radiographythe Singh index
• Dual-Energy X-Ray Absorptiometry (DXA): T
score dan Z score
• Clasification of OP by WHO 1994
Clasification T-Score
Normal -1 atau lebih besar
Osteopenia Antara 1- dan -2,5
Osteoporosis -2,5 atau kurang
Osteoporosis berat -2,5 atau kurang dan fraktur
fragilitas
 How to diagnosis OP
• WHO FRAX Tool 2008  www.shef.ac.uk/frax
 How to diagnosis OP
Laboratory evaluation:
 Management
• Education and Prevention
• Excercise and Rehabilitation program
• Pharmacology :
1. Bisfosfonat 5. Vit. D
2. Reloksifen 6. Calsitrol
3. Terapi sulih Hormon 7. Calsium
4. Calsitonin 8. Strontium renelat
• Surgery
Thank You
 MAJOR CAUSES OF
OSTEOPOROSIS IN MEN

Alcohol

Primary Glucocorticoids ~45%

35-40%
Hypogonadism

Other

~15-20%
 OTHER CAUSES OF
OSTEOPOROSIS IN MEN

• Immobilization
• Gastrointestinal disorders • Osteogenesis imperfecta
• Hypercalciuria • Homocystinuria
• Anticonvulsants • Mastocytosis
• Thyrotoxicosis
• Primary
Hyperparathyroidism
• Neoplastic disease
• Rheumatoid arthritis
• Cushing’s disease
 Osteoporosis
⁺ -
⁻
Disbalance
Osteoclastic Bone Resorption
Osteoblastic Bone Formation

Loss of bone mass

Decrease in total bone volume
Change in bone architecture
Risk for fragility & fractures
8/31/2018 Deformities
2973 NRS P&P-1
/ziad.khaled@iat.ac.ae/FCHS
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