Osteoporosis
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Osteoporosis is a disease characterized by reduced bone mass and density, leading to fragile bones. It affects 35% of people over 50, with women four times more likely than men to have osteoporosis. It is classified as primary, including postmenopausal and senile osteoporosis, or secondary, caused by conditions like malnutrition, inflammatory diseases, corticosteroid use, and cancers. Postmenopausal osteoporosis is caused by accelerated bone loss following menopause. Risk factors include ethnicity, family history, and early menopause. Symptoms include back pain and fractures. Treatment focuses on lifestyle changes, hormone replacement therapy, bisphosphonates, denosumab, and
Osteoporosis
- 1. OSTEOPOROSIS
- 2. DEFINITION • Is a ds characterized by increased porosity of the skeleton resulting from reduced BONE MASS PREVALENCE • 35% over 50s • F:M = 4:1
- 3. CLASSIFICATION • PRIMARY – Postmenopausal Osteoporosis – Senile Osteoporosis • SECONDARY Nutritional Malabsorption, malnutrition Inflammatory ds Rheumatiod ds, ankylosing spondylitis Drug induced Corticosteroids, excessive alcohol Endocrine ds Hyperparathyroidism, hypogonadism Malignant ds Multiple myeloma, carcinomatosis Other Immobilization, smoking
- 4. 1. Postmenopausal Osteoporosis • An exaggerated form of physiological bone depletion that usually follow ageing & gonadal insufficiency • Around menopause, & for next 10y, bone loss normally accelerates to abt 3% per year during the preceding 2 decades
- 5. Risk Factors 1. Caucasoid (white) or Asiatic ethnicity 2. Family history of osteoporosis 3. History of anorexia nervosa and/or amenorrhoea 4. Low peak bone mass in the third decade 5. Early onset of menopause
- 6. Clinical Features • Back pain • Increased thoracic kyphosis • Hx of previous Colles’/ankle/femoral neck fracture • Xray spine : compression of 1 or more vertebral bodies • DEXA : sig. reduced bone density In vertebral bodies/femoral neck
- 7. Prevention & Rx • Advice – Maintain adequate level of dietary calcium & vit D – Physical axtivity, avoid smoking & excessive alcohol intake • HRT – Most widely used – Take estrogen(combo estrogen+progesterone) for 5- 10y – reduce risk of fracture – SE : risk of thromboembolism, stroke, Ca breast & uterine
- 8. • Biphosphonates – Preferred medication – Suppress osteoclastic bone resorption reduce risk of fracture – Alendronate orally once-weekly doses – Pamidronate IV 3monthly • Denosumab – Human monoclonal antibody – Inhibit receptor activator needed to activate osteoclast differentiation – SC every 6month – Supplemented with calcium & vit D
- 9. • Mx of fracture – Femoral neck & other long bone • Operative rx – Vertebral • Analgesic • Partial rest • Physiotherapy
- 10. 2.Postclimacteric Osteoporosis in Men • d/t gradual depletion in androgenic hormones • Occurs abt 15y later • Osteoporotic fracture in men <60y should always arouse suspicion – Hypogonadism, metastatic bone ds, multiple myeloma, liver ds, alcohol abuse • Rx : similar to postmenopausal osteoporosis
- 11. 3.Involutional Osteoporosis • Causes : rising incidence of • Rx – Initially directed at managing fracture • Stabilized fracture • Mobilized & rehabilitated – Calcium & vit D Chronic illness Muscular atrophy Dietary deficiency Loss of balance Lack of exposure to sunlight Increased tendency to fall
- 12. Dx & INVESTIGATION • Dual-energy x-ray absorptiometry (DEXA) – Method of choice – measure bone density – Value of -2.5SD below norm : indicative of abnormal bone loss – Measured of spine & hip – Indication : • To assess degree & progress of bone loss in pts with clinically dx metabolic bone ds • Screening procedure
- 13. T-score Osteoporosis -2.5 Osteopenia -1 to -2.5 Normal <-1 • Result reported as • T-score – corresponds to the number of SD that the patient's bone density differs from the peak bone mass of a healthy, young person of the same sex and ethnicity. • Z-score – corresponds to the number of standard deviations that the patient's bone mineral density differs from that of a person of the same age and sex – should be used for children, premenopausal women, or men < 50 yr. – If the Z-score is ≤ -2.0, bone density is low for the patient's age
- 14. REFERENCE 1. Apley & Solomon Concise System of Othopaedics and Trauma 4TH edition 2. http://www.merckmanuals.com/professional /musculoskeletal-and-connective-tissue- disorders/osteoporosis/osteoporosis 3. http://www.healthline.com/health/osteopor osis-complications#Complications4