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Osteoporosisfdh
Osteoporosisfdh
EPIDEMIOLOGY
Osteoporosis is a major public health problem,
and postmenopausal osteoporosis constitutes as a
major part of the problem.
Claus Christiansen, Am J Med 1993
Introduction
Osteoporosis is a disease characterized
by low bone mass and microarchitectural
deterioration of bone tissue, leading to
enhance bone fragility and a consequent
increase in fracture risk
(WHO)
Senile Osteoporosis
Occurs in men and women over the age of
70 years with female to male ratio of 2:1
It affects : cortical and trabecular bone
equally, predisposing patient to multiple
wedges vertebral and femoral neck
fractures
Aging and long-term calcium deficiency is
more important.
Etiology :
General factor predictive of osteoporosis :
1. Peak bone mass at maturity :
General / familial
Nutritional
Physical (activity status, exercise, etc)
Life style (alcohol, cigarettes, caffeine)
Medical (chronic disease, hypogonadal states, etc
Iatrogenic (corticosteroid, anticonvulsant, etc)
Orthopaedics Study Guide, Metabolic Bone Disease, 1999, p.885-889
Bone Mass
Development
Bone Mass
Bone Loss
male
Menopause
female
20
40
age
Age (year)
60
80
4. Risk factors
Genetic, life style, Medical, Iatrogenic
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
- Female sex
- Caucasian / Asian ethnicity
- Family history of osteoporosis
2. Life Style
3. Medical :
- Early menopause
- Gonadal hormone deficiency
states
- Eating disorders
- Chronic liver / kidney disease
- Malabsorption syndrome
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
4. Iatrogenic
- Corticosteroids
- Excessive thyroid hormone
- Chronic heparin therapy
- Radiotherapy to skeleton
- Long-term anticonvulsants
- Loop diuretics
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
DIAGNOSIS
History :
o ras, sex and age
o health status
o life style (alcohol, smoking)
o physical activity (sports)
o history of previous disease including administration of
drugs, previous fracture.
Physical Examination :
Body weight and height (BMI)
Extremities and spine including :
deformity, MMT and ROM
Laboratory findings :
o blood serum
o hormone
o Urine
LABORATORY FINDINGS :
Routine:
- Serum :
- Complete blood counts
- Electrolytes, creatinine, blood urea, nitrogen calcium
- Phosphorus, protein, albumin, alkaline phosphatase,
liver enzyme
- Protein electrophoresis
- Thyroid function tests
- Testoterone (men only)
- 24 hours urine :
- calcium
- Pyridinium cross-links
LABORATORY FINDINGS :
Spesial :
- Serum:
- 25 hydroxyvitamin D3
- 1,25 hydroxyvitamin D3
- intact parathyroid hormone
- osteocalcium (bone Gla protein)
- Urine :
- Immunoelectrophoresis
- Bence-Jones protein
IMAGING :
Radiology : plain X-ray
(especially the spine, hip and wirst)
The spine
The Hip
- Singh Index
The Wirst
Fracture risk
Teatment
> +1
very low
no treatment
densitometry with indication
-1 s/d 0
low
no treatment
densitometry after 5 years
- 1 s/d +1
low
no treatment
densitometry after 2 years
-1s/d -2,5
midle
prevention
densitometry after 1 years
< - 2,5
no fracture
high
osteoporosis treatment
continue prevention
densitometry after 1 years
< - 2,5
With fracture
very high
osteoporosis treatment
continue prevention
surgery with indication
densitometry after within
6 month 1 years
Prevention
Aging process is a natural process of a person
getting old
3 steps of osteoporosis prevention :
I. Up to the end of 3rd decade
where Peak Bone Mass should be
achieved
II. After the 3rd decade up to menopause /
Andropause
III. Senile, prevent from minor injury /
accident
1st Prevention :
Good nutrition
2nd Prevention