INVESTIGATIONS IN By OSTEOPOROSIS

Dr. Deepti Patil

INTRODUCTION
Most common in women after menopause. It is estimated that 1 in 3 women and 1 in 12 men over the age of 50 worldwide have osteoporosis. It is responsible for millions of fractures annually, mostly involving the lumbar vertebrae, hip, and wrist.
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DEFINATION
Systemic skeletal disease characterizes by lowered bone mass and micro architectural deterioration of bone tissue. Reduction in Bone Mineral Content and Bone Mineral Density distrust's micro architecture of the bone
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ETIOLOGY
Remains asymptomatic for considerable period till bone loss become advanced. Estrogen deficiency Inadequate bone formation Over consumption of dietary protein
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RISK FACTORS

Age :
Post-menopause Advance age Low testosterone in men Decreased calcitonin

Nutrition :
Low calcium intake Low vitamin D High phosphate intake Inadequate calories

a.

a.

b.

b.

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SIGNS AND SYMPTOMS
Pain Tenderness General debility Weakness (muscular and skeletal) Abdominal distension Insomnia Kyphosis and Scoliosis

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INVESTIGATIONS
X ray DEXA - (Dual Energy X ray Absorptiometry) Quantitative computed tomography (QCT) and Quantitative ultrasound (QUS)

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Conti….
Bone biopsy Bone markers
a.

Formation markers (osteoblastic activity). Resorption markers (osteoclastic activity).

b.

Neutron activation analysis

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CONT…
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DEXA
Dual Energy X-ray Absorp tiometry
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Dual Energy X-ray Absorptiometry A scanner used to measure bone density. Indirect indicator of osteoporosis and fracture risk. Painless and non-invasive and involves minimal 7/18/10 Investigations in 1212 radiation exposure

INDICATIONS
All women aged 65 and older regardless of risk factors Younger postmenopausal women with one or more risk factors. Postmenopausal women who present with fractures (to confirm the diagnosis and determine disease severity). Estrogen deficient women at clinical risk for osteoporosis.
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Individuals with vertebral abnormalities. Individuals being monitored to assess the response or efficacy of an approved osteoporosis drug therapy. Individuals with a history of eating disorders
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INTERPRETATION
Results are often reported in 3 terms: Measured density in g cm-3 z-score, the number of standard deviations above or below the mean for the patient's age, sex and ethnicity t-score, the number of standard deviations above or below the mean for a healthy 30 year old adult of the same sex and ethnicity as the
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LIMITATIONS
Can be affected by the size of the patient, the thickness of tissue overlying the bone. Reference standards for some populations (e.g., children) are unavailable for many of the methods used.
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QUANTITATIVE COMPUTED TOMOGRAPHY (QCT)
commonly abbreviated as pQCT. A type of quantitative computed tomography (QCT), used for making measurements of the bone mineral density (BMD) in a peripheral part of the body. It is useful for measuring bone strength.
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Quantitative Computed Tomography
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Comparison to DXA
A pQCT scan is able to measure volumetric bone mineral density, plus other measures such as the stressstrain index (SSI) and the geometry of the bone. DXA is only able to provide the areal bone mineral density

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QUANTITATIVE ULTRASOUND (QUS)
The modality is small, no ionizing radiation is involved, measurements can be made quickly and easily. The calcaneus is the most common skeletal site for quantitative ultrasound assessment. The method can be applied to children, neonates, and preterm infants, just as well as to adults.
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BONE BIOPSY A bone biopsy is the removal of a piece of bone or bone marrow for examination
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Bone Marrow Aspirati on
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Position of the patient during procedure
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PROCEDURE
By applying a numbing medicine (local anesthetic) to the area, and make a small (about 1/8 inch) cut in the skin. A special drill needle is usually used. The biopsy needle is pushed and twisted into the bone.
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Conti…
Once the sample is obtained, the needle is twisted out and the sample is sent for examination. Pressure is applied to the site. Once bleeding stops, the site is cleaned and covered with a bandage.
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RISKS
Bone fracture Bone infection (osteomyelitis) Damage to surrounding tissue Discomfort Excessive bleeding Infection near the biopsy area
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BONE MARKERS
a.

Formation markers (osteoblastic activity). Resorption markers (osteoclastic activity).

b.

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Conti…
Bone markers are blood and urine tests that helps to determine the rate of bone resorption and/or formation is abnormally increased or decreased, Used to determine a person’s risk of bone fracture and to monitor drug therapy for patients receiving treatment for skeletal disorders, 7/18/10 Investigations in
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Conti…
During bone resorption, cells called osteoclasts dissolve small amounts of bone, while enzymes dissolve the protein network. Bone formation is then initiated by cells called osteoblasts. They secrete a variety of compounds that help form a new protein network, which is then mineralized with calcium and
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FORMATION MARKERS (osteoblastic activity).
Bone formation blood tests include: Bone-specific alkaline phosphatase (ALP) Osteocalcin (bone gla protein) P1NP (Procollagen Type 1 N-Terminal Propeptide)

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RESORPTION MARKERS
(osteoclastic activity).

Urine or blood tests for bone resorption include: C-telopeptide (C-terminal telopeptide of type 1 collagen (CTx)) N-telopeptide (N-terminal telopeptide of type 1 collagen (NTx)) Deoxypyridinoline (DPD) 7/18/10 Investigations in
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NEUTRON ACTIVATION ANALYSIS Neutron Activation Analysis (NAA)
is a nuclear process used for determining certain concentrations of elements in a vast amount of materials. NAA allows discrete sampling of elements as it disregards the chemical
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Conti…
Neutron activation analysis is a technique used to very accurately determine the concentrations of elements in a sample.

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THANK YOU
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