‘+ Minor status of asialsheeton is assessed by dual photon absorptiometry (DEXA) and {quansiative CT scan + Total body neutron activation analysis to Altermine clcktm content the entire Body "rae bone Bip I 6am smportant diagnostic tool in patents of more than 50 year in pontneno pal dneare Blo chemistry: Serum calciom, phosphors and alkaline phosphatase levels are usually nota ‘Management of Osteoporosis Preventing osteoporosis i ot easier than treating The treatment plan consins of general measures ‘verses and drug therapy Gover esses = "High protein and calcium ich dit. + Rest chat is adequate 4 Muscle selaants and supports ike belt cola, etc for symprornaic rele of pain ‘Spinal orthnls when patent erect nd mabe. Exercises Exercises like walking and light aerobics are beneficial (Fg. 46 + Postureenteie: Wall arc, back bending and wall sliding postural exercises help tosmprove ponte fand overcome huncaed back (Figs J65 to). + Fill prevention is of utmost importance. Drug Therapy in Osteoporosis Drs form the mainstay of treatment of osteo [porons The varios combinations naggesta areas onfusing as the disease. However on etortismade bere 0 provide a simplistic malysis ofthe doogs commonly used in osteoporosis Calc ov vitamin D: For those patent dlagnosed by DEXA as osteoporosis, 129) mig a elem a 700-800 IV of vitamin D per day istecommended as the fat ine of therapy. ‘Hormone Replacement Therapy ‘The raleafestrogen and progesigens in preventing and teatingoseoporosihas been well documented tidronate is another commonly used biphos- pphonateTludronat, asedronate, and sbandzonote fre some of the newer re. catstonin Salmon calcitonin has been used for treating ‘osteoporosis Calcitonin can be given in the form of Injections (Dose 50100 1U/day) or in the form of ‘nasal spray (dose 200 TU). Is used forthe weatment ‘of ceeoporoisn women who are at lest ive yrs postmenopausal and in some cases of men. Tt Known to show down bore loss, a it sa powerta Inhibitor of usteoclasic activity, increane bone eas suketnn tame tans Rate © lg. 40.4: Rega neces the waking of grat ip ‘cory pans sutoreg wom Saoptoas me Figs 4888 to C: Vers poate conection eerie i Caecporaes patent A) Wa srhng (8) Back bane, 1G) Wer ting ecrosoe Estrogens are the most effective treatment for ‘steoporosis in perimenopausal and early meno [paul women. Estrogens Gose = 0425 mg dally {03 mg combined with calcium. HRT is Know fo reduce the rate of fractares by 75 percent in the ‘trogen group. Bith conto pills ate alee kncwen to prevent osteoporosis. The ole of progesterone Is still not well-documented Bphosphonates ‘Those drugs inhibit the action ofthe osteoclast bone cll, which are responsible for removing the bone macs by binding themes othe ier binge of the bones. The doe of alendronate it 10-mg/aay. ©) enasomae avaiable in the market with many permutationsand ‘combinations Though the initial choice ofthe drugs ‘depends on various factors like sex, age, presence ‘oratsenceof uterusin women, tolerate ost (ofthe times, ithe treating physician who males the choice based on ns expersence An ifort smade here to present the more appropriate of the drug ‘options inthe order of preference Common Prelerence CCaleium supplements in the dose of 1000-1500 mg shay and vitorun Daralogue (025 ng BD or tars Din the doe of 600-2800 10/9).Blidronate is ancther commonly weed biphoe- phonate Tudronate, risedronate, and foandrenate Bre some ofthe never drag Catetonin Salmon calcitonin has heen used for treating coteoporois, Ca:onin can be give in hoes of fmections (Dose 50-100 IU /day) oF i the form of rasa spray (dose 2001), eis used forthe weatment ‘tostenperoni in women who are at leant Sve ears postmenopausal and in some cases of men. It i Jenown to slow dosin bone loss, ais a power Inhibitor of osteoclastic activity, inerease bone ensity ane reduce the rick of factures Its also sown to radace the pain ‘Atlacatidot ‘This is a synthoic analogue of eactil. an active metabolite of vitamin D. lt changes to cleteol #9 thelive. Ttdesteases Lone resorption nereases bone ‘mineralization ane formation. ralso reduces the rate of fractures and improves the bone quality Recommended dose s 05 mg/day. Iissometimes piven along th cai, Role of Fides in tho Treatment of Osteoporosis Fluorides are known to increase the bone mass Lower done of 25 mg slow release Mores tice Abily along eth 400 mg of calcium twice daily recommended. The se effects are gastrointestinal Upsets anc increased risk of coral bone fractures ‘A quickrecep ofthe drugs used in osteoporosis: * cecum ana varia 0 ter | Bpnospnenaes * Ghnsorn ‘toons Fores Serus. Pankier ‘emir nd arenes. Drug Options in the Treatment of Osteoporosis Treatment of osteoporosis with the drugs i 48 ‘confusing as the disease self Many drugs ae now sateen th eet wilh ain portions ae Combinations. Though the nial choice ofthe drugs leper om various factors like ex, age, presence tor abseace of utrusin women, tolerabty ete ost Of te Gams ts Che ting plait thea a the choice based on hisexperence.Aneffortismade heve 1 present the more appropriate of the drug, pte ba to ender of pootrene ‘Common Preference Clear supplements i the dose of 1060-1500 m/ day and vitamin D analogue (025 mg BD vitamin DD's the dove of 600-2800 1U lay). First Proteronce Perimenopassal and eatly postmenopausal (firs 5 eats) estrogen replacement therapy (0425 mg/ sy ‘Second Preference For the next ten years, SERMS (eg, Ralowofene). ‘Thay ove knw to dense tho ettogas dened side effects (ike causing increased incidence of “uterine of breast cancers) while maintaining their Deneficll effets (like increasing bone mineral onaity), decreasing, menopausal symptoms, cardioprotective activity, et. SERMS are known t0 ‘ey selectively blocking certain estrogen rept ‘Ted Preference Alendronate (10 mg/day). Thins prfered next de to is proven efficacy In decreasing he hip fractures. Four Praterance Calcitonin 200 TU puff/day intranasal oF 100 1 subcutaneously. Ths is found ta be very effective to reduce the pain de to crush fractures of the Sete ity Proteranco Combination ofthe above drugs. However, despite of the several options, the final choice is of the tweating physician, weighingallthenacesay actors 692/515 © Not: Chie ofthe deg vcienscxding tothe ting, ektelna daa pn Prevention of Osteoporotic Fractures he flwing mesure ap prevent oepurte ‘+ Antisall measures for old persons at home by cvaluating and correcting home hazards end encouraging exercises and other physical aaivitien ‘+ Vitamin D (700-800 TL) with or without calm (1200 mg/day) daily doses for all persons > 60 years of age + Toprevent hip spine and non-vertebalfracares biphosphonates tn varying doses (Eg. Alen: rate 70 mg/week, Ibandrorate 180 mg/ month Risedronate 45 mg/week) ae recommended. ‘+ Inpostmenopausal women with osteoporot, lonifene is used © Galeton can be taed'to prevent tmenttent vertebral fracturesCCrapter 14 Metboke dues efbone Osteoporosis As commonly used, this tem is based clinical and radloglcl fending ater than on path tg. es mort comenon fod age and pty Ssyse mcg one nga is causes probably inde aitay defer penia or oseamalicla, and harmenal changes shih eny arty infucncingtbe efecto pray ther wont, ll the mechanisms of reduction of aahoeaed ne meat my sey {inca features Fe analy affects worn over a v0 2 ese tent men of the ame age Occadonaly, symp pause. Theta features arene pains asitde Fractures. The radeal development of» Kyphots an os of eight are the ain features. Hp see ture nthe ape are alist ceainly rated to teoporni Diagnosis Alpttents should be screen bochemlly ard ft fnes anc thianing of the eomees fom tithin, The bones may hive a “ghostly” quality Yertebeae maybe wedge the dss ay po- 1H, Kyphont use and ses eactres may Wis now possible to ase the degre of ote pores by measuring bone dens sing a dust ‘ery X-ray abroptomrc devi, known the hique to detect patents at sk, particularly pox menopausal wore. Androgen therapy has lo een tid wth ite proven bane High fuorde keels inking water are atone with lower tncence of ante poross 40 Bure ety hasbeen advocate, ‘ba it haste shown to be asic wit a high inchdence of sent have incided ealetorin and Bspotpho- acute, Newer forms of ea gue 144 Osecertcpnewtn nec istological features ‘be aren and spase. The bone which present saan adequately mineaiond but thee ray be "Heatment and prophylas are contovtsia. 1 sul to give the patient an orthopaedic support for he spine, to encourage exercse and Wo gve dietary plement of skips, vain D and proteins although the ttt i! sr abe Thormone replacement therapy” (HET, I owe cepted 3 wef metho of prophylai for pr and postmenopausal women Wentied by Setenng a belng prunes, Compliance fr often poor, partialany 13 fomltion wich mere nave been feats of pecitating beast and atabotcdseerct tone Chapter 14 ‘of osteoporaticactres Many forms of ssn ‘an be sown t0 Influence the biochemistry of thar they influence the canton ofthe beso ‘hat they alleviate symptoms,