Pendekatan Diagnosis Osteoporosis

Dr. dr. Em Yunir Masthor, SpPD-KEMD

Division of Endocrinology and Metabolis, IInternal Medicine Department
Dr. Cipto Mangunkusumo National General Hospital
Faculty of Medicine, Universitas Indonesia
Outline
• Epidemiology
• Introduksi
• Fisiologis metabolisme tulang
• Faktor-faktor risiko osteoporosis
• Pendekatan diagnosis klinis osteoporosis
• Pemeriksaan Bone Mass Densitometry
 Definition of Osteoporosis
Kelainan skeletal sistemik yang ditandai oleh penurunan
densitas massa atau voume dari tulang sehingga tulang
mudah patah
 Prevalensi osteoporosis di Indonesia tahun 2006

Tirtarahardja Gunawan, Setyohadi Bambang, Zhou Weynand Q. Bone Mineral Density Reference Values for Indonesian Men and Women. ASBMR presentation slide. 2006.
 Penyebab Osteoporosis

Primer Sekunder
• Menua • Kekurangan hormon:
• Idiopatik hipogonadisme, hipotiroid
• Obat-obatan (steroid)
• Alkoholism
• Gangguan saluran cerna
• Merokok
• Berbaring terlalu lama
• Keganasan
Proses Pembentukan massa tulang
• Faktor yang
memengaruhi:
• Gender
• Ras
• Hormon
• Nutrisi
• Aktifitas fisik
• Lifestyle
The bone
remodeling
process
Risk factor of Osteoporosis
 The prevalence
of osteoporosis
and fracture risk
factors
regarding age
(N=1274)

Schurer C, Wallaschofski H, Nauck M,, Vozke H, Schober HC. Fracture risk and risk factors for osteoporosis. Dtsch Arztebl Int. 2015 May;
112(21-22): 365–371.
 Odds ratio for
osteoporosis
concerning risk
factors
(N=1274)
univariate and
multivariate
regression

Schurer C, Wallaschofski H, Nauck M,, Vozke H, Schober HC. Fracture risk and risk factors for osteoporosis. Dtsch Arztebl Int. 2015 May;
112(21-22): 365–371.
 Risiko fraktur berdasarkan kelompok usia

Schurer C, Wallaschofski H, Nauck M,, Vozke H, Schober HC. Fracture risk and risk factors for osteoporosis. Dtsch Arztebl Int. 2015 May;
112(21-22): 365–371.
 Pengaruh olah raga thd BMD

Multani, Kaur NK, Chahal A. Impact of sporting activities on bone mineral density. Journal of exercise science and physiotherapy. 2011; 7(2): 103-9
 Pengaruh jenis olah raga terhadap BMD

Multani, Kaur NK, Chahal A. Impact of sporting activities on bone mineral density. Journal of exercise science and physiotherapy. 2011; 7(2): 103-9
 Pendekatan Klinis Osteoporosis
Anamnesis
Physical & Supporting
Examination
Risk Factor Assessment:
• Background (age, family
history, habits)
• Ongoing
conditions/medicines LABORATORY EXAMINATION
• Nutrition Rontgen
• Exercise +
• Surgical History BMD
• Frax Criteria
Clinical Manifestations
• Fragilitity Fractures
• Compression Fracture
• Radiculopatic Pain
• Spinal Cord compression or
Cauda Equina Syndrome
Tulang belakang Wanita Normal Osteoporosis
Genant et al. JBMR 1993; 8(9): 1137-48.
 Diagnosis
• Seringkali (65%) osteoporosis tanpa
gejala dan tak diketahui
• Bila ada patah tulang belakang
 diagnosis tidak sulit

•Bila tidak ada patah tulang

 Identifikasi faktor risiko

Pemeriksaan foto rontgen

diperlukan Tulang Belakang
 Frax Criteria
“ diagnostic tool to evaluate fracture risk in 10-year
probability”

WEBSITE: https://tinyurl.com/osteoporosisindo
 Pemeriksaan penunjang pada osteoporosis

Jeannette E. Paul S. Osteoporosis: part i. evaluation and assessment Am Fam Physician. 2001 Mar 1;63(5):897-905.
 Bone turnover markers

Shetty S, Kapoo N, Bondu JD, Thomas N, Paul TV. Bone turnover markers: Emerging tool in the management of osteoporosis. Indian J Endocrinol Metab. 2016 Nov-Dec;
20(6): 846–852.
 Bone Mineral Density (BMD)

• Dual X-Ray to diagnose

osteoporosis, assess fracture risk,
and monitor changes
• Different technologies for
measuring BMD:
• DXA
• QCT
• pQCT
• HR-pQCT
• QUS
 Indikasi pemeriksaan BMD

Garg MK, Kharb S. Dual energy X-ray absorptiometry: pitfalls in measurement and interpretation of bone mineral density. Indian J Endocrinol Metab. 2013 Mar-Apr; 17(2): 203–210.
 Pemeriksaan Bone
Mass Density
(BMD)

• DEXA of a female patient, 23

years old, with vasculitis, on
daily oral corticosteroids for
one year (18.3 g cumulative
dose) showing osteoporosis
in the lumbar spine and
osteopenia in the left hip

Salem D, Talaat S, Abdel-Halim MRE, Mohsen KM.

Assessment of bone mineral density by dual x-ray
absorptiometry in dermatological patients treated by
corticosteroids. Indian Journal of Dermatology.
2010;55(3):238-245.
BMD Osteopenia
 The Result of BMD
Age Category Criteria
Below expeted range
< 50 years Z-score ≤ -2.0
for age
Within Expeted range
Z-score > -2.0
for age
Severe (established) T-score ≤ -2.5 with
≥ 50 years
osteoporosis fragility fracture
Osteoporosis T-score ≤ -2.5
Low bone Mass T-score -1.0 to -2.5
Normal T-score ≥ -1.0
Sheu A, Diamond T. Bone mineral density: testing for osteoporosis. Aust Prescr. 2016 Apr; 39(2): 35–39.
Kesimpulan
• Osteoporosis merupakan penyakit kronis progresif
• Faktor risiko yang alami dipengaruhi oleh : usia, jenis kelamin, gaya
hidup
• Faktor risiko sekunder, beberapa penyakit dapat meningkatkan
osteoporosis seperti
• Diagnosis berdasar gejala klinis dan faktor risiko, pemeriksaan fisik,
laboratorium danpemeriksaan BMD