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  • Osteoporosis

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    Osteoporosis is a quantitative bone disorder characterized by decreased bone mineral density and distortion of bone microarchitecture, leading to pathological fractures. It is most common in post-menopausal women. Risk factors include estrogen deficiency, low calcium/vitamin D, smoking, alcoholism, steroid use, rheumatoid arthritis, and family history of fractures. Diagnosis involves dual energy x-ray absorptiometry scans comparing bone mineral density to young healthy adults using T-scores or same-aged individuals using Z-scores. Treatment focuses on lifestyle changes, calcium/vitamin D supplementation, and medications that inhibit bone resorption like bisphosphonates or stimulate bone formation like teriparatide.

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    Osteoporosis is a quantitative bone disorder characterized by decreased bone mineral density and distortion of bone microarchitecture, leading to pathological fractures. It is most common in post-menopausal women. Risk factors include estrogen deficiency, low calcium/vitamin D, smoking, alcoholism, steroid use, rheumatoid arthritis, and family history of fractures. Diagnosis involves dual energy x-ray absorptiometry scans comparing bone mineral density to young healthy adults using T-scores or same-aged individuals using Z-scores. Treatment focuses on lifestyle changes, calcium/vitamin D supplementation, and medications that inhibit bone resorption like bisphosphonates or stimulate bone formation like teriparatide.

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    17 views15 pages

    Osteoporosis

    Uploaded by

    priyathileepan-1
    Osteoporosis is a quantitative bone disorder characterized by decreased bone mineral density and distortion of bone microarchitecture, leading to pathological fractures. It is most common in post-menopausal women. Risk factors include estrogen deficiency, low calcium/vitamin D, smoking, alcoholism, steroid use, rheumatoid arthritis, and family history of fractures. Diagnosis involves dual energy x-ray absorptiometry scans comparing bone mineral density to young healthy adults using T-scores or same-aged individuals using Z-scores. Treatment focuses on lifestyle changes, calcium/vitamin D supplementation, and medications that inhibit bone resorption like bisphosphonates or stimulate bone formation like teriparatide.

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    of 15

    Osteoporosis

    • Quantitative bone disorder

    • Decrease in
    • Osteoid matrix
    • Mineral phase
    • Bone mineral density

    • Micro architectural bone distortion (bone geometry is affected)


    • Leading to pathological fractures
    Peak bone mass

    • Spine:20years
    • Long bones:25-30years

    • Pathological fractures:vertebral>hip>distal radius.


    • After 70 years-hip fracture
    • Distal forearm fracture are the early and sensitive marker of bone
    fragility in males.
    • Most common in post menopausal females(40%)
    • Secondary osteoporosis is due to metabolic causes
    Risk factors
    • Modifiable causes
    • Smoking
    • Estrogen deficiency (early menopause,oophorectomy)
    • Decrease calcium
    • Decrease vitamin D
    • Alcoholism
    Non modifiable causes

    • History of fracture
    • As an adult
    • In 1st degree relative

    • Female gender
    • Age
    • White race
    • Dementia
    Secondary causes
    • Steroids
    • Proton pump inhibitors
    • Heparin
    • Lithium
    • SSRI
    • Cyclosporine
    • Pioglitazone
    • Eltroxin
    • Hypogonadism
    • Hyperprolactinemia
    • Turner syndrome
    • Klinefelter syndrome

    • Endocrine
    1. Hyperparathyroidism
    2. Cushings syndrome
    3. Diabetes mellitus (type 1 and 2)
    4. Thyrotoxicosis
    5. Adrenal insufficiency
    • Rheumatological disorders
    1. Rheumatoid arthritis
    2. Ankylosing spondylitis

    • Miscellaneous causes:
    1. Multiple myeloma
    2. Thalassemia
    3. Hemochromatosis
    4. Marfan syndrome
    5. Ehler danlos syndrome
    6. Sarcoidosis
    Pathophysiology
    • Increased peak bone mass
    • Increased osteoclastic activity
    • Decreased osteoblastic activity
    • Micro architectural bone changes

    • Diagnosis of osteoporosis
    1. Dexa scan:dual energy xray absorptiometry
    • Indications
    1. Women>65 years/men >70 years
    2. Younger males/females with risk factors
    3. Prior fragility fracture.
    • Prior fragility fracture
    • Family history
    • Smoking
    • Steroid
    • Alcoholic
    • Rheumatoid arthritis/ankylosing spondylitis.

    • Bone mineral density in comparison with:


    1. Young healthy adult-T score
    2. Same age-Z score
    • T score
    1. It is the BMD at the site when conpared to the young normal
    reference mean. It is a comparison of a patients BMD to that of a
    healthy 30 year old
    2. Normal is a T score of -1 or higher
    3. Osteopenia is defined as a T score between -1.0 and -2.5
    4. Osteoporosis is defined as a T score of -2.5 or lower ,that is,a BMD
    which is two and half standard deviation below the mean of a 30
    year old women.
    Zscore
    • It is the number of standard deviations a patients BMD differs from
    the average BMD of their age ,sex, and ethnicity.

    • A z score of -2 or below should trigger investigations for underlying


    disease.
    Treatment of osteoporosis
    • Smoking cessation
    • Physical activity
    • Stop alcohol
    • Adequate calcium -1000mg/day
    • Vitamin D -2000IU /day
    • Drugs
    1. Inhibitors of bone resorption:
    • A)bisphosphonates: DOC
    • Alendronate
    • Risedronate
    • Ibandronate
    • Zolendronate

    • B)calcitonin
    • C)hormone replacement therapy
    • D)SERM
    • Stimulators of bone formation
    1. Fluoride
    2. Recombinant PTH- Teriparatide

    • Mixed mechanisms
    • Strontium ranelate

    • Adjunctive therapy
    1. Calcium
    2. Vitamin D
    3. Denosumab

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