Dr Getasew

OSR 1
February 2016

osteoporosis
Objective

 After this presentation students should be able to know:

 Definition of osteoporosis
 Epidemiology of osteoporosis
 Pathophysiology of osteoporosis
 risk factors
 clinical features
 how to work up patients
 principles of managment
Definition
 It is multifactorial progessive skeletal disorder
characterized by reduced bone mass and
deterioration of bone microarchitecture
predisposing to increased fracture risk.

 It is called a ‘silent disease’ because it progress with

out symptoms and remain unnoticed for long time
as bone resorption process in early stages and later
usually present with fracture following trivial
trauma.
 Definition…

 Bone mass density more than 2.5

standard deviations below the
averge in young healthy
subjects(T-score< -2.5) is
osteoporosis.
WHO definition…
Epidmology
 Osteoporosis affects about 75 million people in USA Japan
and Europe.

 It’s prevalence increases with age and it mainly affects

postmenopausal women and older men.

 In 1990 there were 1.7 million hip fractures worldwide.

 with anticipated increase of world population and life
expectancy this figure is estimated to be 6.3 million by 2050.

 Two million bone breaks a year.

Epidemiology …
 Worldwide one in 3 women over 50 will suffer a
fracture due to osteoporosis ;this increases to one in
2 in women over 60.

 One in 5 men over 50 will suffer a fracture due to

osteoporosis ; this increases one in 3 over 60.
pathophysiology
 Multiple pathogenetic mechanisms involved.

 Under physiologic condition there is fair balance between bone

resorption and bone formation.

 If there is a change in either i.e if there increased bone

resorption or decreased bone formation it may result in
osteoporosis

 The hallmark of osteoporosis is a reduction in skeletal mass

caused by an imbalance between bone resorption and bone
formation.
.
Pathophysiology …..
 Osteoclasts drived from haematopoitic cells are responsible
for bone resorption where as osteoblasts drived from
mesenchymal cells are responsible for bone formation.

 Osteoclasts reqiure weeks to resorb the bone where as

osteoblasts need months to produce the bone.

 Therefore , anything that increases the rate of bone

remodeling will result in net effect of bone loss over time.

 RANKL/RANK/OPG system is the final pathway for bone

resorption.
Risk factors
 Nonmodifiable  Potentially modifiable
 Age (>50)  Cigarette smoking
 Low body weight
 Female sex
 Alcohol intake
 Ethnicity (whites)
 Inadequate physical exercise
 Genetic (family history)  Drugs
 Dementia  Early menopause
 Frequent falls
 Estrogen deficiency
 Poor health
 Calcium deficiency
Clinical feature

 Half of patients are asymptomatic

 Acute or chronic back pain

 Loss of height

 kyphosis

 Fracture due to trivial trauma

Investigations

 Plain radiography

 Bone mass density measurement using

 DEXA gold standard

 Biochemical markers of bone turnover

Principle of managment

 Prevention
 By correcting modifiable risk factors

 Treating underlying secondary causes

 Addressing falling risks

 Commencing drug therapy