• 1 Tuesday 28 Oct 2008 Hall I Session I: 8:00-10:00 Symposium ...

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A.Shahla, MD (Iran). 9:14-9:22. Treatment of femoral shaft fractures a comparative study between open intramedullary nail and plate & screw (paper) ...

Evaluation of osteoporosis in patients with a hip fracture

A,SHAHLA.MDUrmia university of medical sciences

“…a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.”

Definition of osteoporosis

World Health Organization (WHO), 1994

normal osteoporotic

Trabecular bone

Bone quality is not the only factor …

Osteoporosis major public healt treat55% people 50yr and older

Bone loss starts slow decline 3rd decade 0.5-1% pr/yr

6rd decade 2-3% pr/yr

The life risk of sustaining an osteoporotic fracture has been estimated at50%,compared with9% for

breast cancer and 31% for coronary artery disease

Arch intern med1989;149:2445-8.

Osteoporosis evaluation

Bone mineral density (BMD)

World Health Organization (WHO)guidelines for osteoporosis

Osteoporosis Osteopenia

Normal

Peak Bone Mass

-2.5 -2 1 0T-Score

Definitions: BMD Results

Status T-scoreT-score= # of SDs below or above mean value of BMD for young (20-29yo) adults

Normal +2.5 to −1.0, inclusiveOsteopenia Between −1.0 and −2.5Osteoporosis −2.5Severe osteoporosis −2.5 + fragility fracture

Z-score= # of SDs below the mean value for people ofthe same age

Kanis JA. J Bone Miner Res 1994;9:1137-1141.

Osteoporotic fractures

• 1.5 million in USA• 250.000 fx/yr• 300.000 hip• 250.000 wrist• 700.000 spine• 300.000 other sites

• National osteoporosis foundaton.2005

Hip fracture is serious consequence of hip fractureeven small increase in lifespan will lead to large

increase in the rate of hip fractures

Hip fractures worldwidewas1.7million in1990 and projected to 6.3 million in2050

Curr osteoporos.2003;1:66-70

Consequences of hip fracture

• 20%mortality within 6months• 50%loss ability to walk• 20%sever impaired mobility after 12 months

requiring nursing care• Increased risk of furher fracture5.2%first yr-

10.3% 3 yr

Optimal fracture treatment – a prerequisite for maintaining quality of life

Care gap

Few patients are offered investigation or treatment for osteoporosis

Interventions to improve osteoporosis treatment following hip fracture

Gardner MJ. JBJS(American).2005;87:3-7

Barriers and solution to osteoporosis care in patients with a hip fracture

Kaufman JD. JBJS(American).2003;85:1837-43

Orthopedic surgeon should identify and initiate the assessment of osteoporosis in patients with fragility fractures

Intrnational osteoporosis foundation(IOF)

osteoporosis int.2005;16 suppl:44-53

BMD,T score is suggested for evaluation of osteoporotic fractures

USA National osteoporosis risk assessment(NORA)

Osteoporos int.2006;17:565-74

Evaluation of osteoporosis in patients with a hip fracture in Urmia

Shahid motahhari hospitalSeptember2004-january2006

Contra lateral hip BMD were detected

Excluding criteria

• Previous hip fracture• Precedent osteoporosis treatment• Acute medical complications requiring intense

care• Long term steroid therapy• Paralytic patients• bedridden

76 hip fracture patients

• 50yr and older• Low energy trauma(fall)

Men 44(57.9%) Women 32(42.1%0)Age 50-90 mean 66yrTrochantric 55(77.4%)Femoral neck 21(27.6%)

.

Fixation 58(76.3%)Hemiathroplasty 12(15.8%)Traction 3(3.95)Conservative 3(3.9%)

.

55(72%) osteoprosis17(23%) osteopenia4(5%) normal

.

There were not significance

men and womenNeck and trochantric fractures

age

Urmia • 76 patients• Female 42%• Male 58%• Mean age 66yr• Femural neck 27.6%• Intertrochantric 77.4%• Subtrochantric –• Osteporosis 72%

Florida Kamel H. Clin Rheumatol 2005;11:68-71. • 95 patients• Female 71%• Male29%• Mean age 81yr• Femural neck 51%• Intertrochantric 46%• Subtrochantric 3%• Osteoporosis 17%

Definition vs Treatment

• Defination• T score > _1.0 normal• T score = _1 to_2.5

osteopenia• T score <_2.5

osteoporosis

• Treat for osteoporosis• WHO T score<_2.0• NOF T score<_1.5

with additional risk factors

Alendronate 10mg /day_70mg /week

Vit D 800-1000 iu/dayCalcium 500-1000 mg/day

bisphosphonates

• Mechanism: blind to hydroxappetite at site of active bone resorption inhibiting osteoclast function

• Alendronate 10mg /day_70mg /week

Advantages of bisphosphonates

• Increased BMD 1-4%• Decrease fracture risk 41-44%• No increased risk of breast,uterine

thromboembolic events• Weekly dosing