osteoporosis

WelcomeBICC|27th July, 2010

Osteoporosis: Challenges, When & How to Treat

DRAFT Aclasta Brand Book

Prof. Muhammad Shahiduzzaman

Prof & Head, Department of Orthopaedics and Traumatology

Dhaka Medical College Hospital

Osteoporosis: Challenges to meet

Bone and its component Bone Homeostasis Bone remodeling Definition and classification of osteoporosis Prevalence Risk Factors and presentation Diagnosis Consequences Management principle Treatment goal

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Objectives


Bone and its component Organic Component: protein collagen & specialized

cells called osteoclasts, osteoblasts, and osteocytes

Inorganic component: Mainly as calcium phosphate,

in the form of Hydroxyapatite


Bone Homeostasis

Bone Homeostasis: the situation when the body

requires and achieves an equal amount of bone resorption and bone formation

the amount of bone eroded by osteoclasts is equal to theamount of bone produced by osteoblasts, thereby producing a stable net mass of bone in the body

Homeostasis

Bone Remodeling The combined processes of breaking down bone and

building new bone are called Bone Remodeling.

It is the body’s way of maintaining bone homeostasis.

5 Stages: Initiation, Resorption, Reversal, Bone formation and Completion of remodeling.


Remodeling: Activation


Osteoclast precursor cells are attracted to a bone site and penetrate the bone lining cells. These osteoclast precursor cells then form activated osteoclasts that align themselves in direct contact with mineralized bone matrix.

Remodeling: Resorption


The osteoclasts erode a cavity by removing mineral and organic components from the bone. The osteoclasts eventually die. This completes the resorption phase.

Remodeling: Revarsal


Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance.

Remodeling: Formation


Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance.

Remodeling: Resting


The lining cells rest on the bone surface until the next cycle of bone remodeling begins.

Some osteoblasts become osteocytes.

Remodeling timeline


Osteoporosis

Under diagnosed

Under reported

Inadequately researched

Challenges of Osteoporosis


Definition of OsteoporoisNational Osteoporosis Foundation: a disease characterized by low bone

mass an micro-architectural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures.”

World Health Organization (1994) : bone mineral density T-score greater

than –2.5 standard deviations from the mean peak adult bone mass (ie. a woman in her 30’s).”


Classification of Osteoporosis Primary osteoporosis• Juvenile osteoporosis. • Idiopathic osteoporosis• Postmenopausal

osteoporosis• Age-related, or senile,

osteoporosis

• Secondary osteoporosis• Congenital• Diet• Drugs• Endocrine disorder• Other Systemic Disorder


Osteoporosis

Losing bone with years

Prevalence

“Osteoporosis, the silent thief of your bone”


Prevalence…


Worldwide, over age of 50 1 in 3 women / 1 in 8 men have osteoporosis.

80 % of those suffering from osteoporosis are women. Affects 75 million persons in the US, Europe and Japan.

Over 50% of women aged 50 years or older and 20% of men will suffer an osteoporosis-related fracture within their remaining lifetime

Risk Factors


Being female Older age Family history of osteoporosis or broken bones Being small and thin History of broken bones Low sex hormones

• Low estrogen levels in women, including menopause

• Missing periods (amenorrhea)

• Low levels of testosterone and estrogen in men

Risk Factors…


Diet• Low calcium intake • Low vitamin D intake • Excessive intake of protein,

sodium and caffeine Inactive lifestyle Smoking , Alcohol abuse Certain medications• steroid , anticonvulsants etc

Certain diseases• anorexia nervosa, rheumatoid

arthritis, gastrointestinal diseases and others

Presentation


People may not know that they have osteoporosis until they break a bone.

Vertebral (spinal) fractures may initially be felt or seen in the form of Persistent, unexplained back pain Loss of height Spinal deformities such as

kyphosis or stooped posture.

Diagnosis


Bone mineral density (BMD) tests can measure bone density in various sites of the body.

BMD test is done to diagnose and predict fracture risk and to monitor therapy.

For patients on pharmacotherapy, it is typically performed 2 years after initiating therapy and every 2 years thereafter; however, more frequent testing may be warranted in certain clinical situations.

Diagnosis…


Dual-energy X-ray Absorptiometry (DXA) Scan

• “Gold-standard” for BMD measurement.• Measures “central” or “axial” skeletal sites: spine and

hip.• May measure other sites: total body and forearm.• Validated in many clinical trials.• Available in Bangladesh.

Diagnosis…


Dual-energy X-ray Absorptiometry (DXA) Scan

Classification T-score

Normal -1 or greater

Osteopenia Between -1 and -2.5

Osteoporosis -2.5 or less

Severe Osteoporosis -2.5 or less and fragility fracture

Complications


FRACTURE , The most serious complication of

Osteoporosis that leads to

Increased morbidity Increased mortality

Decreased quality of life

Complications…


Wrist fracturemen 1 in 40 (2.5%)

women 1 in 6 (16%)

Spinal fracturemen 1 in 20 (5%)

women 1 in 6 (16%)

Hip fracturemen 1 in 17 (6%)

women 1 in 6 (17.5%)

Management principle


Decreased fracture risk

Life style modification Therapeutic Intervention

• Minimizing risk factors Slowing/stopping bone loss

• Minimizing factors that Contribute to fall

Maintaining or increasing bone density and strength

Maintaining or improving bone microarchitecture

Pharmacologic management


Supplements such as which maintain bone mass Calcium, Vitamin D

Anti-resorptive agents which inhibit bone resorption Bisphosphonates

Anabolic agents, which stimulate bone formation and, in turn, increase

bone mass.

Goal of treatment


Prevent further bone loss Increase or at least stabilize bone density Prevent further fractures Relieve deformity (e.g., kyphoplasty) Relieve pain Increase level of physical functioning Increase quality of life

Thank You

osteoporosis

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