King Abdul Aziz University

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• King Abdul Aziz University
• Faculty Of Pharmacy
• Department Of Clinical Pharmacy
• Prepared by Ahmed Fahad Basilim
• Supervised by Dr. Abdurrahman Al Ahdal

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OSTEOPOROSIS
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MAIN POINT

• I- Definition and types.
• II- Pathogenesis.
• III- Diagnosis of osteoporosis.
• IV- Prevention Treatment.

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I- Definition

• A systemic skeletal disease characterized by low
  bone mass and micro architectural deterioration
  of bone tissue lead to bone fragility and
  susceptibility to fracture.

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Common Fracture Sites
Vertebral Fracture
Forearm Fracture
Hip Fracture
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Cont.

• There are two types
• A- Primary osteoporosis.
• B- Secondary osteoporosis.

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A- Primary osteoporosis

• -Primary osteoporosis classified as
• 1. Type I (menopausal)
• - Occurs mainly in persons aged 51 to 75.
• - Six times more common in women.
• - Associated with vertebral and Colles' (distal
  radius) fractures.

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Cont.

• 2. Type II (senescent)
• - Occurs in persons gt 60.
• - Two times more common in women.
• - Associated with vertebral and hip fractures.
• Overlap between types I and II is substantial, so
  this classification is of limited clinical use.

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B- Secondary osteoporosis
Endocrine
Nutritional
Drug-Induced
Immobilization
Other
Rheumatoid A. Diabetes Tumors (Myeloma, etc.)
Hyperthyroidism Hypogonadism Cushing Syndrome
Glucocorticoids Immunosuppressly Anticonvulsants
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II- Pathogenesis

• Diminished bone mass can result from
• A- Failure to reach an optimal peak bone mass in
  early adulthood.
• B- Increased bone resorption.
• C- Decreased bone formation after peak bone mass
  has been achieved.
• All three of these factors probably play a
  role in most elderly persons. Low bone mass,
  rapid bone loss, and increased fracture risk
  correlate with high rates of bone turnover (i.e.,
  resorption and formation).

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Cont.

• In osteoporosis, the rate of formation is
  inadequate to offset the rate of resorption and
  maintain the structural integrity of the skeleton.

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III- Diagnosis of Osteoporosis

• A- Physical examination.
• B- Measurement of bone mineral content
• 1. Dual X-ray absorptiometry (DXA).
• 2. Ultrasonic measurement of bone.
• 3. CT scan.
• 4. Plain radiography .

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A- Physical examination

• Osteoporosis
• Height loss
• Body weight
• Kyphosis
• Humped back
• Tooth loss

No single maneuver is sufficient to rule in or
rule out osteoporosis without further testing.
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1. Dual X-ray absorptiometry
-The test is non-invasive and involves no special
preparation. -Accuracy at hip gt 90. -Low
radiation exposure and the procedure is
rapid. -Error in Osteomalacia Osteoarthriti
s Previous fracture
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2. Ultrasonic measurement
-Can assess the density and structure of the
skeleton. -No radiation exposure, Inexpensive
and portable. -Preferred use in assessment of
fracture risk.
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3. CT scan
-True volumetric study. -Most useful in
cancellous bone assessment. -Drawback High
cost High radiation exposure Difficult quality
control
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4. Plain radiography

• -Low sensitivity.
• -High availability.

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IV- Prevention and treatment

• Optimal calcium intake reduces bone loss.
• Routine to recommend supplemental vitamin D.
• Exercise in young individuals increase the
  likelihood that they will attain the maximal
  genetically determined peak bone mass.

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Cont.

• Person with low bone mass and multiple risk
  factors, particularly those who have already had
  an osteoporotic fracture should be consider for
  antiresorptive therapy.

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Antiresoptive drugs

• Include
• 1- Estrogens.
• 2- Bisphosphonate.
• 3- Selective estrogen receptor modulators
  (SERMs).
• 4- Calcitonin.

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1- Estrogens Activella

• Can prevent menopausal bone loss in most women.
• The treatment of choice for postmenopausal women,
  particularly those who had an early menopause,
  and for women who have had a hysterectomy.
• Decreases the risk of osteoporotic fractures by
  30 to 50.

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2- Bisphosphonates

• Bisphosphonates drugs like alendronate Fosamax
  and pamidronate.
• Use for women cannot tolerate estrogen or have
  contraindications (e.g., preexisting breast
  cancer, risk factors of breast cancer).
• These drugs increased bone mass and decrease the
  risk of fractures, particularly in patient taking
  glucocrticoids.

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Cont.

• 3- Selective estrogen receptor modulators
• -These drugs are antiestrogenic and have
  antiresorptive effects on bone.
• 4- Calcitonin
• -Used for many years in prevention and treatment
  of osteoporosis.

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Other therapies

• 1- Anabolic therapy.
• 2- Parathyroid hormone and fluoride
• Stimulate bone formation and inhibit bone
  resorption.
• Their efficacy and safety remain to be
  established.
• 3- Thiazides
• Decrease urinary calcium excretion and slow bone
  loss.

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Conclusion

• Osteoporosis is chronic silent disease no
  symptoms at the early stage of bone loss.
• Osteoporosis requires early intervention before
  the dramatic 1st fracture followed by a cascade
  of others fractures.

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Cont.

• Patient should be educated to reduce the
  likelihood of any risk factors associated with
  bone loss and falling.
• Osteoporosis does not directly cause death.
  However, an excess mortality of 10 to 20 occurs
  in patient with established osteoporosis,
  particularly those with hip fractures.

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sources

• 1- www.osteoporosis.
• 2- www.osteo.org.
• 3- www.webmd.com /osteoporosis/default.
• 4-www.nof.org.
• 5- www.endocrineweb.com/osteoporosis.

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Thank you