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OSTEOPOROSIS AND OSTEOMALACIA

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OSTEOPOROSIS AND OSTEOMALACIA Prof. Mohamad S. Al-Hadramy Professor of Medicine/Consultant King Abdulaziz University Jeddah, Saudi Arabia F. 19-year-old presented ... – PowerPoint PPT presentation

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Title: OSTEOPOROSIS AND OSTEOMALACIA


1
OSTEOPOROSIS AND OSTEOMALACIA
  • Prof. Mohamad S. Al-Hadramy
  • Professor of Medicine/Consultant
  • King Abdulaziz University
  • Jeddah, Saudi Arabia

2
  • F. 19-year-old presented with difficulty in
    walking for many years, especially going
    upstairs. She felt parasthesia in hands feet
    and occasional spasm. P/E waddling gait.
  • Ca 1.8 mmol/l (2.1-2.6) P 0.54 mmol/l
    (0.7-1.4). Alk Phos 562 ( - 125).
  • What other test results you need?

3
  • Alb Urea PTH

4
  • What signs for low Ca would you look for?
  • Chovestick
  • Trouseau 4 min.

5
OSTEOMALACIA
  • Raised bone turnover
  • Failure of mineralization
  • Most common cause decreased Vitamin D
  • Darker skin more susceptible

6
  • Less common
  • Heriditary resistance to Vitamin D
  • 1 a-hydroxylase def.
  • Familial X-linked hypophosphatemia
  • Mesynchymal tumours produce phosphatonin

7
Radiology
  • Subperiosteal resorption of phalanges
  • Looser zones
  • Brown cysts

8
Chemistry
  • Decreased corrected Ca
  • (40-Alb) x 0.02 Ca
  • Decreased P Why?
  • Decreased urinary Ca
  • Decreased 25 (oH) Vit. D

9
Treatment
  • 1000 2000 IU Vitamin D/day 500 1000 mg of
    Ca/day. Rarely 50,000 100,000 u/d or 1 a 0.5
    2.5 µg/day . shorter acting to decrease tox.
  • Check Ca Q 2-4 weeks
  • Phosphate for hypophosph Rickets

10
OSTEOPOROSIS
  • Low bone density
  • Microarchitectural deterioration
  • ? fractures

11
  • Balance between bone formation and bone resorption

12
  • Max bone mass at 25 35 years
  • Increased by exercise and good Ca intake. Later
    bone mass ?, especially with ?oestrogens
    (Menopause).

13
Dx T score. What is it?
  • Normal T 1
  • Osteopenia -1gt T -2.5
  • Osteoporosis T lt - 2.5
  • Severe osteoporosis T lt-2.5 with 1 or more
    fragility, fractures

14
Chemistry normalWhy ?alk, but not persistent
15
Primary Osteoporosis
  • Senile or post-menopausal 95
  • Indiopathic

16
Secondary Osteoporosis
  • Endocrine
  • Cushing exog steroids
  • Hyperthyroidism
  • Hypogonadism
  • Hyperparathyroidism
  • DM
  • Proclatinoma
  • Acromegaly
  • Preg lactation

17
Connective Tissue
  • Osteogenesis inperfecta
  • Marfan
  • Homocystinuria

18
Drugs
  • Heparin
  • Steroids
  • Anti-convulsants

19
Renal
  • C R F

20
Nutrition and GIT
  • Malabsorption, Celiac
  • Gastrectomy
  • T P N
  • Hepatobiliary disease
  • Chronic hypophosphatemia

21
Elite female athletes and anorexia nervosa
22
Risk increased by
  • F sex
  • Menopause
  • Decreased Ca
  • Smoking
  • Alcohol
  • Inactivity
  • Leanness
  • White Race (? black)

23
Signs Symptoms
  • Asymptomatic unless
  • Back pain
  • ? Height
  • Kyphosis
  • Effect especially in
  • Dorsalverts
  • Femoral neck
  • Distal radius

24
DD Lytic lesions
  • Ca breast, Lung, Kidney, Thyroid
  • Prostate ? wall sclerosis
  • MM ? generalized thinning

25
Prevention
  • Exercise
  • Good Ca intake
  • Non-smoking

26
Screening
  • Screen post-menopausal
  • F gt64 or with multiple risk factors (e.g.,
    ?weight, fragility fractures
  • Frag of limb or spine post fall from standing
    height or less

27
TREATMENT
  • Ca 1200 mg/day
  • Vitamin D- 400-2000 IU / day
  • HRT
  • Biphosphonates
  • Calcintonin
  • S E R M S
  • Parathyroid hormone

28
Thank You !
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