Osteoporosis

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Osteoporosis

• Dr. Aisha Sheikh
• FCPS (Pak),
• Fellowship Diabetes/Endocrinology (AKUH),
• PG Dip Diab (UK)
• Consultant Endocrinologist

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Normal Bone Vs osteoporotic bone
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Definition

• Osteoporosis is a skeletal disorder characterized
  by compromised bone strength, predisposing to an
  increased risk for the development of fragility
  fractures

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Bone Living tissue

• Bone remodeling and osteoporosis

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• Osteoporosis results from an unhealthy imbalance
  between two normal acitivites of bone i.e.
• Bone formation
• Bone resorption

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Bone remodeling

• The combined processes of bone formation and bone
  resorption allow the healthy skeleton to be
  maintained continually by the removal of the old
  bone and its replacement with new bone
• These combined processes are termed bone
  remodeling or bone turnover
• During the first 20 to 25 years of life, these
  processes are balanced

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• Following a period of balanced bone formation and
  resorption, the destruction of bone exceeds the
  formation of bone this imbalance leads to a net
  loss of bone, and the beginning of osteoporosis
• With every 10 decrease in bone mass the risk of
  fracture increases from 1.5 to 3 folds

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Prevalence of osteoporosis
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Osteoporosis - prevalence
Estimated global prevalence
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Osteoporosis and fractures
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Increased risk of hip fracture
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Increased risk of vertebral fractures
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Epidemiology
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• The risk of osteoporotic fracture increases with
  age
• Fracture rates in men are approximately one half
  those seen in women of the same age
• Each year in UK
• 25,000 vertebral fractures
• 40,000 wrist fractures
• 50,000 hip fractures
• 1/5 victims die in next 6 months
• Only 50 return to their previous level of
  independence
• Huge costs

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Pathogenesis
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• Diminished bone mass can result from
• Failure to reach an optimal peak bone mass in
  early adulthood
• Increased bone resorption
• Decreased bone formation after peak bone mass has
  been achieved
• 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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Risk factors
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Diagnosing osteoporosis
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• Without a fracture on bone density screening
  there is no way to diagnose the presence of
  osteoporosis
• Get information on compounding risk factors

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Bone densitometry

• Only method of diagnosing or confirming
  osteoporosis in the absence of a fracture
• National Osteoporosis Foundation recommends that
  bone densitometry be performed routinely in all
  women gt 65, particularly in those who have one or
  more risk factors
• Densitometry can also be used for monitoring the
  response to therapy

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Osteoporosis prevention and treatment
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• Patients should be thoroughly educated to reduce
  the likelihood of any risk factors associated
  with bone loss and falling
• Optimal calcium intake
• Supplemental vitamin D
• Exercise in young individuals increases the
  likelihood that they will attain the maximal
  genetically determined peak bone mass

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Prevention of falls

• Sedatives (sleeping pills) should be minimized or
  discontinued
• Visual impairment should be corrected
• Ambulatory aids (walking aids) should be used
  when appropriate
• Make the home fall proof adequate lighting,
  carpeting, handrails, non-slip surfaces in
  bathrooms, removal of obstacles to walking

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Osteoporosis treatment

• Management of fracture and treatment of
  underlying disease
• Medical treatment of osteoporosis
• Antiresorptive therapy
• Anabolic agents

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Key points

• Osteoporosis is a common condition resulting in
  significant morbidity and mortality by
  predisposing to fragility fractures
• Adequate calcium, vitamin D intake and weight
  bearing exercises should be utilized for its
  prevention
• Measures should be taken for prevention of falls
  in elderly

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Key points (Contd.)

• DEXA scan is the most accurate and precise tool
  for measurement of bone mineral density, with
  least radiation exposure as well.
• Risk factors should be addressed
• Medical treatment should be offered to patients
  with osteoporosis

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Thank you!!