PRAKASH HOSPITAL &PRAKASH INSTITUTE OF TRAUMA AND ORTHOPAEDICSNOIDA : PRAKASH HOSPITAL &PRAKASH INSTITUTE OF TRAUMA AND ORTHOPAEDICSNOIDA 1 17 September 2009 Dr. V. S. Chauhan
Hospital Dr. Indranil Halder
Prakash Hospital Slide 2: osteoporosis Slide 6: “Osteoporosis is not serious enough for me to worry about” 6 ON THIN ICE Osteoporosis Myths : 7 “I’m a healthy person. I do the right things so I am not at risk.” Osteoporosis Myths Osteoporosis Myths : 8 Osteoporosis Myths “I’m too young to worry about Osteoporosis now.” Osteoporosis Myths : Osteoporosis Myths “It’s too late for me to do anything
about Osteoporosis.” Osteoporosis – Problems to address : Osteoporosis – Problems to address BURDEN OF DISEASE
FRAGILITY FRACTURES What is Osteoporosis ? : What is Osteoporosis ? A disease characterized by:
low bone mass
microarchitectural deterioration of the bone tissue
enhanced bone fragility
increase in fracture risk 11 17 September 2009 Two components of the bone: Cortical bone: compact boneCancellous bone: spongy bone : Two components of the bone: Cortical bone: compact boneCancellous bone: spongy bone Burden of Disease“silent epidemic” : 13 Burden of Disease“silent epidemic” Osteoporosis - epidemiology : Osteoporosis - epidemiology Disorder of postmenopausal women of northern European descent
Increase in the incidence related to decreasing physical activity
Over 27 million or 1of 3 women are affected with osteoporosis
Over 5 million or 1of 5 men are affected with osteoporosis Slide 15: 26 million osteoporotic patients (2003 figures),
36 million by 2013.
Indian women aged 30-60 years from low income groups, BMD values were much lower than developed countries.
High prevalence of
osteopenia (52%) and
Mainly to be due to inadequate nutrition 15 17 September 2009 WHO guidelines defining osteoporosis : WHO guidelines defining osteoporosis Based on BMD values as
measured by DEXA
Normal: SD value +1 to -1
Osteopenia: -1 to -2.5
Osteoporosis: > -2.5
Severe osteoporosis: > -2.5
This does not apply to men and children Bone Mass – Physiological change : Bone Mass – Physiological change Determinants of Bone Mass and Architecture : Determinants of Bone Mass and Architecture ethnicity *
peak bone mass *
rate of change *
and interactions *
exercise 18 9/17/2009 * =Genetically endowed Physiology of remodeling : Physiology of remodeling 19 9/17/2009 Lets understand – what causes osteoporosis ? : Lets understand – what causes osteoporosis ? Osteoporosis : Osteoporosis Mechanisms causing osteoporosis
Imbalance between rate of resorption and formation
Failure to complete 3 stages of remodeling
Types of osteoporosis
Type I PRIMARY
Type II OSTEOPOROSIS
SECONDARY Osteoporosis - types : Osteoporosis - types Postmenopausal osteoporosis (type I)
Caused by lack of estrogen
Causes PTH to overstimulate osteoclasts
Excessive loss of trabecular bone
Age-associated osteoporosis (type II)
Bone loss due to increased bone turnover
Mineral and vitamin deficiency Secondary osteoporosis : Secondary osteoporosis Who gets osteoporosis ? : Who gets osteoporosis ? Age
Low body weight (being thin and small)
Race and ethnicity
Medical conditions 24 17 September 2009 Are men spared from osteoporosis ? : 25 Underdiagnosed Unrecognized Underreported Inadequately researched Are men spared from osteoporosis ? The ‘silent epidemic’ strikes men too : The ‘silent epidemic’ strikes men too It may be cost-effective to screen and treat osteoporosis in men
age 65 and older who've had fractures and
all men age 80-85. Symptoms of osteoporosis : Symptoms of osteoporosis Osteoporosis as a silent illness
Often diagnosed with osteoporosis only after a fall or bump causes a bone to break or fracture.
As the illness progresses, symptoms may include:
Back pain, which can be severe if you have a fractured or collapsed vertebra
Loss of height over time, with an accompanying stooped posture
Fracture of the vertebra, wrists, hips, or other bones How can I find out if I have osteoporosis ? : 28 How can I find out if I have osteoporosis ? No accurate ways to measure bone strength. : No accurate ways to measure bone strength. Bone mineral density (DEXA)
X-ray 29 17 September 2009 Who should have bone mineral measurements? : Who should have bone mineral measurements? Ideally, all women, at age 45 and then again after their menstrual periods have ceased.
Second, all individuals with multiple risk factors, regardless of age.
Third, patients with various diseases and/or who take various medications. 30 17 September 2009 When Measurement of BMD IsNot Appropriate ? : When Measurement of BMD IsNot Appropriate ? Healthy premenopausal women
Healthy children and adolescents
Women initiating ET/HT for menopausal symptom relief (other osteoporosis therapies should not be initiated without BMD measurement) Who Should Be Consideredfor Prevention or Treatment? : Who Should Be Consideredfor Prevention or Treatment? Postmenopausal women with T-score below –2.0 with no risk factors
Postmenopausal women with T-score below –1.5 with one or more risk factors Can I prevent osteoporosis ? : Can I prevent osteoporosis ? Five Steps to Bone Health and Osteoporosis Prevention:
1. Get your daily recommended amounts of calcium and vitamin D
2. Engage in regular weight-
3. Avoid smoking and excessive
4. Talk to your healthcare
provider about bone health
5. When appropriate, have a
bone density test and take
medication. 33 17 September 2009 Prevention : 34 Prevention Slide 35: Weight-Bearing Exercise Consult your doctor first Can I prevent my bone loss ? : 36 Can I prevent my bone loss ? PharmacologicalTreatment of osteoporosis : PharmacologicalTreatment of osteoporosis A. Anti-resorption drugs: commonly used
Calcium and vitamin D (1000 mg of calcium and 800 U of vitamin D3 daily)
Hormone replacement – estrogen (SERMs) evista, raloxifen (fiona)
Calcitonin- nasal spray (osteospray, miacalcin)
Bisfosfonates – alendronate (osteophos),
residronate (risophos, gemphos),
ibandronate(idrophos). B. Bone forming drugs :
Fluorides 17 September 2009 37 Bone insufficiency and falls : Bone insufficiency and falls Low bone mineral density predicts fracture risk.
At least 30% of individuals fall at least once in their life.
Only 5% of falls result in fracture.
Most fractures occur in the home. 38 17 September 2009 Avoid falls and fracture : Avoid falls and fracture 1. Fall proof your HOME
2. Take good care of your HEALTH
Feet and footwear
Blood pressure and blood sugar
Don’t hesitate to see your doctor
Be slow and steady.
3. Keep your body in shape
Which came first, the fall or the fracture? 40 17 September 2009 Fracture risk – women Vs men : Fracture risk – women Vs men Common osteoporotic fractures: hip fracture : Common osteoporotic fractures: hip fracture Elderly persons with hip fractures numbers will double to 2.6 million by 2025.
The lifetime risk of hip fracture is 11.1% for men and 22.7% for women.
Almost half of all hip fractures occur in patients aged 80 or over. 45 17 September 2009 Wrist fracture : Wrist fracture Common consequence of osteoporosis.
More likely to occur in women with OSTEOPOROSIS who are healthy and active. 47 17 September 2009 Fractures of spine : Fractures of spine Osteoporotic vertebral compression fractures are very common.
25% of women aged 70 years and older and 40% of women aged 80 and older.
Significant performance impairments in physical, functional, and psychosocial domains and increased risk of mortality and hospitalization. 48 17 September 2009 Cervical and Lumbar region of the spine.Minimal trauma, such as sneezing, lifting, bending, or coughing. : Cervical and Lumbar region of the spine.Minimal trauma, such as sneezing, lifting, bending, or coughing. 49 17 September 2009 Kyphosis :
reduction in pulmonary
mobility. Slide 50: BUT IS THAT ENOUGH ?? Conclusion : Conclusion Two aspects of Osteoporosis management
Timely treatment of osteoporosis and prevent fractures
2. Emergency and optimal treatment of osteoporotic fractures
TEAM WORK AIMING FOR TOTAL CARE 55 17 September 2009 Goals to achieve : Goals to achieve Restore mobility
Reduce pain and deformity
Increase fitness level 56 17 September 2009 Take home message : Take home message 1. 2. 3. 4. 5. Recapitulate : Recapitulate Exercises in osteoporosis : Exercises in osteoporosis Take consultation of your doctor first THANKYOU : 60 17 September 2009 THANKYOU