osteoporosis pesentation

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PRAKASH HOSPITAL &PRAKASH INSTITUTE OF TRAUMA AND ORTHOPAEDICSNOIDA : 

PRAKASH HOSPITAL &PRAKASH INSTITUTE OF TRAUMA AND ORTHOPAEDICSNOIDA 1 17 September 2009 Dr. V. S. Chauhan MS Ortho C.M.D. Prakash Hospital Dr. Indranil Halder D-ortho, DNB-ortho Orthopaedic surgeon 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 CAUSE DIAGNOSIS PREVENTION TREATMENT FRAGILITY FRACTURES

What is Osteoporosis ? : 

What is Osteoporosis ? A disease characterized by: low bone mass microarchitectural deterioration of the bone tissue Leading to: 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 osteoporosis (29%). 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 with fracture 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 * hormonal status extraneous factors and interactions * diet 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 Malabsorption Mineral and vitamin deficiency

Secondary osteoporosis : 

Secondary osteoporosis

Who gets osteoporosis ? : 

Who gets osteoporosis ? Age Sex Family history Low body weight (being thin and small) Race and ethnicity Menopause Diet Life style Medications 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) QUS QCT 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- bearing exercise 3. Avoid smoking and excessive alcohol 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

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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), palmidronate, ibandronate(idrophos). B. Bone forming drugs : PTrH (forteo) Strontium 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 Vision Hearing 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 Regular exercise Don’t smoke Limit alcohol 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 : deformed posture, reduction in pulmonary capacity and decreased physical 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