Bone Osteoporosis

Bone Osteoporosis:

Bone Osteoporosis The Silent Disease Dr. Hani Kamel

Definition;:

Definition; It is a skeletal disorder characterized by low Bone Mineral Density (BMD) , and poor bone quality that leads to an increased risk of insufficiency fractures It is subdivided into Type 1 and Type 2 .

Type 1 osteoporosis:

Type 1 osteoporosis Primarily result of low Oestrogen conc. In postmenopausal women and an increase in the interleukine 6 ( cytokinase ) and tumer necrosis factor (TNF) .

Type 2 Osteopoross:

Type 2 Osteopoross It is a result of combination of secondary hyperparathyrodism and decreased bone formation rates due to decreased oestrogen concentration in aging women and men .

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In 1994 WHO offered definition of osteoporosis based on bone density measurement (BMD) as equal or less than2.5 standard deviation (SD) Below young adult mean value , and osteopenia as BMD greater than 1.5 but less than 2.5 SD below young adult mean value .

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Recently ,International Society for Clinical Densitometry it is estimated that 1-2 million men have osteoporosis and 8-13 million men have osteopenia .

History ;:

History ; Osteoporosis is considered as a silent disease until an insufficiency fracture occurs . Usually clinical Risk factors are increasing age and female gender . Other significant risk factors include : Previous insufficiency fractures . Glucocorticoid therapy . Low body weight .(Anorexia Nervosa) . Poor visual acuity . (Diabetes) Decreased proximal muscle strength . Family history

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Cont., Ankylosing Spondylitis and Rheumatoid arthritis Crohn’s Disease . Premature menopause. Malabsorption syndrome eg . Coeliac disease Prolonged immobilization or sedentary life . Primary Hyperparathyrodism . Hyperthyrodism . Post transplantaion . Chronic Renal failure . Caucasian and Asian races.

Diagnosis;:

Diagnosis; BMD testing remains as the cornerstone in the diagnosis of osteoporosis. But Who should be tested ?? According to National Osteoporosis Foundation, * all women aged 65 and older regardless the risk * Postmenopausal women undergoing treatment * Postmenopausal women presenting with insufficiency fractures

Additional Tests ;:

Additional Tests ; Serum Calcium Magnesium . Creatinin . Parathyroid Hormone . 25 Hydroxy Vit D levels . Testosterone in men Serum and Urine electrophoresis , to screen multiple myeloma Screening of Malabsorption Syndrome 24 h. Urine examination may help with identifying Ca++ malabsorption or idiopathic hypercalcuria

presentation;:

presentation; Unfortunately osteoporosis declares itself with an insufficiency fracture eg ; Colles ’ Fracture . Neck femur fracture . Sacral fracture . Femoral Shaft fracture. Spine insufficiency fractures

Management;:

Management; It is multifactorial and includes combination of Lifestyle Modification ,Nutritional and Pharmacutical intervention and of course surgical intervention to treat the resulting fractures which is followed by physiotherapy.

Life Style Modification ;:

Life Style Modification ; All pts. should pursue a combination of Wt. bearing exercises & strength training . Pts. advised on fall prevention as proper lighting in rooms, removal of rugs and door steps , the use of walking devices and the avoidance of uneven walking surfaces.

Pharmacological Therapy;:

Pharmacological Therapy; Bisphosphonates , eg . Sod Alendronate ( Fosamax ) , Risedronates ( Actonel ) , Ibandronate ( Boniva ) . They are poorly abosrbed so they should be taken on empty stomach . They could be associated with oesphagitis . They are implicated with Osteonecrosis of the Jaw . Annual infusion of Zoledronic acid leads to decrease in fr . Risk by 35%

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Raloxifene ; A selective estrogen receptor modulator (SERM). Acts on bone by decreasing bone resorption by Osteoclasts . Calcitonin ; works by directly inhibiting oseoclast activity via calcitonin receptor on the surface of osteoclasts by affecting actin cytoskeleton which is needed for osteoblastic activity

Bone Anabolic Agents ;:

Bone Anabolic Agents ; It is the only anabolic agent currently approved for The treatment of osteoporosis . It is composed of Amino terminal portion of human parathyroid hormone . This fragment binds to parathyroid H. 1 receptor resulting in recruitment of osteoblasts resulting in net bone formation .

Strontium Ranelate :

Strontium Ranelate It causes the uptake of Strontium ( Sr ) in place of Calcium into bone matrix thus leading to increased Bone mineral density , but makes it harder to Follow up prognosis with Densitometry as Sr is not the same as Ca++ , so it needs special techniques for monitoring .

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Thank you