OsteoporosisOsteoporosisDr Salwa Al-AnsariDr Salwa Al-Ansari

• Definition• Fragile bones (porous bones ): low density

bones• Progress to painful fractures (hip; spine; wrist)• Permanent or temporarily disability or death.• Affects women 4x men• Less Ca; PO4 and minerals.

• Signs and symptoms• In the early stages : no pain or symptoms. • symptoms include:• Sudden onset of pain, typically in the front of the

thigh, the side of the hip, the buttocks or the groin (No previous accident or injury to the joint that would trigger pain )

• Limited motion; pain intensifies with turning movements.

• Pain intensifies with weight bearing and may lessen with rest.

• Pain gradually increases over a period of weeks or month and may be so intense that it is disabling.

• A change in gait as the patient tries to protect the joint and ease the pain.

• Back pain, : a fractured or collapsed vertebra

• Loss of height over time, with an accompanying stooped posture

• Fracture of the vertebrae, wrists, hips or other bones

Bone Remolding

• Bone is continuously changing — new bone is made and old bone is broken down : a process called remodeling, or bone turnover.

• cycle of bone remodeling: two - three months. When you're young, your body makes new bone faster than it breaks down old bone, and your bone mass increases. You reach your peak bone mass in your mid-30s. After that, bone remodeling continues, but you lose slightly more than you gain.

• how much bone mass you attained between ages 25 and 35 (peak bone mass)

• Presentation• Usually silent →fracture.• Vertebral fracture:• 2/3 no attention clinically• Sudden pain:• unrelated to exertion.• Bed rest• Not generalized skeleton pain• Peripheral fractures.

Risk factors

• sex • Age • Race • Family history • Frame size • Tobacco use • Lifetime exposure to estrogen • Eating disorders • Thyroid hormone

• Some diuretics • Other medications • Breast cancer • Low calcium intake • Medical conditions and procedures that decrease

calcium absorption • Sedentary lifestyle • Excess soda consumption • Chronic alcoholism. • Depression

• pregnancy appears to help protect a woman’s calcium reserves in several ways:

• Pregnant women absorb calcium better from food and supplements than women who are not pregnant. This is especially true during the last half of pregnancy, when the baby is growing quickly and has the greatest need for calcium.

• During pregnancy, women produce more estrogen, a hormone that protects bones.

• Any bone mass lost during pregnancy is typically restored within several months after

Osteoporosis and Pregnancy

• the baby’s delivery (or several months after breastfeeding is stoppe.

• Some studies suggest that pregnancy may be good for bone health overall. There is some evidence that the more times a woman has been pregnant (for at least 28 weeks), the greater her bone density and the lower her risk of fracture.

• In some cases, women develop osteoporosis during pregnancy and/or breastfeeding, although this is rare. Osteoporosis is bone loss that is serious enough to result in fragile bones and increased risk of fracture.

Screening and diagnosis 1-X-RayDetect bone loss after 30 percent of the skeleton depleted.

2- Bone Mineral Density Tests

• Dual Energy X-R Absorptiometry (DEXA): T-score

• Hip and spine. • Identify osteoporosis• Determine your risk for fractures (broken

bones:

• Colle’s ; vertebral, hip, proximal humerus, rib, pelvis)

●Measure your response to osteoporosis treatment.

3 -Bone Scans : dye injection ●Cancer

●Bone lesions ●Inflammation ●New fractures

ultrasound and quantitative computerized tomography (CT) scanning.

MRI

• 4-Laboratroy Tests• Blood• A-blood calcium levels • B- Blood vitamin D levels • C-thyroid function • D- Parathyroid hormone levels • E- Estradiol levels to measure estrogen (in

women)

• F- Follicle stimulating hormone (FSH) test to establish menopause status

• G- Testosterone levels (in men) • H- Osteocalcin levels to measure bone

formation• Endomyseal AB (coeliac Dis).

• Bone Specific Alkaline Phosphatase (bone formation   (

• Deoxypyridinoline Crosslinks (bone resorption )• Telopeptide, Cross-Linked, Urine• N-Telopeptide, Cross-Linked• Pyridinium Crosslinks (Total)

• Urine• 24-hour urine collection to measure calcium

metabolism • tests to measure the rate at which a person is

breaking down or resorbing bone.

• Prevention• Avoid risk factors: adequate calcium and vitamin D

(helps Ca absorption, strengthen muscel and against cancer).

• TreatmentCoping with pain

• Heat and ice • Transcutaneous Electrical Nerve Stimulation (TENS)• Braces and supports • Exercise and physical therapy• Acupuncture and acupressure • Massage therapy

Physical Methods of Pain Management

• Relaxation training • Biofeedback • Visual imagery and distraction • Hypnosis • Individual, group, or family therapy

Medication for Pain Management

• Aspirin• Acetaminophen• Ibuprofen• Narcotic drugs • Antidepressant medication

Medication for osteoporosis

• Bisphosphonates • Raloxifene • Calcitonin • Teriparatide • Tamoxifen

• Emerging therapies : spinal weighted kypho-orthosis (WKO) combined with a light weight attached — and specific back extension exercises :

• Daily for 30 minutes in the morning and 30 minutes in the afternoon and while performing 10 repetitions of back extension exercises.

• References• http://www.fda.gov/• Oxford Handbook of Endocrinology and

diabetes. J Turner and J Wass.