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Osteoporosis
a bone disease that is characterized by progressive loss of bone density and thinning of bone tissue
higher risk of fractures
25 yr – balance between bone resorption & formation - PBM (peak bone mass)
duration approx. 5 yrexaggerated resorption (0,5% /year)climacterium
Sceletal status by age
time after climacteriumlate menarcherace differences – Caucasians, etc.drugs – antiepileptics, etc.diseases – malabsorption, Cushing sy
Risk factors for osteoporosis II
Concomitant factors
unhealthy lifestylelow of calcium intakelack of vitamin Dexcessive alcohol intakestress, smoking
Primary prevention
Increase of body performance – stimulation of osteoblasts
Sufficient intake of calcium – at least 1 g/d, people in higher risk up to 2 g/d
vitamin D - food, sun
Regulatory mechanisms of bone metabolism
parathormone
calcitonine
sexual hormones - estrogens & gestagens
Vitamin D
at least 400 IU, in elderly up to 800 IUformulations containing ergocalciferole,
cholecalciferolerisk of overdosage
Antiresorptive treatment - HRT
Estrogens support bone synthesis & inhibit resorption
Proliferaratory effects are inhibited by gestagens
Referral from EMEA
SERM
selective modulators of estrogen receptorsnon-steroidal structureprotection of endometrium raloxifen, tamoxifen, droloxifen
Calcitonine
inhibition of osteoclasts, increase of tubular reabsorption of calcium, analgesic eff., stimulatuon of bone formation
calcitoninum salmonis or humanum (200 IU)
Bisphosphonates
Influence on calcium metabolismInhibition of resorption (via cytotoxicity on
osteoclasts?)Accumulation in bonesElimination via kidneys
1st generation - etidronate, clodronate2nd generation - pamidronate, alendronate3rd generation - risedronate, ibandronate
CI – disease of oesophagus, stomach or kidneys, pregnancy, lactation
Bisphosphonates
Thiazide diuretics
diminished renal excretion of calcium;
??? increase of BMD ??? good for patients with hypertension