Osteoporosis Prevention Dr Moh Hasan

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Osteoporosis

Osteoporosis or "porous bone"

Is a disease of the skeletal system

Characterized by:

Low bone mass

Deterioration of bone tissue.

Increase risk of bone fractures typically in

the wrist, hip, and spine.

Definition


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Osteoporosis Epidemiology

1 in 3 women and 1 in 12 men over the age of 50worldwide have osteoporosis.

It is responsible for millions of fractures annually,

mostly involving the lumbar vertebrae, hip, and

wrist.

Fragility fractures of ribs are also common in men.

Osteoporosis is a major public health threat inUSA it afflicts 55% of Americans aged 50 and

above.

Of these, approximately 80% are women.


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Risk of osteoporosis development

In Spite of:

Both Sexes

All Ages EveryEthnic group

Can develop osteoporosis.

Yet some are at more risk than others.


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Osteoporosis Risk Factors

1. Non-modifiable

2. Potentially modifiable

3. Specific diseases and disorders4. Medications

Risk Factors can be classified as follows:


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Non-modifiable Risk Factors

1.Advanced age

2.Female sex

3.Estrogen deficiency following menopose

(Causes rapid reduction of bone miniral density)4.Decrease in testosterone levels has a less

pronounced effect than estrogen

5.European and Asian ethnic origin

6.Family history of osteoporosis or fracture7.Heritability and genitics (at least 30 genes

associated with osteoporosis development)

8.Previous fracture


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Diseases and disorders as

Risk Factors1. Imobilization disorders (eg fracture, space flight)2.Hpergonadal states (eg Anorexia nervousa)

3.Premature ovarian failer

4.Endocrine disorders that can induce bone loss

(eg Cushings syndrome) Inactivity

5.Conditions of malabsorption

6.Hematologic disorders (eg sickle cell disease)

7.Several inherited disorders (eg osteogeniss

imperfecta)

8.Patients with rheumatologic disorders

9.Renal insuffeciency

10. Severe liver diseases


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Medications as Risk Factors

1.Steroids and Glucocorticoids

2.Barbiturates and Antiepileptics

3.L-Thyroxin overreplacement4.Hypogonadism inducing drugs

5.Anticoagulants

6.Thiazolidines used for diabetes

7.Chronic Lithium therapy


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Primordial Osteoporosis prevention

Prevent modifiable risk factors specially:

1. Calcium deficiency avoidance

2. Weight-Bearing physical activities


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Calcium needs by AGE

Amount mg/dayAges210Birth6 months

2706 months1 year

50013

80048

1300913

13001418

10001930

10003150

12005170

120070 or older

Source: Dietary Reference Intakes for Calcium, National Academy of Sciences, 1997


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Recommended daily Calcium intake

among pregnant women

Amount mg/dayAges

13001418

100019

50


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Good sources of calcium

Dairy productslow fat or nonfat milk,cheese, and yogurt

Dark green leafy vegetablesbok choyandbroccoli

Calcium fortified foodsorange juice,cereal, bread, soybeverages, and tofu

products

Nutsalmonds

Vitamin D helps in the absorption

of calcium


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Weight-Bearing Physical Activity

Walking, Jogging, or running

Tennis or Racquetball

Stair climbing Jumping rope

Basketball

Soccer Weight lifting

Dancing


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Weight-Bearing Physical Activity

Adults: spend 30 minutes of moderate

physical activity on most days of the week

Childen: spend 60 minutes of moderate

physical activity on most days of the week


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Primary Prevention

Screening for Early Case finding

AND

Immediate treatment


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How to screen? Dual energy X-ray absorpitometry (DXA). Bone miniral density less than 2.5 standard

deviation below that of a young referencepopulation is diagnostic of osteoporosis.

WHODefinitions:T-score is the number of standard deviation for a

density below the mean of reference population

T-score -1.0 or greater is "normal"

T-score between -1.0 and -2.5 is "low bonemass" (or osteopenia")

T-score -2.5 or below is osteoporosis


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Who is to screen?

All women 65 years of age or older

Women at 60 to 64 years of age who are

at increased risk.

Highe risk person with lower body weight

(weight < 70 kg), with less evidence for

smoking or family history of low weight.


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Secondary prevention

Medication

Diet Calcium and Vitamin D

Exercise


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Tertiary prevention

Hip fracture complicated by:

Deep venous thrombosis, pulmonary embolism orpneumonia.

Need total assistance to mobilize

The 6-month mortality rate following is approximately13.5%.

Vertebral fractures complicated by:

Can lead to severe chronic pain of neurogenic origin

Deformity. Multiple vertebral fractures can lead to such severehunch back (Kyphosis) causes pressure on internalorgans and can impair one's ability to breathe.

Reduction of health related Quality of life

Prevention of these complications

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Osteoporosis Prevention Dr Moh Hasan