OSTEOPOROSIS

OSTEOPOROSISWidya ArsaIntroductionBecome major health problemCanada: 1 of 4, 1 0f 8USA: > 1 million fragility fracturecost US$ 10 billionIn 2041, elderly people > 25%Preventable diseaseBone Remodeling CycleBone lining cellsBoneOsteoclastsResorption byosteoclastsOsteoblasts3The steps involved in the remodeling cycle include:Initiation of recruitment of osteoclasts (bone-resorbing cells) to the lining cells on the bone surfaceErosion of the bone surface by the osteoclasts, which dissolve the mineral and matrix and produce a resorption cavityAttraction of osteoblasts (bone-forming cells) to the resorption pitMineralization and completion of the cycle by covering the bone surface with lining cells of collagen and mineralsThe complete process from resorption to the formation of new bone takes about 100 days per site.It should be noted that collagen crosslinks are released as a by-product of osteoclastic resorption. Normal Bone Osteoporosis

Bone Regulation

Low bone mass + micro structure damagedFragileIncreased # riskDecreased bone quality Decreased bone strengthDefinitionConsensus Development Conference (1993) a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk

DefinitionUnited States National Institutes of Health (2000) a skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength reflects the integration of 2 main features: bone density and bone quality.

Osteoporosis according World Health Organization (WHO)

NormalOsteo-peniaOsteo-porosisSevere Osteo-porosisCorticalTrabecularSincere thanks to Dr. Susan Ott for permission to use the above imagesClassificationPrimary OsteoporosisType 1 high turnoverType 2 low turnover

Secondary Osteoporosis (type 3)ClassificationType I (high turnover)Early menopause 10 yrs after

Estrogen osteoclast activity

Losses 3% annualy fast bone depletion

ClassificationType 2 low turnover7th or 8th DecadeOsteoblast activity due to aging, nutritional insufficiencyLosses 0,5% annually# at minor traumaClassificationType 3 Careful : < 50 yo, rapid bone lossUnderlying diseaseRisk Factors

Clinical signs and symptoms"silent disease" Back painDecreased in heightKyposisFracture caused by minor trauma (Pathological fracture)

Bone fracture in osteoporosis

Osteoporosis

Fracture locations

Osteoporosis detectionRadiographic findings

BMD (Bone Mineral Density) measurement

Biochemical markersBMD (Bone Mineral Density) measurementIndication:Assess degree & progressivity bone metabolic diseaseScreening high riskFollow upBMD (Bone Mineral Density) measurementDual-energy x-ray absorptiometry (DEXA)Calcaneal quantitative ultrasonometry (QUS)Quantitative CTRadiographic absorptiometrySingle-energy x-ray absoprtiometry

Singh Index

Osteoporosis detection

DXA (Dual Energy X-ray Absorptiometry) Prevention & TreatmentAim: early intervention to ensure retention of bone mass, preserve structural integrity, prevent fragility fracturePrevention & TreatmentConsist of:Non-pharmacological interventionPharmacological interventionOperative therapyNon-pharmacological interventionAdequate Ca & Vit D intakeRDA for Ca:4 8 yo: 800 mg9 18 yo: 1300 mgPremenopause: 1000 mgMale < 50 yo : 1000 mgMenopause & male > 50 yo: 1500 mgPregnant & lactating: 1000 mg

Non-pharmacological interventionRDA for Vit D:< 50 yo: 400 IU> 50yo: 800 IUVit D3 more potent than D2Maintain adequate protein intakePhysical activity imapct typePrevention of fall Osteoporosis prevention

Vitamin D

Vitamin D meningkatkan penyerapan kalsium Exercise

Fall PreventionTranqualizerVisus problemGait abnormality

Pharmacological interventionEstrogen (hormone replacement therapy/HRT)BiphosphonateCalcitoninSelective estrogen-receptor modulator (SERM)Iprivlafone

Pharmacological intervention

Operative treatmentIf theres any fractureVertebrae vertebropalsty, kyphoplastyHip ORIF, hemiarthroplastyWrist ORIF