Osteoporosis

OSTEOPOROSISOSTEOPOROSISA Preventable EpidemicA Preventable Epidemic

Dr Vispi JokhiDr Vispi Jokhi

Orthopedic SurgeonOrthopedic Surgeon

OSTEOPOROSIS DEFINITIONOSTEOPOROSIS DEFINITION

Osteoporosis is a Osteoporosis is a bony disorder bony disorder characterized by characterized by progressive progressive decrease in bone decrease in bone density and density and mass.mass.

Osteon is bone Osteon is bone and porosis is and porosis is hole in Greek.hole in Greek.

EPIDEMIOLOGYEPIDEMIOLOGY

Over 75 million osteoporotic Over 75 million osteoporotic patients in US, Europe and patients in US, Europe and Japan.Japan.

In India 26 million by 2003 In India 26 million by 2003 expected to increase to 36 expected to increase to 36 million by 2013.million by 2013.

EPIDEMIOLOGYEPIDEMIOLOGY

Female male ratio 4:1 and higher Female male ratio 4:1 and higher incidence of male osteoporosis.incidence of male osteoporosis.

50% post-menopausal women 50% post-menopausal women affected.affected.

Normal Indian bones 15% less dense Normal Indian bones 15% less dense than Caucasians and fractures occur than Caucasians and fractures occur 10-20 years earlier in Indians.10-20 years earlier in Indians.

NORMAL BONE FORMATIONNORMAL BONE FORMATION

Bone is made of Bone is made of collagen (tough elastic collagen (tough elastic fibers) and mineral fibers) and mineral (gritty hard material).(gritty hard material).

Lack of the hard Lack of the hard mineral content leads mineral content leads to softening of bones to softening of bones and fracturesand fractures

BONE AND CALCIUM BONE AND CALCIUM METABOLISM METABOLISM

Bone has 99% of Bone has 99% of calcium in calcium in hydroxyapatite form.hydroxyapatite form.

Cortical hard outer Cortical hard outer bone with more mineral bone with more mineral content.content.

Cancellous soft spongy Cancellous soft spongy bone at bony ends and bone at bony ends and in vertebrae with low in vertebrae with low mineral content.mineral content.

BONE AND CALCIUM BONE AND CALCIUM METABOLISM BONE TURNOVERMETABOLISM BONE TURNOVER

Bone live tissue Bone live tissue forming and forming and remodeling according remodeling according to body needs.to body needs.

Osteoblasts form Osteoblasts form bone.bone.

Osteoclasts resorb Osteoclasts resorb bone. bone.

CALCIUM PARATHYROID AND CALCIUM PARATHYROID AND VITAMIN D VITAMIN D

BANK OF BONESBANK OF BONES

Amount of Strong Bones formed During Amount of Strong Bones formed During Youth up to age 30-40 Youth up to age 30-40

- minus-- minus- Amount of Bone lost to RemodelingAmount of Bone lost to Remodeling

after 30-40 years to 70 years after 30-40 years to 70 years - equals - - equals -

Level of Bone Mass as an Adult (or Level of Bone Mass as an Adult (or degree of osteoporosis)degree of osteoporosis)

OSTEOPOROSIS CAUSESOSTEOPOROSIS CAUSES

Primary Osteoporosis due to nutritional Primary Osteoporosis due to nutritional causes.causes.

Couch Potato and sedentary life style.Couch Potato and sedentary life style. Age related or Senile Osteoporosis.Age related or Senile Osteoporosis. Lack of sunshine leading to decreased Lack of sunshine leading to decreased

active form of Vit D3active form of Vit D3

SECONDARY OSTEOPOROSISSECONDARY OSTEOPOROSIS

Post Menopausal due to lack of estrogen which Post Menopausal due to lack of estrogen which compensates for normal bone loss.compensates for normal bone loss.

Hyperthyroidism causes increased bone turnover.Hyperthyroidism causes increased bone turnover. Hyperparathyroidism leads to increased bone Hyperparathyroidism leads to increased bone

resorption and hypercalcemia.resorption and hypercalcemia. Hypogonadism decreased testosterone leads to Hypogonadism decreased testosterone leads to

impotence and porosis.impotence and porosis. Liver disease leading to decreased bone formationLiver disease leading to decreased bone formation

OSTEOPOROSIS DRUG RELATEDOSTEOPOROSIS DRUG RELATED

Steroid intake over prolonged periods for Steroid intake over prolonged periods for arthritic, auto-immune, asthmatic and arthritic, auto-immune, asthmatic and endocrinological disorders cause excessive endocrinological disorders cause excessive bone resorption.bone resorption.

Cyclosporine, heparin, vitamin A, certain Cyclosporine, heparin, vitamin A, certain synthetic retinoids and anti-epileptics affect synthetic retinoids and anti-epileptics affect the liver and cause decreased bone the liver and cause decreased bone formation.formation.

OSTEOPOROSIS RISK FACTORSOSTEOPOROSIS RISK FACTORS

History of fracture as an adult and in an History of fracture as an adult and in an immediate (first-degree) relativeimmediate (first-degree) relative

Low body weight (less than 127 lb [58 kg]) Low body weight (less than 127 lb [58 kg]) or weight lossor weight loss

Lifelong low calcium intakeLifelong low calcium intake Current cigarette smokingCurrent cigarette smoking AlcoholismAlcoholism Advanced ageAdvanced age

OSTEOPOROSIS RISK FACTORSOSTEOPOROSIS RISK FACTORS

Estrogen deficiency menopause before age Estrogen deficiency menopause before age 45, surgical removal of both ovaries45, surgical removal of both ovaries

Inadequate physical activityInadequate physical activity Poor healthPoor health Repeated fallsRepeated falls Dementia (ie, progressive deterioration of Dementia (ie, progressive deterioration of

intellectual abilities)intellectual abilities) Impaired vision despite adequate correction.Impaired vision despite adequate correction.

OSTEOPOROSIS vs OSTEOPOROSIS vs OSTEOMALACIAOSTEOMALACIA

Bone mass Bone mass reduced, reduced, mineralization mineralization normal elderly normal elderly

Idiopathic, Idiopathic, Endocrine abn., Endocrine abn., inactivity, disuse, inactivity, disuse, alcoholism, calcium alcoholism, calcium deficiency deficiency

Bone mass Bone mass variable, variable, mineralization mineralization decreases decreases

Vitamin D or its Vitamin D or its metab. deficiency, metab. deficiency, hypophosphatasia hypophosphatasia syndromes, renal syndromes, renal tubular acidosistubular acidosis

OSTEOPOROSIS CLINICAL OSTEOPOROSIS CLINICAL PICTUREPICTURE

OSTEOPOROSIS DIAGNOSISOSTEOPOROSIS DIAGNOSIS

Clinical picture and risk factors most Clinical picture and risk factors most important.important.

Radiological Hip Singh’s Index.Radiological Hip Singh’s Index. Serological Se Calcium, Phosphorus Serological Se Calcium, Phosphorus

and Alkaline Phosphatase.and Alkaline Phosphatase. Other markers from blood and urine.Other markers from blood and urine.

SINGH’S INDEXSINGH’S INDEX

BIOCHEMICAL MARKERSBIOCHEMICAL MARKERS

Vitamin K levels and undercarboxylated to Vitamin K levels and undercarboxylated to carboxylated osteocalcin ratio.carboxylated osteocalcin ratio.

New Collagen type 1 measured by P1NP New Collagen type 1 measured by P1NP marker and mineralization by bone specific marker and mineralization by bone specific Alkaline Phosphatase.Alkaline Phosphatase.

Bone resorption markers breakdown of Bone resorption markers breakdown of collagen, include deoxypyridinoline and collagen, include deoxypyridinoline and pyridinoline and their associated peptides pyridinoline and their associated peptides (NTX and CTX). (NTX and CTX).

BONE DENSITOMETRYBONE DENSITOMETRY

Bone densitometry is a way of measuring Bone densitometry is a way of measuring your bone density, which is a method of your bone density, which is a method of estimating the strength of bones and the estimating the strength of bones and the likelihood of bone fractures with minimal or likelihood of bone fractures with minimal or no trauma. no trauma.

On X-ray you will see changes only after 30-On X-ray you will see changes only after 30-40% bone loss.40% bone loss.


Dual Energy X-ray Absorptiometry Dual Energy X-ray Absorptiometry abbreviated DEXA or DXA is the gold abbreviated DEXA or DXA is the gold standard method.standard method.

Only 1/30Only 1/30thth of the radiation of x-ray is used. of the radiation of x-ray is used. Central BMD of spine and hip region and Central BMD of spine and hip region and

peripheral BMD of wrist forearm and heel peripheral BMD of wrist forearm and heel are done.are done.

Non-invasive safe but western standards so Non-invasive safe but western standards so tend to overestimate osteoporosis.tend to overestimate osteoporosis.


T scoreT score —compares —compares your score with healthy your score with healthy adult. A score above -1 adult. A score above -1 is considered normal, is considered normal, between -1 and -2.5 is between -1 and -2.5 is osteopeniaosteopenia, A score , A score below -2.5 is defined below -2.5 is defined as osteoporosis. as osteoporosis.

Z scoreZ score —compares —compares your score other your score other people of same age people of same age size and gender.size and gender.

http://www.radiologyinfo.org/glossary/glossary1.cfm?Term=osteopenia

QUANTITATIVE MRIQUANTITATIVE MRI

To predict the mechanical To predict the mechanical properties of bone trabeculaeproperties of bone trabeculae

To help quantify the element of To help quantify the element of osteoporosis as against osteoporosis as against osteomalaciaosteomalacia

Better follow-up investigation than Better follow-up investigation than BMDBMD

OSTEOPOROSIS TREATMENTOSTEOPOROSIS TREATMENT

Diet calcium rich foods vs. calcium Diet calcium rich foods vs. calcium available foods. Milk cause of available foods. Milk cause of osteoporosis. Sugar a calcium stealer.osteoporosis. Sugar a calcium stealer.

Supplements of calcium along with Supplements of calcium along with active vitamin D only as a temporary active vitamin D only as a temporary measure.measure.

No smoking no alcohol no milk no sugar.No smoking no alcohol no milk no sugar.

MILKMILK

Excessive Calcium is not digested as much Excessive Calcium is not digested as much as ingested as bound to complex protein.as ingested as bound to complex protein.

Excessive protein leads to acidity buffered Excessive protein leads to acidity buffered by sodium and calcium by sodium and calcium

However prolonged excessive dairy product However prolonged excessive dairy product consumption leads to overuse and ageing of consumption leads to overuse and ageing of osteoblasts and depletion of bone matrixosteoblasts and depletion of bone matrix

So bone cannot hold the calciumSo bone cannot hold the calcium


• Infants Infants Birth to 6 months 400mg 6 months to 1year 600mg Birth to 6 months 400mg 6 months to 1year 600mg Children/Young Adults 1Children/Young Adults 1 to 10 years800 - 1,200 mg11 to to 10 years800 - 1,200 mg11 to

24 years1,200 - 1,500 mg24 years1,200 - 1,500 mg Adult Women Adult Women Pregnant or Lactating1,200 - 1,500 mg25 to Pregnant or Lactating1,200 - 1,500 mg25 to

49 years (premenopausal)1,000 mg 50 to 64 years 49 years (premenopausal)1,000 mg 50 to 64 years (postmenopausal taking estrogen or similar hormone)1,000 (postmenopausal taking estrogen or similar hormone)1,000 mg 50 to 64 years (postmenopausal not takingmg 50 to 64 years (postmenopausal not takingestrogen or similar hormone)1,500 mgOver 65 years estrogen or similar hormone)1,500 mgOver 65 years old1,500 mgold1,500 mg

Adult Men Adult Men 25 to 64 years old1,000 mgOver 65 years 25 to 64 years old1,000 mgOver 65 years old1,500 mgold1,500 mg


Exercise in moderation at least 4-5 days a Exercise in moderation at least 4-5 days a week for ½ to 1 hour.week for ½ to 1 hour.

Stretches and weight lifting important.Stretches and weight lifting important. Yoga is holistic since the whole body is Yoga is holistic since the whole body is

exercised. exercised. Exposure to the early morning and late Exposure to the early morning and late

evening sunlight.evening sunlight.

YOGA AND OSTEOPOROSISYOGA AND OSTEOPOROSIS

Most complete holistic form of exercise.Most complete holistic form of exercise. Most asanas can penetrate and make Most asanas can penetrate and make

energy flow into all the cells of the energy flow into all the cells of the body.body.

Ability to involve the hip and pelvis Ability to involve the hip and pelvis region is much more than other forms region is much more than other forms of therapy.of therapy.


Hormone Replacement Therapy with Hormone Replacement Therapy with estrogen and Selective estrogen receptor estrogen and Selective estrogen receptor modulators (SERM’s). modulators (SERM’s).

Anti-resorptive therapies or biphosphonates Anti-resorptive therapies or biphosphonates also can be used in a crisis.also can be used in a crisis.

Calcitonin injectable is used or in spray form.Calcitonin injectable is used or in spray form. Active form of Vitamin D3 Alpha-calcidol and Active form of Vitamin D3 Alpha-calcidol and

Calcitriol are also useful.Calcitriol are also useful.


Strontium Raleate acts by direct Strontium Raleate acts by direct mineral deposition in bonemineral deposition in bone

Teriparatide injection a derived Teriparatide injection a derived form of PTH is used in form of PTH is used in extremely severe forms of extremely severe forms of OsteoporosisOsteoporosis

TAKE HOME MESSAGETAKE HOME MESSAGE

Our health is in our hands and we Our health is in our hands and we must take responsibility for it.must take responsibility for it.

Life style modifications diet changes Life style modifications diet changes and exercise require efforts.and exercise require efforts.

The fruits are a healthy active The fruits are a healthy active fracture free life.fracture free life.

Osteoporosis is a preventable Osteoporosis is a preventable epidemicepidemic

Thank you Thank you

Osteoporosis

Health & Medicine

Transcript of Osteoporosis