Osteoporosis, prevalence and risk

14.1.05 Osteoporosis 1

Osteoporosis, prevalence and risk.

Chit Soe, Aye Aye Khaing, Pandora Aung Gyi


Introduction


Rank Cause1 Lower respiratory infections

2 Diarrheal diseases

3 Peripheral conditions

4 Unipolar major depression

5 Ischemic heart disease

6 Cerebrovascular disease

7 Tuberculosis

8 Measles

9 Road Traffic accidents

10 Congenital abnormalities

Worldwide Disease Projection

Estimated 1990 Projected 2020

Rank Cause1 Ischemic heart disease

2 Unipolar major depression

3 BJD (Road traffic accidents)

4 Cerebrovascular disease

5 COPD

6 Lower respiratory infections

7 Tuberculosis

8 War

9 Diarrheal diseases

10 HIV

Neil B, Chapman N, Patel A. Eur Heart J 2002;4(suppl F):F2-F6.


To target 5 Areas

• 1. Rheumatoid Arthritis• 2. Osteoporosis• 3. Low Back Pain• 4. OA knee• 5. Limb trauma

14.1.0514.1.05 OsteoporosisOsteoporosis 55

Epidemic of the millenniumsEpidemic of the millenniumsOsteoporosisOsteoporosis

The lifetime risk of vertebral fracture The lifetime risk of vertebral fracture has been estimated to be 15.4% has been estimated to be 15.4% after age 45 yearsafter age 45 years

but this most likely largely but this most likely largely underestimates the true risk. (12-underestimates the true risk. (12-30% in diff. studies)30% in diff. studies)

The demand on the health care The demand on the health care system is therefore increasing, as are system is therefore increasing, as are costs for society costs for society


Most costly silent Most costly silent Epidemic of the HistoryEpidemic of the History


Low Trauma FracturesLow Trauma Fractures

14.1.0514.1.05 OsteoporosisOsteoporosis 99Mechanisms of osteoporosisMechanisms of osteoporosis


New findings inNew findings inrecent yearsrecent years


BMP=Bone Morphogenic ProteinBMP=Bone Morphogenic Protein SOST=SclerostinSOST=Sclerostin RANK=Receptor Activator of Nuclear Factor KappaRANK=Receptor Activator of Nuclear Factor Kappa OPG=OsteoprotegerinOPG=Osteoprotegerin


WHO Diagnostic Categories for WHO Diagnostic Categories for Osteoporosis (1994)Osteoporosis (1994)

NormalNormal -BMD not more than 1 SD below -BMD not more than 1 SD below the young adultthe young adult

OsteopeniaOsteopenia -BMD between 1 and 2.5 -BMD between 1 and 2.5 SDSD

OsteoporosisOsteoporosis -BMD more than 2.5 SD -BMD more than 2.5 SD below the young adult mean value.below the young adult mean value.

Severe osteoporosisSevere osteoporosis -BMD value more -BMD value more than 2.5 SD in the than 2.5 SD in the presence of 1 or presence of 1 or

more fragility fractures.more fragility fractures.


BMDBMD


How do you interpret a bone How do you interpret a bone mass report?mass report?

The bone mass report includes three The bone mass report includes three values at each skeletal site analyzed: values at each skeletal site analyzed: absolute bone mass in gm/cm2, T-absolute bone mass in gm/cm2, T-score, and Z-score.score, and Z-score.

The T-score is the number of The T-score is the number of standard deviations (SDs) that a standard deviations (SDs) that a patient's value lies above or below patient's value lies above or below the mean peak value for young the mean peak value for young adults.adults.


Any T-score between -1 and -2.5 is Any T-score between -1 and -2.5 is termed osteopenia and any value termed osteopenia and any value below -2.5 is considered below -2.5 is considered osteoporosis.osteoporosis.

The Z-score is the number of SDs The Z-score is the number of SDs that a patient's value lies above or that a patient's value lies above or below the mean value for age-below the mean value for age-matched adults.matched adults.


Risk factors for osteoporosisRisk factors for osteoporosis GeneticGenetic Race, Low body weight, Family HistoryRace, Low body weight, Family History Osteogenesis imperfecta, Homocystinuria, GaucherOsteogenesis imperfecta, Homocystinuria, Gaucher

SmokingSmoking ImmobilizationImmobilization Alcohol useAlcohol use EndocrineEndocrine Hyperthyroidism, HyperparathyroidismHyperthyroidism, Hyperparathyroidism Cushing's syndrome, Androgen loss, Hypogonadism, Cushing's syndrome, Androgen loss, Hypogonadism,

Menopause (natural or surgical)Menopause (natural or surgical)


Risk factors for osteoporosis (con) Risk factors for osteoporosis (con) Calcium deficiencyCalcium deficiency Dietary, Chronic liver diseaseDietary, Chronic liver disease Malabsorption, IBSMalabsorption, IBS Losses in renal diseaseLosses in renal disease Vitamin D deficiencyVitamin D deficiency Decreased exposure to sunlightDecreased exposure to sunlight Renal diseaseRenal disease DrugsDrugs CorticosteroidsCorticosteroids Cyclosporine, anticonvulsants, SedativesCyclosporine, anticonvulsants, Sedatives Chronic heparin, GnRHChronic heparin, GnRH


Risk factors for osteoporosis #Risk factors for osteoporosis #

FallsFalls Visual diseases (glaucoma, cataracts, Visual diseases (glaucoma, cataracts,

refractive errors)refractive errors) Postural hypotensionPostural hypotension Muscle weakness (disuses, myopathy)Muscle weakness (disuses, myopathy) ArthritisArthritis Neurologic (Parkinson's, multiple Neurologic (Parkinson's, multiple

sclerosis, previous strokes)sclerosis, previous strokes)


Aim

• To explore the prevalence of osteoporosis and osteopenia in Post-Menopausal females (Teachers and Nurses) and

• To find out the proportion of risk factors for osteoporosis in two occupation groups

• To find out Bone Mass Density and association to known risk factors.


Methods

• All the postmenopausal teachers from a state high school from Mingalar Taung Nyunt Township (n=45) and

• Postmenopausal staffs from Yangon General Hospital (n=38) were included in the study.

• All the participants were asked to fill up a questionarrie for risk factors and

• Bone Mass Density (BMD) was measured by ultrasound densitometer.


Quantitative Ultrasound

• BUA= broadband ultrasound attenuation

• SOS= speed of sound• Stiffness= combination of BUA & SOS

• BUA reflect the attenuation of sound waves as they pass through bone tissue and are proportionate to the density of the tissue.


• QUS also assesses aspects of bone quality and structure that are not captured by BMD measurements.

• It is complementary to and additive with BMD


Combination of DEXA and USGCombination of DEXA and USGJ Bone Miner Res 1995:10:353J Bone Miner Res 1995:10:353


ResultsResults


Bone Mass, Osteopenia & Osteoporosis

• Mean BMD for teachers was 64.71 dB/MHZ (SD 4.8) and that for staff was 64.24 dB/MHZ (SD 4.2).

• Osteopenia (T score less than -1.0 to -2.5) was seen in

• 31% of teachers (14 out of 45) and • 31.5% of staffs (12 out of 38). • Surprisingly, there was no patient with

osteoporosis (T score less than -2.5) in this study.


Prevalence of Osteoporosis

0

5

10

15

20

25

30

35

Normal Osteopenia Osteoporosis

Teacher

Med Staff31% 31.5%


Risk Factors

• low trauma fracture in family was mentioned by 7.2%,

• high coffee intake (14.5%), • smoking (2.4%), • alcohol (1.2%), • sedentary life (61.4%), • hyperthyroid (2.7%), and • history of steroid (8.4%).


• Milk intake was very low (48% answered no milk in last week and only 4.8% took one cup of milk each day).


• Only 2 participants were taking HRT (2.4%) and

• 14.5% were taking calcium supplement.


Risk factors in Teachers vs Staff

• The presence of risks factors did not differ significantly between two groups of teachers and staff.


Presence of risk factors vs osteopenia

• Apart from thin body built and lack of exercise,

• the presence of risk factors did not associate significantly with osteopenia in this study.


Presence of risk factors in normal people and osteopenia patients

Risk Normal(56)

Osteopenia(26)

p

Mean body weight 134lb 121 lb 0.04

Exercise days/ week 2.1 0.7 0.01

Coffee >3 cups/day 8 3 0.9

Milk intake (cup)/wk 1 0.9 0.8

Small fish intake days/ wk

2.59 2.5 0.8


Presence of risk factors in normal people and osteopenia patients

Risk Normal(56)

Osteopenia(26)

p

Surgical menopause >1 yr

8 5 0.9

Steroid 6 1 0.49

Taking Calcium supplement

4 8 0.4

Fruit intake/ week 13 8 0.7


Discussion


Indications for Bone Densitometry

• Early menopause (<45)

• Hypogonadism• Family history of

osteoporotic fracture• Radiological evidence

of osteoporosis• Previous fracture after

minimal trauma (fall from standing height)

• Clinical features of OP (height loss, kyphosis)

*Strong risk factor Low body weight (<19BMI)*Steroid (>7.5mg daily for >3month) *Co.- existing disease Endocrine Malabsorption IBD RA*Prolonged immobility*after OP treatment


• Since the osteoporosis prevalence range from 15% at age 60 and 38% at age 80 (Melton 1995), sample size of 82 people was enough to find the prevalence.

• But failure to find any one with osteoporosis on screening is not expected and need larger scale study to explain.


Life style modificationLife style modification All postmenopausal women should engage in All postmenopausal women should engage in

lifestyle modifications that promote bone healthlifestyle modifications that promote bone health• (1) taking adequate amounts of calcium (1) taking adequate amounts of calcium

(1200 mg/day) either through diet or (1200 mg/day) either through diet or supplementssupplements

• (2) taking vitamin D (400 to 800 IU daily)(2) taking vitamin D (400 to 800 IU daily)• (3) engaging in weight-bearing physical (3) engaging in weight-bearing physical

activity to decrease the risk of fallingactivity to decrease the risk of falling• (4) smoking cessation(4) smoking cessation• (5) avoidance of excessive alcohol intake.(5) avoidance of excessive alcohol intake.


Conclusion

• The prevalence of osteoporosis is not high in this study as European studies.

• The presence of risks factors did not differ significantly between two groups of teachers and staff.

• Apart from thin body built and lack of exercise, the presence of risk factors did not associate significantly with osteopenia in this study.

Osteoporosis, prevalence and risk

Health & Medicine

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