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Osteoporosis

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  • 1. OSTEOPOROSISANITA SRIWATY PARDEDE SKM
  • 2. OSTEOPOROSIS KEROPOS TULANG MASALAH KESEHATAN (KURANG DISADARI)
  • 3. Osteoporosis• The most common metabolic bone disorder• A large, silent epidemic, afflicting the whole world• Insidious & progressive : → frequently diagnosed only after a fracture• Cause enormous socio – economic impact ( Ang, K.C 2005)• The exact pathogenesis remains unclear• Impairement of calcium absorption is one of its primary cause ( Dechant, K.L et al 1994 )
  • 4. Osteoporosis• Ditandai dengan: – Massa tulang yang berkurang – Deteriorasi struktur tulang (mikroskopis)• Tulang jadi rapuh - risiko fraktur ↑
  • 5. MASSA TULANG • PUNCAK KEPADATAN MASSA TULANG MAKSIMAL + USIA 30 TAHUN • KONSEP MASSA TULANG RENDAH,TULANG TULANG FAKTOR RISIKO PATAH TULANGDEWASA USIA LANJUT
  • 6. TULANG : PEMBENTUKAN MASSA TULANG PUNCAK MASSA TULANG REMODELLING TULANG - KEHILANGAN MASSA TULANG WANITA : 45 – 50 % PRIA : 20 – 30 %
  • 7. Faktor Genetik Bentuk tubuh, gaya hidup Status nutrisi Menopause Penyakit Perubahan hormonal Akibat usia Trauma ringan MASSA Puncak Massa Penurunan Massa Sangat Rentan TULANG Tulang Tulang Terhadap Fraktur 0 20 40 50 60 70 80 100 Usia ( tahun ) Takao Suzuki, 2001
  • 8. FAKTOR RISIKO PADA OSTEOPOROSISTIDAK DAPAT DIMODIFIKASI DAPAT DIMODIFIKASI• JENIS KELAMIN • POSTUR TUBUH KURUS• USIA LANJUT (WANITA) • JATUH BERULANG• RAS KAUKASIA (KULIT PUTIH) • AKTIFITAS FISIK KURANG• RIWAYAT PATAH TULANG • KEKURANGAN ESTROGEN • KEKURANGAN KALSIUM • PEROKOK • PEMINUM ALKOHOL • TINGKAT KESEHATAN BURUK
  • 9. Osteoporosis KriteriaNormal Nilai BMD < 1 SD di bawah nilai rata-rata dewasa mudaOsteopenia Nilai BMD 1 – 2.5 SD d bawah nilai rata-rataOsteoporosis Nilai BMD > 2.5 SD di bawah nilai rata-rataOsterporosis Nilai BMD > 2.5 SD di bawah nilai rata-rataberat + ada ≥ 1 fraktur osteoporosis
  • 10. Osteoporosis in MenA public health concern :• Age – spesific incidence of fractures is increasing in men• Prevalence of spinal fractures are similar in women• Over the next 15 yrs, 30 % of all hip fractures will occur in men• Mortality after spinal & hip fractures is higher than in women ( Ebeling, P.R at al 2001 )
  • 11. Osteoporosis in Men cont’d• As devastating as in women• Detection & treatment in men are dismal – Not as extensively as in woman• International Society for Clinical Densitometry, 2003 : ≥ 70 yrs : regular BMD – T score < - 2 : treatment of OP & other risk factors
  • 12. The Osteoporosis Continuum KyphoticHealthy spine spine 50 Menopausal 55+ Postmenopausal 75+ Kyphotic Experiencing At greater risk for vertebral At risk for vasomotor fracture than any other hip fracture symptoms type of fracture
  • 13. Fraktur Vertebra• Fraktur vertebra terjadinya lebih awal dari fraktur lain.
  • 14. Fraktur Vertebra
  • 15. Masa Tulang Patah Nyeri Kelainan Bentuk Kecacatan Rendah Tulang Kualitas Hidup
  • 16. PENCEGAHAN 1. PRIMER 2. SEKUNDERPRIMER : • NUTRISI YANG BAIK • POLA HIDUP AKTIF • HINDARI FAKTOR RISIKO • TES UNTUK DETEKSI DINI • UPAYA-2 KHUSUS : (OBAT-OBAT TERTENTU)
  • 17. FAKTOR NUTRISI : 1. CUKUP KALSIUM 2. CUKUP VIT.D 3. KURANGI FOSFAT 4. CUKUP PROTEIN 5. BATASI KAFEIN 6. HINDARI ALKOHOL 7. KURANGI GARAM, GULA 8. HENTIKAN ROKOKPOLA HIDUP AKTIF :KURANG GERAK PROGRAM LATIHAN FISIK
  • 18. Osteoporosis Exercise Program, 1998 :• Improve gait, balance, coordination, propioception, reaction time, and key – muscles strength → prevent falls• Increase bone – mass / preserve bone – mass → prevent osteoporosis“keep both young & older person moving” ( Oliver, D. et al. 2005 )
  • 19. PENCEGAHAN SEKUNDER : • SUDAH ADA OP SEBELUM ADA PATAH TULANG • PENCEGAHAN PRIMER + OBAT-2AN (ESTROGEN, BISFOSFONAT, DLL)
  • 20. JATUH PADA USIA LANJUTFAKTOR FAKTOR EKSTRINSIKINSTRINSIKKONDISI FISIK OBAT-2AN YANGDAN DIMINUMKEJIWAANPENURUNAN ALAT-2 BANTUPENGLIHATAN & JATUH BERJALANPENDENGARANPERUBAHAN LINGKUNGANPERSYARAFAN, GAYA YANG TIDAKBERJALAN, REFLEK MENDUKUNGBERDIRI
  • 21. Falls In The Elderly• A common problem• 30 % - 50 % ≥ 65 in the community, female > male• 70 % occurs at home, 50 % from environmental hazard• Majority occur with mild to moderate activity• Compared with children, 10x to be hospitalized, 8x more likely to die∀ ≤ 10 % result in fracture, especially hip fracture• May be a non spesific presenting sign of acute illness / acute exacerbation of a chronic disease
  • 22. Fall cont’d• The true geriatric giant : an indication for a more detailed assessment ( Davidson, C. 2000 )• Psychologic impact of a fall : post-fall anxiety – Fear of falling → activity restriction, dependance & increasing immobility → further risk factor : muscle atrophy, poorer balance, deconditioning → greater risk of falling
  • 23. Cycle of Osteoporosis FallOld Age Osteoporosis Fracture Immobility• Strong association : Osteoporosis, Fall, Fracture → must be managed together – Preventing both : osteoporosis & fall
  • 24. KOMPLIKASI PATAH TULANGSIKLUS OSTEOPOROSIS RUDA PAKSAUSIA LANJUT OSTEOPOROSIS PATAH TULANG MOBILITAS BERKURANG• ASESMEN PENYEBAB JATUH• ASESMEN PATAH TULANG YANG TERJADI
  • 25. Indonesian Rheumatic Association’s Recommendation : Drug Treatment in Osteoporosis Kelompok risiko tinggi Patah tulang dengan Atau faktor risiko rudapaksa minimal atau kekurangan massa tulang Merubah gaya hidup diet, latihan fisik, merokok Pengukuran kepadatan tulang (Bone Densitometri)Diatas + 1 SD + 1 SD sp –1 SD -1 SD sp –2,5 SD Dibawah –2,5 SDUlang 5 th lagi Ulang 1 th lagi Estrogen Estrogen Bisfosfonat Kalsitriol Kalsitonin Source : Harry Isbagio et al 2002
  • 26. Calcitriol• Photosynthesis of vitamin D : – Occurred on earth, over 750 millions years – Vertebrates, including human, obtain most of their vit. D, from exposure to sunlight – Sunlight : • High energy ultraviolet B radiation : photolysis 7 dehydro calciferol → pre vit D3, leaves the epidermal cell membrane → circulation• Requires two hydroxylations processes in the liver & kidney → biologically active metabolite : 1.25 (OH)2 D3 “CALCITRIOL”
  • 27. The Primary Role of Calcitriol• The main regulator of intestinal calcium absorption → active absorption• Responsible for calcium homeostasis & mineralisation of the bone• Stimulate bone spesific protein’s production : osteocalcin
  • 28. Charaterizes of Type II OP• Decreased calcium absorption, particularly ≥ 70 yrs : Age – related decline in serum levels of calcitriol : – Decreased capacity of the ageing skin to synthezise vit. D3 – Decreased renal hydroxylase activity with ageing – Decreased osteoblast function calcitriol is the logical course of treatment in the elderly
  • 29. UPAYAPENCEGAHAN &PENGOBATAN
  • 30. Never too late toPrevent a Fracture