OsteoporosisDr. Uday PawarJunior Spine ConsultantDNB OrthopaedicHinduja Hospital, Mahim, Mumbaihttp://www.hindujahospital....
With age comes wisdom………..and Osteoporosis
What is osteoporosis ?Normal Osteoprosis
Jargon buster………• Softening of bones …….• A reduction in the quantity and quality ofbones
What is osteoporosis• A condition rather than a disease• Silent until complications arise• Spine, hip & wrist fractures
WHO criteria for diagnosis ofOsteoporosisKanis et al. J Bone Miner Res 1994; 9:1137-41T-scoreNormal - 1.0 and aboveOsteopa...
Food for thought…..
1. Osteoporosis ≠ Calcium deficiency• So, calcium is NOT the treatment ofosteoporosis• Bone mineral v/s bone mass
2. Osteoporosis is a generalized disease• affects all the bones
3. Treating osteoporosis• Prevention is the only treatment ofosteoporosis• Hence early diagnosis is the most importantstep...
Size of the Problem in India• 26 million (2003) 36 million by 2013• 1 out of 8 males and 1 out of 3 females suffers from o...
The Magnitude Of The ProblemIn women > 50 years, the lifetime risk of:• Vertebral fracture is 1/3• Hip fracture is 1/5NICE...
Osteoporotic Fractures in Women:Comparison with Other Diseases1 500 000*0500100015002000OsteoporoticFractures*annual incid...
Osteoporosis affects entire skeleton• Osteoporosis is responsible for >1.5 million vertebral andnon-vertebral fractures pe...
Morbidity associated with Fractures
Osteoporosis: Classification• Primary OsteoporosisType 1- Post menopausal osteoporosisType 2- Senile/Age related osteopo...
ConsequencesReduced quality of life
How is osteoporosis diagnosedDiagnosis is made on the basis of-• Detailed medical history• Examination• Blood and other te...
Early diagnosis of Osteoporosis• Clinical parameters– ‘at risk’ subject– Bone pains– Generalized tiredness– Progressive ky...
Clinical Risk Fractures (CRF)Predictors of low bone mass-• Female• Advanced age• Low bone mineral density• Gonadal hormone...
Clinical Presentation• Severe backache after minor injury• Pain worse on sneezing, coughing , standingerect, changing posi...
X-rays• Osteopenia• Loss of height of vertebralbody• Wedging
Osteoporosis – RadiographicOsteoporosis – RadiographicDifferential DiagnosisDifferential Diagnosis• Osteomalacia• Hyperpar...
• Osteogenesis imperfecta• Hepatic insufficiency• Diabetes mellitus• Multiple myeloma• Metastatic disease• Drug inducedOst...
Assessment of bone mineral density by DXACurrent gold standard for diagnosis of osteoporosisBMD (g/cm2) = Bone mineral con...
• Blood count , CRP• Calcium, Phosphate, AlkalinePhosphatase (AP)• Kidney function studies• Basal Thyroid and parathyroid....
Preventing OsteoporosisalciumalciumCCDDVitaminVitaminxercisexerciseEEFFPreventPrevent allsallsain weightain weightGGStopSt...
Modifiable Risk FactorsVit DCalciumExerciseQuit Alcohol Quit Smoking
Non-modifiable Risk Factors• Older age• Female gender• Ethnic background• Small bone structure• Family history of osteopor...
Treatments of osteoporosis• Calcium and vitamin D• HRT• SERMs (raloxifene)• Calcitonin• Bisphosphonates– ibandronateibandr...
How much and which Calcium??• 1000-1500mg “elemental calcium”Type of calcium Elemental CalciumCalcium carbonate 40%Calcium...
Bisphoshonates• Etidronate, Alendronate, Risendronate,Ibandronate, Zolendronate– Anti resorptive agents– Reduce osteoclasis
Bisphoshonates• Induce apoptosis (self destruction) in the osteoclasts• Thus it reduces bone resorption
Bisphoshonates• On this ‘preserved’ lattice – mineralization takesplace• Thus ‘better mineralized’ bone is formed andDEXA ...
Teriparatide (PTH)• In small / pulse doses, is a powerful stimulant forbone formation• The only drug that can induce osteo...
Teriparatide• Teriparatide stimulates formation of new bonematrix / framework
Teriparatide• On this denser, better structured matrix,mineralization takes place giving rise to anoverall stronger bone
BoneStrength(Mass+Quality)TimeEffect of Anabolic vs Anti-resorptiveson Bone StrengthAnabolic‘Laying down new bone’Anti-res...
Treatment with PTH(woman 69 years)Dempster DW et al, J Bone Miner Res, 2001;16:1846-1853Before CtTh: 0.32 mmCD: 2.9 mm3Aft...
Take home points…• No longer a problem of the WEST• Awareness essential amongst general public• Prevention is the best tre...
OPD Schedule: Tue- 1500 to 1600 hours, Thu- 0900 to 1100hours, Sat- 1100 to 1300 hoursAppointment Helpline: 022-39818181/6...
Webinar on Osteoporosis by Hinduja Hospital
Webinar on Osteoporosis by Hinduja Hospital
Webinar on Osteoporosis by Hinduja Hospital
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Webinar on Osteoporosis by Hinduja Hospital

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Hinduja hospital conducts regular webinars and tweetinars for online users where they can seek advice from expert doctors of hinduja hospital for free. Above is the webinar conducted by hinduja hospital on Osteoporosis where issues like osteoporosis symptoms, osteoporosis prevention, osteoporosis treatment were discussed successfully by Spine Consultant, Dr. Uday Pawar.
To know more about such upcoming webinars and tweetinars from hinduja hospital, visit http://www.hindujahospital.com/communityportal/

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  • Treatment and prevention (7) One of the most important preventive strategies is to encourage the achievement of optimal peak bone mass in the young, since this has a major impact on bone mass and the risk of osteoporosis after the menopause. Although peak bone mass is largely determined by genetics and diet (calcium and vitamin D intake), it can also be influenced by physical activity, smoking and alcohol consumption. It is, therefore, important to encourage both children and adolescents to adopt a healthy lifestyle.
  • Treatment and prevention (8) For those patients at particularly high risk of osteoporosis, or who have developed osteoporosis, there are a number of pharmacological interventions available for the prevention and management of osteoporosis. The aim of these interventions should be to reduce the frequency of fractures, which are responsible for the high levels of morbidity associated with the disease.
  • Webinar on Osteoporosis by Hinduja Hospital

    1. 1. OsteoporosisDr. Uday PawarJunior Spine ConsultantDNB OrthopaedicHinduja Hospital, Mahim, Mumbaihttp://www.hindujahospital.com/dr-uday-pawar/
    2. 2. With age comes wisdom………..and Osteoporosis
    3. 3. What is osteoporosis ?Normal Osteoprosis
    4. 4. Jargon buster………• Softening of bones …….• A reduction in the quantity and quality ofbones
    5. 5. What is osteoporosis• A condition rather than a disease• Silent until complications arise• Spine, hip & wrist fractures
    6. 6. WHO criteria for diagnosis ofOsteoporosisKanis et al. J Bone Miner Res 1994; 9:1137-41T-scoreNormal - 1.0 and aboveOsteopaenia - 1.0 to - 2.5Osteoporosis - 2.5 and belowSevere (established)osteoporosis- 2.5 and below, plus oneor more osteoporoticfracture(s)
    7. 7. Food for thought…..
    8. 8. 1. Osteoporosis ≠ Calcium deficiency• So, calcium is NOT the treatment ofosteoporosis• Bone mineral v/s bone mass
    9. 9. 2. Osteoporosis is a generalized disease• affects all the bones
    10. 10. 3. Treating osteoporosis• Prevention is the only treatment ofosteoporosis• Hence early diagnosis is the most importantstep in treating osteoporosis !
    11. 11. Size of the Problem in India• 26 million (2003) 36 million by 2013• 1 out of 8 males and 1 out of 3 females suffers from osteoporosis• The high incidence among men and the lower age of peak incidencecompared to Western countries• Peak incidence of osteoporosis– Western countries-70-80 years of age– India –50-60 yearsInternational Osteoporosis Foundation
    12. 12. The Magnitude Of The ProblemIn women > 50 years, the lifetime risk of:• Vertebral fracture is 1/3• Hip fracture is 1/5NICE guidance 160 October 2008
    13. 13. Osteoporotic Fractures in Women:Comparison with Other Diseases1 500 000*0500100015002000OsteoporoticFractures*annual incidence all ages†annual estimate women 29+‡annual estimate women 30+§1996 new cases, all ages513 000†228 000‡184 300§750 000vertebral250 000other sites250 000forearm250 000hipHeartAttackStroke BreastCancerAnnualincidencex1000Riggs BL, Melton LJ. Bone 1995Heart and Stroke Facts, 1996, American Heart AssociationCancer Facts & Figures, 1996, American Cancer Society
    14. 14. Osteoporosis affects entire skeleton• Osteoporosis is responsible for >1.5 million vertebral andnon-vertebral fractures per year• Spine, hip, and wrist fractures are most common
    15. 15. Morbidity associated with Fractures
    16. 16. Osteoporosis: Classification• Primary OsteoporosisType 1- Post menopausal osteoporosisType 2- Senile/Age related osteoporosis• Secondary OsteoporosisSecondary to various causes17
    17. 17. ConsequencesReduced quality of life
    18. 18. How is osteoporosis diagnosedDiagnosis is made on the basis of-• Detailed medical history• Examination• Blood and other tests
    19. 19. Early diagnosis of Osteoporosis• Clinical parameters– ‘at risk’ subject– Bone pains– Generalized tiredness– Progressive kyphosis• Investigations– Radiographs– DEXA– QCT, MRI, Bone scan– Blood markers
    20. 20. Clinical Risk Fractures (CRF)Predictors of low bone mass-• Female• Advanced age• Low bone mineral density• Gonadal hormone deficiency ( estrogen or testosterone )• White race• Low body weight & BMI• Family history of osteoporosis• Low calcium intake• Smoking / excessive alcohol intake• Low level of physical activity• Chronic glucocorticoid use• Prior fragility fractureNational Osteoporosis Foundation (NOF)
    21. 21. Clinical Presentation• Severe backache after minor injury• Pain worse on sneezing, coughing , standingerect, changing positions.• Limited to wheelchair• Stooped Posture• Weakness in legs
    22. 22. X-rays• Osteopenia• Loss of height of vertebralbody• Wedging
    23. 23. Osteoporosis – RadiographicOsteoporosis – RadiographicDifferential DiagnosisDifferential Diagnosis• Osteomalacia• Hyperparathyroidism• Hypercortisolism• Hyperthyroidism• Renal insufficiency• Chronic immobilization
    24. 24. • Osteogenesis imperfecta• Hepatic insufficiency• Diabetes mellitus• Multiple myeloma• Metastatic disease• Drug inducedOsteoporosis other causesOsteoporosis other causes
    25. 25. Assessment of bone mineral density by DXACurrent gold standard for diagnosis of osteoporosisBMD (g/cm2) = Bone mineral content (g) / area (cm2)Diagnosis based on comparing patient’sBMD to that of young, healthy individualsof same sex
    26. 26. • Blood count , CRP• Calcium, Phosphate, AlkalinePhosphatase (AP)• Kidney function studies• Basal Thyroid and parathyroid.• Protein-immunoelectrophoresis.• Vit D (25 and 1.25)Laboratory tests*NOTES:- * These are in additionto routine labs tests.- These are screeninglabs, more may beindicated based on theseresults
    27. 27. Preventing OsteoporosisalciumalciumCCDDVitaminVitaminxercisexerciseEEFFPreventPrevent allsallsain weightain weightGGStopStop mokingmokingSS
    28. 28. Modifiable Risk FactorsVit DCalciumExerciseQuit Alcohol Quit Smoking
    29. 29. Non-modifiable Risk Factors• Older age• Female gender• Ethnic background• Small bone structure• Family history of osteoporosis or osteoporosis-related fracture in a parentor siblings• Previous fracture• Menopause/hysterectomy• Some medicines like steroids, anti-epileptics• Rheumatoid arthritis• Reduced levels of Gonadal hormones in men
    30. 30. Treatments of osteoporosis• Calcium and vitamin D• HRT• SERMs (raloxifene)• Calcitonin• Bisphosphonates– ibandronateibandronate– etidronateetidronate– alendronatealendronate– risedronaterisedronate• PTH (1–34)• Fluoride• Strontium ranelate• CombinationHormonal agentsHormonal agentsAnti-resorptiveAnti-resorptiveagentsagentsAnabolic agentsAnabolic agentsDual mechanism ofDual mechanism ofactionactionSERMs = selective oestrogen receptor modulatorsSERMs = selective oestrogen receptor modulatorsPTH = parathyroid hormonePTH = parathyroid hormone
    31. 31. How much and which Calcium??• 1000-1500mg “elemental calcium”Type of calcium Elemental CalciumCalcium carbonate 40%Calcium gluconate 9%Calcium lactate 13%Calcium citrate 20-30%Calcium acetate 30%Micro cryst HA complex 100%◦ May be difficult to attain those levels.◦ To try a combination of diet and medicines◦ Can’t give more than 500mg elemental calcium as tabs at a single dose
    32. 32. Bisphoshonates• Etidronate, Alendronate, Risendronate,Ibandronate, Zolendronate– Anti resorptive agents– Reduce osteoclasis
    33. 33. Bisphoshonates• Induce apoptosis (self destruction) in the osteoclasts• Thus it reduces bone resorption
    34. 34. Bisphoshonates• On this ‘preserved’ lattice – mineralization takesplace• Thus ‘better mineralized’ bone is formed andDEXA improves
    35. 35. Teriparatide (PTH)• In small / pulse doses, is a powerful stimulant forbone formation• The only drug that can induce osteogenesis
    36. 36. Teriparatide• Teriparatide stimulates formation of new bonematrix / framework
    37. 37. Teriparatide• On this denser, better structured matrix,mineralization takes place giving rise to anoverall stronger bone
    38. 38. BoneStrength(Mass+Quality)TimeEffect of Anabolic vs Anti-resorptiveson Bone StrengthAnabolic‘Laying down new bone’Anti-resorptive‘reducing bone resorption’
    39. 39. Treatment with PTH(woman 69 years)Dempster DW et al, J Bone Miner Res, 2001;16:1846-1853Before CtTh: 0.32 mmCD: 2.9 mm3After CtTh: 0.42 mmCD: 4.6 mm31 5 10152025 30Ser Val Ser Glu Ile Gln Leu Met His AsnLeuGlyLysHisLeuAsnSerMetGluArgValGluTrpLeuArg Lys Lys Leu Gln Asp Val His Asn Phe
    40. 40. Take home points…• No longer a problem of the WEST• Awareness essential amongst general public• Prevention is the best treatment• Moms and grandmoms vulnerable group
    41. 41. OPD Schedule: Tue- 1500 to 1600 hours, Thu- 0900 to 1100hours, Sat- 1100 to 1300 hoursAppointment Helpline: 022-39818181/67668181/24451515For any Queries, please write us on: info@hindujahospital.comThank You

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