DR.MANINDER AHUJA CHAIRPERSON GERIATRIC GYNE.COMMITTE FOGSI TO DIAGNOSE OSTEOPOROSIS WE HAVE ALWAYS TO KEEP IT IN MIND WHEN TREATING AGING WOMEN ! Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
What is changing?
The life span of a woman has increased from 23 years in the Roman era to 65 years in India and 80 years in developed countries
Age of menopause is 46&52
1/3rd of a woman’s life is spent after Menopause and no of women in menopause is increasing.
Source: US Dept of Health and Human Services; 1999;47(28).
Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10 Year 1850 1900 1950 2000 0 20 40 80 60 Age (Year)
NUMBER OF AGING WOMEN IS INCREASING Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10 1990 2030 World wise population 470million 1.2 billion Developing countries 40% 24% Developed countries 60% 76%
New Age Approach--Quality Of Life
Early diagnosis and assessment of problems
Prevention of problems main stay is life style modifications
Osteoporotic Fracture 1,200,000 Heart Attack 513,000 Strokes 228,000 Breast Cancer 1,84,000 1 million > 2.0 x > 4.4 x > 5.5 x OSTEOPOROSIS IN WOMEN : CONCERN Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
Osteoporosis – the silent disease Under diagnosed and most common 35 yrs onwards you lose bone mass at 0.5 to 1% per yr(initial quality Imp) Around menopause loss is upto 4-5 % per year You also lose muscle mass from 35 years onwards vitamin D receptor, estrogen receptor, transforming growth factor, interleukin-6, interleukin-1 receptor 2, type I collagen genes, and collagenases are for genetic causes Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
Sarcopenia and osteoporosis go hand in hand Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI Beginning in the fourth decade of life, adults lose 3 % to 5% of muscle mass per decade,rate of decline increases to 1% to 2% per year after age 50 years( RED ALERT FAT) N sarcopenia 05/01/10
“ A systemic skeletal disease characterised by low bone mass and micro-architectural deterioration of bone tissue with a resultant increase in fragility and risk of fracture.”
A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture.
Bone strength reflects the integration of three main features:
Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 300,000 hip fractures 20% die within 6months approximately 10% have a second fracture within a year of the incident hip fracture 60% of those who survive hip fracture do not regain the same level of independence 200,000 broken wrists Limited movement Quality of life impaired
Most of time undiagnosed 500,000 spinal fractures,compression or wedge fractures,
Losing height .>2cms
In extreme cases chest compression
Abdominal space reduced and problems of eating and digestion
COMMON SITES OF FRACTURES 05/01/10
Dental health and osteoporosis
A correlation between lower BMD and/or postmenopausal osteoporosis and parameters of periodontal disease, such as alveolar crestal bone height, tooth loss and, to a lesser degree, gum recession .
Hormone replacement therapy has been associated with reduced tooth loss in several observational studies.
Poor nutrition (with deficient calcium and vitamin D intake)
Smoking,active and passive
Excessive alcohol use>3 drinks /day
Sources: Chan, KM, Anderson M, Lau EM. Exercise interventions: defusing the world’s osteoporosis time bomb. Bulletin of the World Health Organization 2003;81:827-830. National Osteoporosis Foundation: Fast Facts. Available at: www.nof.org/osteoporosis/disease facts.htm . . Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
Medications causing ostoeoporosis
Glucocorticoids>5mg /day predenisolone for > 3months
Up to 80% of the variability in peak bone density might be attributable to genetic factors.
Female children of women who have osteoporotic fractures have lower BMD
First-degree relatives (ie, mother, sister) of women with osteoporosis also tend to have lower BMD than those with no family history.
In one large study of postmenopausal women from five ethnic groups (white Americans, African Americans, Asian Americans, Hispanic Americans, and Native Americans),African Americans had the highest BMD, while Asian Americans had the lowest.
10-year Probability of Fracture in Women by Age and FN T-Score- ”age and BMD are independent predictors” Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
A new paradigm -FRAX
10-year risk for hip and other major fractures. The model, called "FRAX," incorporates BMD, age, sex, body-mass index, and seven other risk factors, family H/O fragility fracture, rheumatoid arthritis, alcohol intake ,smoking, glucocorticoids, secondary osteoprosis
Model does allow the identification of those in the low BMD range (T-score –1 to –2.5) who have the highest risk of fracture and would benefit for treatment,but they should not be on treatment for osteoporosis
Vit D Def & Risk Of Falls Dr.ManinderAhuja chairperson geriatric gynecology committe FOGSI 05/01/10
Genetic Tests in near future
Two variants — one in a protein governing bone formation ( LRP5 ), and another in a receptor involved in bone resorption ( TNFRSF11B ) — were linked to increased risk for osteoporosis or a history of clinical low-impact fractures.
“ Can be measured with near-perfect precision ... years before the age at which fractures tend to occur — which could provide ample lead-time for preventive measures."