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Osteoporosis

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  • 1. Osteoporosis
  • 2. Vertebral column
  • 3. Vertebrae
  • 4. Osteoporosis
    • A reduction of bone mass or the presence of a fragility fracture
    • WHO osteoporosis: a bone density that fall 2.5 SD below the mean for young healthy adults of the same race and gender
    • WHO osteopenia : a bone density that fall 1-2.5 SD below the mean for young healthy adults of the same race and gender
  • 5. Osteoporosis
  • 6. Osteoporosis
    • PATHOGENESIS
    • 1. Peak bone mass : about 20 years old
    • - genetic, hormone, nutrition, life style
    • 2. Rate of bone loss : after age 30-45, bone resorption (osteoclast)> formation (osteoblast) and become exaggerated after menopause
    • (50 years old)
    • 3. Bone remodeling : keep balance at 20-30 years old, after that become negative balance
  • 7. Osteoporosis
    • Type 1 Type 2 Type 3
    • Postmenopausal Senile secondary
    • Age 55 -70 years 70-90 years all
    • Sex(F/M) 6:1 2 :1 1:1
    • Fx site vertebrae vertebrae vertebrae
    • distal forearm hip hip
    • distal forearm
    • The threshold for Fx is reduced for osteoporotic bone
  • 8. Disease associated with increased risk of osteoporosis
    • 1. Hypogonadal states : Turner syndrome, Klinefelter syndrome
    • 2. Endocrine disorder : Cushing’s syndrome, hyper PTH, thyrotoxicosis
    • 3. Nutritional and GI disorder : malnutrition
    • 4. Rheumatologic disorder : RA
    • 5. Hematologic disorder/malignancy : MM, lymphoma, leukemia
    • 6. Inherited disorder : osteogenesis imperfecta
    • 7. Other disorder : immobilization, COPD
  • 9. Drugs associated with increased risk of osteoporosis
    • - Glucocorticoids
    • - Cycosporine
    • - Cytotoxic drugs
    • - Anticonvulsants
    • - Excessive alcohol
    • - Excessive thyroxine
    • - Heparin
    • - Lithium
  • 10. Risk factor for osteoporosis fracture
    • Nonmodifiable
      • 1. Hx of Fx in first degree relative
      • 2. Female (lower peak bone mass and menopause)
      • 3. Advanced age
      • 4. Caucasian , white
      • 5. Dementia
  • 11. Risk factor for osteoporosis fracture
    • Potentially modifiable
      • 1. Cigarette smoking
      • 2. Low body weight ( < 58 kg.)
      • 3. Estrogen deficiency : early menopause
      • (<45 years)
      • 4. Low calcium intake, high salt and protein diet
      • 5. Alcoholism
      • 6. Inadequate physical activity
      • 7. Poor health
  • 12. Measurement of bone mass
    • 1. Dual energy x-ray absorptiometry (DEXA)
        • - standard for measuring bone density
        • - hip, spine, wrist
    • 2. Quantitative computed tomography
        • - expensive, greater radiation exposure
    • 3. Ultrasound
        • - low cost, use as screening procedure
    • Plain radiography not noticeable until 30 % of bone mineral is lost
  • 13.  
  • 14.  
  • 15. Bone mineral density (BMD) should be measured in
    • 1. Post menopausal women > 65 years old.
    • 2. Post menopausal women < 65 years who have 1 or more risk factor.
    • 3. Post menopausal women with Fx.
    • 4. Women who considering therapy by using BMD decision.
    • 5. Women who have been HRT for long time.
    • 6. Men who experience Fx after minor trauma.
    • 7. Evidence of osteopenia/osteoporosis on film.
  • 16. Management of osteoporosis
    • 1. Risk factor reduction
    • 2. Nutritional recommendations
      • Calcium, vitamin D
      • Avoid salt, caffeine, excessive protein intake
    • 3. Exercise
    • 4. Protective pads
  • 17. Management of osteoporosis
    • 5. Pharmacologic therapies
      • A. Estrogens (prevention & Rx)
      • B. Selective estrogen response modulator (SERMs) prevention & Rx :Tamoxifen, Raloxifene
      • C. Biphosphonates (prevention & Rx) : Alendronate, Risedronate
      • D. Calcitonin : Rx, pain relief effect, not indicated for prevention
      • E. Parathyroid hormone, fluoride
  • 18. Spine compression fracture in osteoporosis
    • Compression Fx may be caused by trauma, osteoporosis, malignancy, infection
    • Found 25 % in women over 50 years old and 40 % in women 80 years old
    • Many cases found incidental during CXR
    • Causes : - Hx of trauma
    • - No Hx of increased force on spine
    • - stepping out bathtub, lifting trivial object, bending forward, raising window (in severe osteoporosis)
  • 19. Spine compression fracture in osteoporosis
    • Fx site : any where ( in trauma usually at T11,12 and L1)
    • Symptoms : - 1/3 are symptomatic, sudden back pain
    • - sudden injury – severe pain
    • - collapse in gradual –
    • mild pain
    • - chronic pain – change in spine alignment, muscle spasm
  • 20. Spine compression fracture in osteoporosis
    • Investigation
    • 1. Plain radiography : may not differentiate between old and recent fracture.
    • 2. MRI can determine
      • Old v.s. recent Fx
      • Osteoporosis v.s. malignancy
  • 21. Spine compression fracture in osteoporosis
    • Investigation
    • 3. Bone scan :
      • help determine acuity of Fx
  • 22. Spine compression fracture in osteoporosis
    • Management
    • 1. Rest
    • 2. Analgesic, NSAID
    • 3. Calcitonin
    • 4. Brace
  • 23. Spine compression fracture in osteoporosis
    • Management
    • 5. Vertebroplasty
    • 6. Surgical Rx

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