Peran bone & joint

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Peran bone & joint

  1. 1. SOELARTO REKSOPRODJOSOELARTO REKSOPRODJODivision of Orthopaedic & TraumatologyDivision of Orthopaedic & TraumatologyFaculty of Medicine, Univ. of IndonesiaFaculty of Medicine, Univ. of IndonesiaDr. Cipto Mangunkusumo – JakartaDr. Cipto Mangunkusumo – JakartaSimposium SehariSimposium Sehari““Penanganan Nyeri Tulang Belakang Terkini”Penanganan Nyeri Tulang Belakang Terkini”Graha Sindang Reret, Garut, 29 Mei 2004Graha Sindang Reret, Garut, 29 Mei 2004
  2. 2. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISINTRODUCTIONINTRODUCTIONDeclaration of Bone and Joint DecadeDeclaration of Bone and Joint Decade2000 – 2010 by the WHO was positively2000 – 2010 by the WHO was positivelyrespons by professional as well socialrespons by professional as well socialassociation by nearly all developed andassociation by nearly all developed anddeveloping countries including Indonesiadeveloping countries including Indonesia
  3. 3. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISWhat is the Bone and Joint Decade ?What is the Bone and Joint Decade ? It is a worldwide effort to advance under-It is a worldwide effort to advance under-standing and treatment of muscuolskeletalstanding and treatment of muscuolskeletalconditions and to promote researchconditions and to promote research Patients, physicians, medical specialtyPatients, physicians, medical specialtysocieties, allied health professionals andsocieties, allied health professionals andhealth organizations are urging their nationshealth organizations are urging their nationsworldwide to focus attention on the disordersworldwide to focus attention on the disorderswhich affect millions of peoplewhich affect millions of people
  4. 4. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISIRA (Indonesian Rheumatology Association)IRA (Indonesian Rheumatology Association)was the first professional association inwas the first professional association inIndonesia, at their meeting in Jakarta,Indonesia, at their meeting in Jakarta,May 2000 responded the declaration, whichMay 2000 responded the declaration, whichwas announced by the Minister of Health RIwas announced by the Minister of Health RI
  5. 5. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISIn the same year :In the same year : The Woman Association founded YATUSIThe Woman Association founded YATUSI(Yayasan Tulang Sehat Indonesia)(Yayasan Tulang Sehat Indonesia)June 2000June 2000 The study group of osteoporosis FKUI – RSCMThe study group of osteoporosis FKUI – RSCMfounded the PEROSI (Perhimpunanfounded the PEROSI (PerhimpunanOsteoporosis Indonesia), 28 Oktober 2000Osteoporosis Indonesia), 28 Oktober 2000
  6. 6. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISThe President of the Republic of IndonesiaThe President of the Republic of Indonesiadeclared the participation of Indonesia,declared the participation of Indonesia,read by the Minister of Health at the Goldenread by the Minister of Health at the Goldenanniversary of RSO Prof. DR. R. Soeharsoanniversary of RSO Prof. DR. R. Soeharsoin Solo, August 2001in Solo, August 2001
  7. 7. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISGoals of the Bone and Joint DecadeGoals of the Bone and Joint Decade1.1. ToTo raise awarenessraise awareness of the growing burden ofof the growing burden ofmusculoskeletal disorders on societymusculoskeletal disorders on society2.2. ToTo empower patientsempower patients to participate in theirto participate in theirown careown care3.3. ToTo promote cost – effective prevention andpromote cost – effective prevention andtreatmenttreatment4.4. ToTo improve prevention and treatmentimprove prevention and treatment of muskulo-of muskulo-skeletal disorders through medical researchskeletal disorders through medical research
  8. 8. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISBONE AND JOINTBONE AND JOINTBone and Joint is part of the musculo-Bone and Joint is part of the musculo-skeletal system, function as a locomotorskeletal system, function as a locomotorapparatus; disorders and diseases mayapparatus; disorders and diseases maydisturb the ADLdisturb the ADL
  9. 9. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISDisorders or diseases of musculoskeletalDisorders or diseases of musculoskeletalsystem is classified as follows :system is classified as follows : Congenital anomaliesCongenital anomalies Inflammation / infectionInflammation / infection TraumaTrauma Tumor / cancerTumor / cancer Degenerative diseaseDegenerative disease Metabolic diseaseMetabolic disease MiscellaneousMiscellaneous
  10. 10. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISDisorders or diseases of bone and jointDisorders or diseases of bone and jointwill widely affect socio-economic and ADLwill widely affect socio-economic and ADL(example :(example :- USA in 1995 : 36 million people- USA in 1995 : 36 million peoplethe cost of treatment for musculoskeletalthe cost of treatment for musculoskeletaldisorders was USD $ 210 billion)disorders was USD $ 210 billion)- Musculoskeletal impairment are the- Musculoskeletal impairment are thenumber 1 (one) reported category ofnumber 1 (one) reported category ofimpairment and the number 1 (one) reasonimpairment and the number 1 (one) reasonpeople visit the doctorpeople visit the doctor
  11. 11. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISNatural history of musculoskeletalNatural history of musculoskeletaldiseases through 3 stages of functionaldiseases through 3 stages of functionaldisorders :disorders :1.1. ImpairmentImpairment2.2. DisabilityDisability3.3. HandicapHandicap
  12. 12. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISNot all disorders and diseases of musculo-Not all disorders and diseases of musculo-skeletal either congenital or acquiredskeletal either congenital or acquiredwill recover 100%will recover 100%It needs rehabilitation especially toIt needs rehabilitation especially toimprove functionimprove function
  13. 13. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISThe goal is maximum rehabilitationThe goal is maximum rehabilitationof patient as a wholeof patient as a whole
  14. 14. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISAlthough there are many disease orAlthough there are many disease ordisorders of the musculoskeletal, butdisorders of the musculoskeletal, butit seems the topics of the Bone & Jointit seems the topics of the Bone & Jointdecade is more on the process ofdecade is more on the process ofaging such as (degenerative disease) :aging such as (degenerative disease) : OsteoporosisOsteoporosis OsteoarthritisOsteoarthritis
  15. 15. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISDegenerative process :Degenerative process : All tissue or organs will reduceAll tissue or organs will reducetheir function 1% per year aftertheir function 1% per year afterthe 3the 3rdrddecadedecade(the 1% rule of Andreas & Tobin)(the 1% rule of Andreas & Tobin)
  16. 16. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISAs a whole there is slowly affection ofAs a whole there is slowly affection ofthe tissues / organs :the tissues / organs : The eye : Vision : cataract, hypermetropThe eye : Vision : cataract, hypermetrop The ear : DeafnessThe ear : Deafness The skin : Dry and wrinkledThe skin : Dry and wrinkled The urinary tract : - IncontinentThe urinary tract : - Incontinent- hypertrophy prostate in men- hypertrophy prostate in men The GI tract : - Incontinent, resorptionThe GI tract : - Incontinent, resorption ↓↓ The genital : Frigidity, impotencyThe genital : Frigidity, impotency The mental : Depression, dementiaThe mental : Depression, dementia The nerve : ReflexThe nerve : Reflex ↓↓ Bone & Joint : osteoporosis / osteoarthritisBone & Joint : osteoporosis / osteoarthritis
  17. 17. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISOSTEOPOROSISOSTEOPOROSIS PEROSI is a group of doctor in multidisciplinePEROSI is a group of doctor in multidisciplinemedical sciences interested in problem ofmedical sciences interested in problem ofosteoporosisosteoporosis It is now a associate member of IOF (InternationalIt is now a associate member of IOF (InternationalOsteoporosis Foundation)Osteoporosis Foundation) The patron of IOF is : Queen Rania of JordanThe patron of IOF is : Queen Rania of Jordan
  18. 18. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS““Strong bones build strong lives, andStrong bones build strong lives, andstrong lives build strong future ……….,strong lives build strong future ……….,we must do all we can to make thatwe must do all we can to make thatstrength a reality for all”strength a reality for all”Queen Rania, Lisbon 10 –14 May 2002Queen Rania, Lisbon 10 –14 May 2002
  19. 19. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISResearch in Indonesia :Research in Indonesia : Prof. DR. Djoko Roeshadi, dr. Sp.B., Sp.BOProf. DR. Djoko Roeshadi, dr. Sp.B., Sp.BO DR. Ichramsyah A.R., Sp.OG, KERDR. Ichramsyah A.R., Sp.OG, KER
  20. 20. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS Osteoporosis is a “silent disease”Osteoporosis is a “silent disease”meaning no significant clinical symptomsmeaning no significant clinical symptomsunless a minor trauma produces fractureunless a minor trauma produces fracture A good observation of mild dull achingA good observation of mild dull achingof the back, reduce in height and kyphoticof the back, reduce in height and kyphoticdeformity are the early signs of osteoporoticdeformity are the early signs of osteoporoticespecially in post menopausal womenespecially in post menopausal women
  21. 21. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISWHO definition (1991) :WHO definition (1991) :““Osteoporosis is a disease characterizedOsteoporosis is a disease characterizedby low bone mass and microarchitecturalby low bone mass and microarchitecturaldeterioration of bone tissue, leading todeterioration of bone tissue, leading toenhanced bone fragility and a consequentenhanced bone fragility and a consequentincrease in fracture risk”increase in fracture risk”
  22. 22. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISGold standard to detect osteoporosis :Gold standard to detect osteoporosis :- Densitometry- Densitometry- WHO criteria :- WHO criteria :Normal : 1SD from TScoreNormal : 1SD from TScoreOsteopenia : -1SD to –2,5SD from TScoreOsteopenia : -1SD to –2,5SD from TScoreOsteoporosis : less than –2,5SD from TScoreOsteoporosis : less than –2,5SD from TScore(severe osteoporosis : associated a fracture)(severe osteoporosis : associated a fracture)
  23. 23. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISThe Interpretation of DEXAThe Interpretation of DEXAT Score Bone Loss Fracture RiskT Score Bone Loss Fracture Risk0 to –1 None None0 to –1 None None-1 to –2-1 to –2 Moderate SmallModerate Small-2 to –3-2 to –3 Severe ModerateSevere ModerateLess than –3 Very severe SevereLess than –3 Very severe SevereOrthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889Orthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889
  24. 24. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS4 Sets of factors as the cause of osteoporosis4 Sets of factors as the cause of osteoporosis1.1. Genetic / familialGenetic / familialNutritionalNutritionalPhysical activityPhysical activityLife styleLife styleHealth / disease history with the use of drugsHealth / disease history with the use of drugs2.2. Bone loss post menopauseBone loss post menopause3.3. Bone loss with agingBone loss with aging4.4. RiskRisk
  25. 25. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISWOD and NOD 20 OctoberWOD and NOD 20 October2002 :2002 : Theme :Theme :““ Seberapa jauh anda peduliSeberapa jauh anda peduliterhadap tulang andaterhadap tulang anda ““2003 : “2003 : “ Tulang kuat mulai dari sekarangTulang kuat mulai dari sekarang ””
  26. 26. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISBMD / BMC will reach maximum atBMD / BMC will reach maximum atthe end of the 3the end of the 3rdrddecade :decade :(Peak Bone Mass)(Peak Bone Mass)
  27. 27. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISPrevention is divided into :Prevention is divided into :Primary :Primary : Before osteoporosis, to reachBefore osteoporosis, to reachmaximum PBMmaximum PBMSecondary : -Secondary : - After detected as osteoporosis/After detected as osteoporosis/osteopenia (avoid external factor)osteopenia (avoid external factor)-- If already fracturedIf already fractured
  28. 28. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISOSTEOARTRHITISOSTEOARTRHITISIs a degenerative process non inflammatoryIs a degenerative process non inflammatorydisease of the joint characterized by degradationdisease of the joint characterized by degradationof articular cartilage and spur formation at the edgeof articular cartilage and spur formation at the edgeof the articular surfaceof the articular surface(a lay man will call =(a lay man will call = PengapuranPengapuran))
  29. 29. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISThere are a lot of terminologies forThere are a lot of terminologies fordisorders or diseases of the jointdisorders or diseases of the jointRA : Rheumatology Arthritis (RA : Rheumatology Arthritis (encokencok))Infective arthritis : - StaphylococcusInfective arthritis : - Staphylococcus- Tb, etc- Tb, etcGouty arthritis, etcGouty arthritis, etc
  30. 30. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISMostly affected the elderly peopleMostly affected the elderly people(more than 50 years of age, obese,(more than 50 years of age, obese,and weight bearing joint), stiffnessand weight bearing joint), stiffnessand pain after a rest following a longand pain after a rest following a longperiod of activitiesperiod of activities
  31. 31. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISA multi factoral etiology which causeA multi factoral etiology which causedegradation of articular cartilagedegradation of articular cartilagesuch as :such as : Instability of joint as a biomechanicalInstability of joint as a biomechanicalprocess : wear and tear (use abuse)process : wear and tear (use abuse) Immunology and inflammation reactionImmunology and inflammation reaction Stress oxydatives cause destructionStress oxydatives cause destructionof cartilage, etcof cartilage, etc
  32. 32. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISDIAGNOSISDIAGNOSIS HistoryHistory Physical Examination (PE)Physical Examination (PE) ImagingImaging
  33. 33. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISMANAGEMENTMANAGEMENT PT : - Strengthening exercisePT : - Strengthening exercise- ROM- ROM- Non weight bearing exercise /- Non weight bearing exercise /hydrotherapyhydrotherapy BracingBracing Operative : - ArthroscopyOperative : - Arthroscopy- Arthrodesis- Arthrodesis- Joint Replacement- Joint Replacement
  34. 34. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSISINCONCLUSIONINCONCLUSION Bone and joint decade 2000 – 2010 has beenBone and joint decade 2000 – 2010 has beendeclareddeclared Important of awareness concerning the problemImportant of awareness concerning the problemof sosio-economic by empowering patient toof sosio-economic by empowering patient toparticipate in their own careparticipate in their own care Participation of professional association to raiseParticipation of professional association to raisequality of life by :quality of life by :prevention, treatment base on researchprevention, treatment base on research(Evidence Base Medicine)(Evidence Base Medicine)

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