osteoporosis

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osteoporosis

  1. 1. OSTEOPOROSIS Presented By: Shabana Khatoon M.Pharm 2nd Year
  2. 2. Osteoporosis • Disease that causes bones to become thin,weak and easy to break. • Bone get weaker when there is low level of calcium, phosphorus and other minerals in the bones and results in low bone density.
  3. 3. Normal Moderate Severe
  4. 4. • The reduction of bone mass with distortion of the microarchitecture is termed osteoporosis. • Reduction in the mineral content is termed osteopenia.
  5. 5. OSTEOPOROSIS
  6. 6. 1,500,000 0 500,000 1,000,000 1,500,000 2,000,000 Osteoporotic Fractures * 513,000 Heart Attack ** 228,000 Stroke † 184,300 Breast Cancer ‡ Annualincidenceofcommondiseases Frequency of Common Medical Events in Women
  7. 7. •Osteoporosis is a health threat for an estimated 44 million Americans. •Of that 44 million : •10 million individuals already have the disease •80% of these are women •34 million more are estimated to have low bone mass and increased risk for osteoporosis. Prevalence . • osteoporosis is often thought of as an older person's disease, it can strike at any age.
  8. 8. Bone density can be temporarily lost during breastfeeding. Several studies have shown that recovering full bone density occurs within six months after weaning. Bone loss during breastfeeding? •Women have a hip fracture rate two to three times higher than men. •A woman's risk of hip fracture is equal to her combined risk of breast, uterine and ovarian cancer. OSTEOPOROSIS IN WOMEN
  9. 9. TYPES OF OSTEOPOROSIS Primary Osteoporosis Secondary Osteoporosis
  10. 10. . 1. Rheumatologic disorders •Rheumatoid arthritis, •Ankylosing spondylitis Etiology 2. INHERITED DISORDERS •Osteogenesis imperfecta •Glycogen storage diseases
  11. 11. . 3. Nutritional and gastrointestinal disorders •malnutrition, •parenteral nutrition, •gastrectomy, Etiology 4. Endocrine disorders •hyperparathyroidism •insulin-dependent diabetes mellitus, •adrenal insufficiency
  12. 12. Detection: Bone Mineral Density Tests DXA (Dual Energy X-ray Absorptiometry) spine, hip or total body pDXA (Peripheral Dual Energy X-ray Absorptiometry) wrist, heel or finger SXA (single Energy X-ray Absorptiometry) wrist or heel QUS (Quantitative Ultrasound) heel, shin bone and kneecap QCT (Quantitative Computed Tomography) spine pQCT (Peripheral Quantitative Computed Tomography) wrist RA (Radiographic Absorptiometry) hand DPA (Dual Photon Absorptiometry) spine, hip or total body SPA (Single Photon Absorptiometry) wrist Type of Test Area tested
  13. 13. RISK FACTORS • Amenorrhea • Anorexia • Bulimia • Diet low in calcium • Low testosterone in men • Certain medication
  14. 14. Osteoporosis classification • WHO criteria: – T-score < –1.0 = normal – T-score > –1.0–2.5 = osteopenia – T-score > –2.5 = osteoporosis
  15. 15. Therapeutic Agents Used in Osteoporosis • Inhibitors of bone resorption: – Calcium – Estrogens +/- progest – SERMs – Bisphosphonates – Calcitonin • Stimulators of bone formation – PTH – Fluoride A. Normal Spine B. Moderately Osteoporotic Spine C. Severely Osteoporotic Spine
  16. 16. Management of underlying disease • Non pharmacological • Pharmacological
  17. 17. Non pharmacological management • Adequate diet – in proteins, calories, calcium, Vitamin D • High impact physical activity :  Jogging – increases bone density  Stair climbing – increases bone density  Regular exercises – helps to increase strength and reduce risk of falling.  Balanced exercises – reduce falls
  18. 18. • Cessation of smoking • Stop or reduce alcohol
  19. 19. Pharmacological • Anti resorptive drugs : Bisphosphonates,calcium and vitamin. SERM – Raloxifene Estrogen Calcitonin : PTH - Teriparatide
  20. 20. Mechanism of Action: •inhibition of the production of essential lipid compounds inside osteoclasts •decreased osteoclast activity •induction of cell death. • decreases bone turnover •slowing the rate at which new bone remodeling units are formed •reducing the depth of resorption. • increase in bone mass over time. Bisphosphonates 1. Alendronate (brand name Fosamax®) 2. Ibandronate (brand name Boniva®) 3. Risedronate (brand name Actonel® )
  21. 21. Calcium and vitamin D : Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk Calcium and vitamin D : Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk Calcium and vitamin D : Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk of non-vert Calcium and vitamin D : Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk of non-vert Calcium and vitamin D : • Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk of non-vertebral fractures, including hip fracture. There is also evidence that calcium and vitamin D taken in these benefits are due to vitamin D, calcium or a combination of both. vitamin D alone protects against hip fracture. •
  22. 22. SELECTIVE ESTROGEN RECEPTOR MODULATORS(SERMs) • Mechanism of action – increase osteoblast activity & reduction in osteoclast activity. • Eg.Raloxifene(evista) • Decrease bone resorption • Prescribed to low risk of spinal fractures in women after menopause.
  23. 23. Estrogen/Hormone Therapy (ET/HT)• FDA approved for: – Prevent osteoporosis – Treatment of moderate/severe symptoms of vaginal atrophy associated with menopause.
  24. 24. Hormone Replacement Therapy (HRT )HRT is available in many different forms which provide oestrogen, cyclical oestrogen and progestogen or both hormones in a continuous combined product daily tablets, patches, implants, Gel nasal spray. Eg.A synthetic steroid, tibolone (Livial) is also available .
  25. 25. Calcitonin • FDA-approved for: – Treatment of osteoporosis in women who are > 5 years postmenopausal – Adjunctive therapy for hypercalcemia • Mechanism: – Peptide composed of 32 amino acids which binds to osteoclasts and inhibits bone resorption – Promotes the renal excretion of calcium, phosphate, sodium, magnesium and potassium by decreasing tubular reabsorption
  26. 26. Calcitonin – Clinical Efficacy Has been shown to increase spinal bone mass and may decrease risk of vertebral fracture • Less effective than bisphosphonates in treatment of osteoporosis • Beneficial, short-term effect on acute bone pain after osteoporotic fracture (vertebral)
  27. 27. • PARATHYROID HORMONE( PTH)- • FDA-approved for: – Treatment of osteoporosis in postmenopausal women at high risk for fracture. – Treatment of primary osteoporosis. • Mechanism of action- It stimulates osteoblast activity & enhance bone formation.
  28. 28. • Eg: Teriparatide • Increase bone mass. • Increase bone microarchitecture. • Injection derived from of PTH. • Use in extremely severe form of osteoporosis. • Side effect : nausea,headache,leg cramps.
  29. 29. PTH and Alendronate: Combining Treatments Shows No Bone Density Advantage : • PTH and Alendronate: Combining Treatments Shows No Bone Density Advantage Combining the bone- building treatment parathyroid hormone (PTH) with alendronate, a drug that slows bone loss, produces no significant improvement in bone mineral density (BMD) beyond that produced by the individual drugs, according to two new studies involving postmenopausal women and men with low BMD. The two studies, reported in the September 25 issue of the New England Journal of Medicine and supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), one of the National Institutes of Health, both tested BMD in
  30. 30. • . The two studies, reported in the September 25 issue of the New England Journal of Medicine and supported by the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), one of the National Institutes of Health, both tested BMD in the spine and hip. BMD, a common indicator of bone health, is used to diagnose the bone-weakening disease osteoporosis, detect low bone mass before the disease develops and help predict the risk of future fractures.
  31. 31. RICKETS & OSTEOMALACIA Def.: reduction in bone mineralization !
  32. 32. OSTEOMALACIA,RICKETS Normal bone metabolism • CALCIUM 99% in bone. Main functions- muscle /nerve function, clotting. Plasma calcium- 50% free, 50% bound to albumin.
  33. 33. OSTEOMALACIA,RICKETS Normal bone metabolism • PHOSPHATE 85% in bone. Functions-metabolite and buffer in enzyme systems. • Plasma phosphate mainly unbound. Daily requ. 1-1.5g/day
  34. 34. OSTEOMALACIA,RICKETS Regulation of Calcium & Phosphate Metabolism: Peak bone mass at 16-25 years. Bone loss 0.3- 0.5% per year (2-3% per year after 6th decade). 1. Parathyroid Hormone (PTH) 2. Vitamin D3 3. Calcitonin 4. Other Hormones: Estrogen: Prevents bone loss Corticosteroids: Increases bone loss Thyroid hormones: Leads to osteoporosis Growth hormones: Cause positive calcium balance Growth factors
  35. 35. RICKETS, OSTEOMALACIA CAUSES: 1. Nutritional deficiency 1. Vit D 2. chelators of calcium- phytates, oxalates, phosphorous 3. Antacid abuse, causing reduced dietary phosphate binding 2. GI Absorption defects 1. Post gastrectomy 2. Biliary disease (reduced absorption of Vitamins ) 3. Small bowel disease 4. liver disease 3. Renal tubular defects 4. Renal osteodystrophy 5. Miscellaneous causes
  36. 36. RICKETS, OSTEOMALACIA CLINICAL FEATURES: • Rickets - Tetany , convulsions, failure to thrive, restlessness, muscular flaccidity. Flattening of skull (craniotabes), Thickening of wrists from epiphyseal overgrowth, Stunted growth, Rickety rosary, spinal curvature, Coxa vara, bowing, # of long bones • Osteomalacia, - Aches and pains, muscle weakness loss of
  37. 37. • Glucosamine sulfate is a naturally occurring chemical found in the human body. It is in the fluid that is around joints. Glucosamine is also found in other places in nature. For example, the glucosamine sulfate that is put into dietary supplements is often harvested from the shells of shellfish. Glucosamine sulfate used in dietary supplements does not always come from natural sources. It can also be made in a laboratory.
  38. 38. These additional ingredients are frequently chondroitin sulfate, MSM, or shark cartilage. How does it work? Glucosamine sulfate is a chemical found in the human body. It is used by the body to produce a variety of other chemicals that are involved in building tendons, ligaments, cartilage, and the thick fluid that surrounds joints. In some people with osteoarthritis, the cartilage breaks down and becomes thin. This results in more joint friction, pain, and stiffness.
  39. 39. Thank You

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