Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to bone fragility and susceptibility to fractures. Bone is composed of support cells, remodeling cells, and inorganic mineral salts deposited within a nonmineral collagen matrix. Osteoporosis is diagnosed through physical examination, measurement of bone mineral density via dual-energy X-ray absorptiometry (DXA) scanning, or other imaging techniques. Treatment involves calcium and vitamin D supplementation, hormone replacement therapy, bisphosphonates, parathyroid hormone therapy, and lifestyle modifications.

1. OSTEOPOROSIS
JEEVA P
P.B.PHARM.D II YEAR

2. OSTEOPOROSIS
• A systemic skeletal disease characterized by low bone mass and micro
architectural deterioration of bone tissue lead to bone fragility and
susceptibility to fracture

4. Basic Bone Biology:
• Bone is a highly specialized support tissue which is characterized by its rigidity and
hardness.
• The major functions of bone are:
• To provide structural support for the body to provide protection of vital organs
• To provide an environment for marrow (both blood forming and fat storage)
• To act as a mineral reservoir for calcium homeostasis in the body

5. Bone is composed of:
• Support cells (osteoblasts and osteocytes)
• Remodeling cells (osteoclasts)
• Nonmineral matrix of collagen and noncollagenous proteins (osteoid)
• Inorganic mineral salts deposited within the matrix

6. Pathogenesis:

7. • https://youtu.be/6aLAAc9hEzg

10. Diagnosis of osteoporosis:
Physical examination:
• Measurement of bone mineral content dual x-ray absorptiometry (DXA)
ultrasonic measurement of bone CT scan
• Radiography

12. Dual x-ray absorptiometry
• 2-dimensional study
• BMD = amount of mineral
Area
Accuracy at hip > 90%
Low radiation exposure
Error in
Osteomalacia osteoarthritis previous fracture
WHO criteria - hip BMD
• Normal
• Low bone mass (osteopenia)
• Osteoporosis
• Severe osteoporosis

13. Physical examination
 Osteoporosis
 Height loss
 Body weight
 Humped back
 Tooth loss
 Skinfold thickness
 Grip strength

14. Treatment
Available treatment:
 Calcium and vitamin D hormone replacement therapy
 Selective estrogen receptor modulators ( SERMS )
 Bisphosphonates calcitonin
 Parathyroid hormone
 Other treatments
 Non-pharmacologic intervention

15. Calcium preparations:
Elemental calcium:
Calcium citrate 60mg/300mg
Calcium lactate 80mg/600mg
Calcium gluconate 40mg/500mg
Calcium carbonate 400mg/g
Calcium carbonate+5 mcg vit D2 250mg/tablet

16. Vitamin D:
 Essential for intestinal absorption of calcium daily recommendation400 - 800 IU/day.
 Low sunlight exposure, elderly, low vitamin D intake.
 Decreased risk of fracture in healthy elderly with normal intake & BMD.

17. Hormone replacement therapy:

18. Calcitonin:
 Peptide from thyroid C cell.
 Direct inhibition of osteoclast activity less effective in cortical bone salmon calcitonin
nasal spray.
 Dose 200 IU/day.

19. Parathyroid hormone
 Intermittent injection stimulate new bone formation
CONTRAST to continuous infusion
 Teriparatide ( rhpth[1-34] ) was approved by US-FDA
for treatment of osteoporosis
 Transient dose-related hypercalcemia long term
effects are not known

20. Efficacy:

21. Treatment decision:
Primary prevention:
 Adequate calcium & vit D intake
 HRT is no longer recommended
 Few reacts ( FIT,MORE ) show benefit of alendronate and
raloxifene
Secondary prevention/treatment:
 Bisphosphonate ( risedronate, alendronate )together with calcium +/- vit D
supplement rh-pth ( teriparatide ).
 Salmon calcitonin
 Raloxifene

22. Reference:
1.https://youtu.be/jUQ_tt_zJDo
2.https://youtu.be/Ei4seya3dOg
3.https://youtu.be/QDQ4d5V0K7o

23. THANK YOU