Osteoporosis is a progressive bone disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones that are prone to fracture. It is defined as a bone density 2.5 standard deviations below peak bone mass. Osteoporosis commonly affects older individuals, especially postmenopausal women. Risk factors include age, sex, family history, hormone changes, poor diet, medications, and medical conditions. Diagnosis involves tests like DEXA scans and quantitative CT scans. Treatment includes lifestyle changes, calcium and vitamin D supplementation, bisphosphonates, and other drugs that reduce bone resorption or increase bone formation to manage the disease and prevent fractures.

1. OSTEOPOROSIS
SUBMITTED BY :AJMAL F
Vth PHARM-D

2. DEFINITION
 Osteoporosis is a progressive disease characterised by low bone
mass and micro-architectural deterioration of bone tissue
resulting in increased bone fragility and susceptibility to fracture.
 World Health Organization [WHO] defines osteoporosis as a
bone density that falls 2.5 standard deviations [SD] below the
mean for young healthy adults of the same race and gender, it also
referred to as a T-score of 2.5.
 Osteoporosis is most seen in older individuals, primarily
postmenopausal women, but it can also affect men and younger
women.

3. OSTEOPOROSIS OF HUMAN BONES

4. SYMPTOMS
There are typically no symptoms in the early stages of bone loss. But
once your bones have been weakened by osteoporosis, you might
have signs and symptoms that include:
 Back pain [caused by a fractured or collapsed vertebra]
 Loss of height over time
 A stooped posture [Kyphosis]
 Fracture from a fall

5. RISK FACTORS
 Age
 Sex
 Family history
 Changes to hormones
 Diet
 Medications like glucocorticoids, proton pump inhibitors, cancer
medications, anticonvulsants etc.
 Other medical conditions like Rhuematoid arthritis,
hyperthyroidism, hyperparathyroidism, Cushing's syndrome etc.
 Cigarette smoking and excessive alcohol use.

6. DIAGNOSIS
 Quantitative computed tomography
 Dual-energy x-ray absorptiometry [DEXA]
 Ultrasonography
 Biomarkers

7. MANAGEMENT
NON PARMACOLOGICAL TREATMENT:
 Diet changes : intake of calcium rich foods like milk, yogurt,
cheese etc and vitamin D rich foods like mushroom, cod liver oil,
salmon etc.
 Avoid smoking.
 Avoid consumption of alcohol.
 Exercise.
 Prevention of fall.

8. PHARMACOLOGICAL TREATMENT
 Vitamin D and calcium - Vitamin D deficiency is common in elderly
people. Treatment for 12–18 months with 800 IU of vitamin D plus
1.2g of calcium given daily has been shown to reduce hip and non-
vertebral fractures in elderly women (mean age 84 years). It is not
known whether vitamin D supplementation alone reduces hip fractures.
 Calcitriol and alfacalcidol - Calcitriol , the active metabolite of vitamin
D, and alfacalcidol, a synthetic analogue of calcitriol, reduce bone loss
and have been shown to reduce vertebral fractures, but not consistently.
Serum calcium should be monitored regularly in patients receiving
these drugs.
 Bisphosphonates - Bisphosphonates, synthetic analogues of
pyrophosphate, bind strongly to the bone surface and inhibit bone
resorption. Currently, three oral bisphosphonates are available for the
treatment of osteoporosis: alendronate, etidronate and risedronate.

9.  Hormone replacement therapy (HRT). Oestrogens increase bone
formation and reduce bone resorption. They also increase calcium
absorption and decrease renal calcium loss. HRT, if started soon
after the menopause, is effective in preventing vertebral fractures
but has to be continued lifelong if protection against fractures is
to be maintained.
 Raloxifene - Raloxifene, an oral selective oestrogen receptor
modulator (SERM) that has oestrogenic actions on bone and anti-
oestrogenic actions on the uterus and breast. It reduces the risk of
vertebral fractures.
 Calcitonin – Calcitonin decreases the rate of bone resorption. It is
effective in all age groups in preventing vertebral bone loss. It
should not be given for more than 3-6 months at a time to avoid
it’s inhibitory effects on bone resorption and formation.
Calcitonin is useful in treating acute pain associated with
osteoporotic vertebral fractures.

10.  Parathyroid hormone peptides - Teriparatide is the recombinant
portion of human parathyroid hormone, amino acid sequence 1–
34, of the complete molecule (which has 84 amino acids). It
reduces vertebral and non-vertebral fractures in postmenopausal
women. It is given subcutaneously at a dose of 20 μcg daily.
 Strontium ranelate - Strontium ranelate, which both increases
bone formation and reduces bone resorption, reduces vertebral
and nonvertebral (including hip) fractures in postmenopausal
women with osteoporosis.

11. REFERENCE
 Harrison’s Principle’s of Internal Medicine, Vol 1 by M.D. Longo,
M.D. Fauci, M.D. Kasper, Stephen L. Hauser, Jameson 18th
edition.
 Pharmacotherapy- A Pathophysiological Approach by Joseph T.
Dipiro, Robert L. Talbert, Gary C. Lee, Gary R. Matzke, Barbara
G. Wells, Michael Posey 6th edition.
 Clinical Pharmacy and Therapeutics by Roger Walker and Cate
Whittlesea 5th edition.

12. THANK YOU