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Osteoporosis

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Osteoporosis presentation by Dr. Cho Mar Lwin

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Osteoporosis

  1. 1. Osteoporosis Dr. Cho Mar Lwin Rheumatology Unit, YGH 15th Medical Specialties Conference, 2011 MMA
  2. 2. Definition “Systemic skeletal disease characterized by low bone mass and micro architectural deterioration with a consequent increase in bone fragility and susceptibility to fractures”. 7/10/2011 15th Medical Specialties Conference, 2011 2 Normal bone Osteoporotic Bone Consensus Development Conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.
  3. 3. Definition 7/10/2011 15th Medical Specialties Conference, 2011 3 In 1994, an expert panel convened by The World Health Organization has published criteria for osteoporosis based on bone density
  4. 4. Definition • Osteopenia (low bone mass) - bone density measurement between 1 and 2.5 SD below the young-adult mean (T-score between -1 and -2.5). • Osteoporosis - bone density measurement less than 2.5 SD below young, healthy controls (T-score <2.5). • Established osteoporosis is defined as a T-score <2.5 and the presence of a fracture. 7/10/2011 15th Medical Specialties Conference, 2011 4 - 1 - 2.5 Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task- Force for Osteoporosis. Osteoporos Int 1999;10: 259-64.
  5. 5. Incidence and Prevalence Worldwide estimated to affect 200 million women . 7/10/2011 15th Medical Specialties Conference, 2011 5 Kanis JA (2007) WHO Technical Report, University of Sheffield, UK: 66. 10% of > 60 yr 20% of > 70 yr 40% of > 80 yr 65% of > 90 yr Non Osteoporotic women Osteoporotic women
  6. 6. • An osteoporotic fracture is estimated to occur every 3 seconds world wide • Osteoporotic fractures after 50 year of age 7/10/2011 15th Medical Specialties Conference, 2011 6 1/3 1/5 Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726. Incidence and Prevalence
  7. 7. 80% of osteoporotic people are women By 2050, the worldwide incidence of hip fracture in men is projected to increase by 310% and 240% in women 7/10/2011 15th Medical Specialties Conference, 2011 7 Incidence and Prevalence Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407. Lindsay R et al., 2001, JAMA 285:320
  8. 8. The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke and breast cancer 7/10/2011 15th Medical Specialties Conference, 2011 8 Incidence and Prevalence Riggs BL and Melton LJ, 1995, Bone 17(s5); 505S; American Heart Association, Heart & Stroke Facts 1996; American Cancer Society, Cancer Facts and Figures, 1996
  9. 9. Burden of the Disease The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease 7/10/2011 15th Medical Specialties Conference, 2011 9 Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929.
  10. 10. The disability due to osteoporosis is greater than that caused by cancers (with the exception of lung cancer) and is comparable or greater than that lost to a variety of chronic non communicable diseases, such as rheumatoid arthritis, asthma and high blood pressure related heart disease 7/10/2011 15th Medical Specialties Conference, 2011 10 Burden of Disease Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with osteoporotic fractures. Osteoporos Int 17:1726.
  11. 11. The worldwide cost burden of osteoporosis (for all ages) is forecast to increase to USD131.5 billion by 2050 7/10/2011 15th Medical Specialties Conference, 2011 11 Burden of the Disease Lindsay R et al., 2001, JAMA 285:320
  12. 12. Updates on some Asian Countries 7/10/2011 15th Medical Specialties Conference, 2011 12 300%  last 30 yr 22.5% - men > 50 50.1% - women > 50 Women 30 – 60 yr 52% - osteopenia 29% - osteoporosis Women 50 – 79 yr 35% - spine 9.5% - hip Hip fractures  4 times over 10 yrs Hip fractures  x 5 in women , x 1.5 in men over 3 decades Osteoporosis in 51.8% urban menopausal women Osteoporosis - > 50 % in > 70 yr old women Osteoporosis – 61.5% in women > 50 yr old
  13. 13. 7/10/2011 15th Medical Specialties Conference, 2011 13 Prevalence of 5 main musculoskeletal diseases in Myanmar (C Soe, 2006)
  14. 14. Prevalence in Myanmar • A study on risk factors of bony fractures in post- menopausal Myanmar women, by Thida Win-1998 conducted in Trauma unit YGH Postmenopausal osteoporosis fracture - 53.8% • Osteoporosis, Prevalence and Risk by Chit Soe, Aye Aye Khaing and Pandora Aung Gyi ( Myanmar Health Research Congress, 2004) Osteopenia in 31%of teachers and 31.5%of nurses; no patient with osteoporosis 7/10/2011 15th Medical Specialties Conference, 2011 14
  15. 15. • YGH osteoporosis study (Chit Soe, 2010) conducted in 67 Rheumatology patients 24.1.06 BJD 15 Prevalence in Myanmar Female osteopenia (19.3%), osteoporosis (15.8%) Male osteopenia (20%), osteoporosis (10%)
  16. 16. 1. Primary Previous fracture at <50 yr, parent or sibling with previous fractures, cigarette smoking, weight <127 lb or height >5 ft 7 in 2. Secondary Non modifiable • White race, advanced age, frailty or poor health, dementia Modifiable • Low calcium intake, eating disorder, low testosterone levels (men), premenopausal estrogen deficiency (amenorrhea >1 yr or menopause at age <45 yr), • excessive alcohol intake, physical inactivity, impaired vision, neurologic disorders, lack of sunlight exposure Risk Factors for Osteoporosis 7/10/2011 15th Medical Specialties Conference, 2011 16
  17. 17. Indications for Bone Densitometry • All postmenopausal women <65 yr who have one or more additional risk factors for osteoporosis, besides menopause • All women >65 yr regardless of additional risk factors • Documenting reduced bone density in a patient with a vertebral abnormality or osteopenia on a radiograph • Estrogen-deficient women at risk for low bone density, considering use of estrogen or an alternative therapy, if bone density would facilitate the decision • Women who have been on estrogen replacement therapy for prolonged periods or to monitor the efficacy of a therapeutic intervention or interventions for osteoporosis • Diagnosing low bone mass in glucocorticoid-treated individuals • Documenting low bone density in patients with asymptomatic primary or secondary hyperparathyroidism7/10/2011 15th Medical Specialties Conference, 2011 17

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