3. 14.1.05
Osteoporosis 3
Rank Cause
1 Lower respiratory infections
2 Diarrheal diseases
3 Peripheral conditions
4 Unipolar major depression
5 Ischemic heart disease
6 Cerebrovascular disease
7 Tuberculosis
8 Measles
9 Road Traffic accidents
10 Congenital abnormalities
Worldwide Disease Projection
Estimated 1990 Projected 2020
Rank Cause
1 Ischemic heart disease
2 Unipolar major depression
3 BJD (Road traffic accidents)
4 Cerebrovascular disease
5 COPD
6 Lower respiratory infections
7 Tuberculosis
8 War
9 Diarrheal diseases
10 HIV
Neil B, Chapman N, Patel A. Eur Heart J 2002;4(suppl F):F2-F6.
4. 14.1.05
Osteoporosis 4
To target 5 Areas
• 1. Rheumatoid Arthritis
• 2. Osteoporosis
• 3. Low Back Pain
• 4. OA knee
• 5. Limb trauma
5. 14.1.0514.1.05 OsteoporosisOsteoporosis 55
Epidemic of the millenniumsEpidemic of the millenniums
OsteoporosisOsteoporosis
The lifetime risk of vertebral fractureThe lifetime risk of vertebral fracture
has been estimated to be 15.4%has been estimated to be 15.4%
after age 45 yearsafter age 45 years
but this most likely largelybut this most likely largely
underestimates the true risk. (12-underestimates the true risk. (12-
30% in diff. studies)30% in diff. studies)
The demand on the health careThe demand on the health care
system is therefore increasing, assystem is therefore increasing, as
are costs for societyare costs for society
11. 14.1.0514.1.05 OsteoporosisOsteoporosis 1111
BMP=Bone Morphogenic ProteinBMP=Bone Morphogenic Protein
SOST=SclerostinSOST=Sclerostin
RANK=Receptor Activator of Nuclear Factor KappaRANK=Receptor Activator of Nuclear Factor Kappa
OPG=OsteoprotegerinOPG=Osteoprotegerin
12. 14.1.0514.1.05 OsteoporosisOsteoporosis 1212
WHO Diagnostic Categories forWHO Diagnostic Categories for
Osteoporosis (1994)Osteoporosis (1994)
NormalNormal -BMD not more than 1 SD below-BMD not more than 1 SD below
the young adultthe young adult
OsteopeniaOsteopenia -BMD between 1 and 2.5 SD-BMD between 1 and 2.5 SD
OsteoporosisOsteoporosis -BMD more than 2.5 SD-BMD more than 2.5 SD
below the young adult mean value.below the young adult mean value.
Severe osteoporosisSevere osteoporosis -BMD value more-BMD value more
than 2.5 SD in thethan 2.5 SD in the presence of 1presence of 1
oror more fragility fractures.more fragility fractures.
14. 14.1.0514.1.05 OsteoporosisOsteoporosis 1414
How do you interpret a boneHow do you interpret a bone
mass report?mass report?
The bone mass report includes threeThe bone mass report includes three
values at each skeletal site analyzed:values at each skeletal site analyzed:
absolute bone mass in gm/cm2, T-absolute bone mass in gm/cm2, T-
score, and Z-score.score, and Z-score.
The T-score is the number ofThe T-score is the number of
standard deviations (SDs) that astandard deviations (SDs) that a
patient's value lies above or belowpatient's value lies above or below
the mean peak value for youngthe mean peak value for young
adults.adults.
15. 14.1.0514.1.05 OsteoporosisOsteoporosis 1515
Any T-score between -1 and -2.5 isAny T-score between -1 and -2.5 is
termed osteopenia and any valuetermed osteopenia and any value
below -2.5 is consideredbelow -2.5 is considered
osteoporosis.osteoporosis.
The Z-score is the number of SDsThe Z-score is the number of SDs
that a patient's value lies above orthat a patient's value lies above or
below the mean value for age-below the mean value for age-
matched adults.matched adults.
16. 14.1.0514.1.05 OsteoporosisOsteoporosis 1616
Risk factors for osteoporosisRisk factors for osteoporosis
GeneticGenetic
Race, Low body weight, Family HistoryRace, Low body weight, Family History
Osteogenesis imperfecta, Homocystinuria,Osteogenesis imperfecta, Homocystinuria,
GaucherGaucher
SmokingSmoking
ImmobilizationImmobilization
Alcohol useAlcohol use
EndocrineEndocrine
Hyperthyroidism, HyperparathyroidismHyperthyroidism, Hyperparathyroidism
Cushing's syndrome, Androgen loss,Cushing's syndrome, Androgen loss,
Hypogonadism, Menopause (natural or surgical)Hypogonadism, Menopause (natural or surgical)
17. 14.1.0514.1.05 OsteoporosisOsteoporosis 1717
Risk factors for osteoporosis (con)Risk factors for osteoporosis (con)
Calcium deficiencyCalcium deficiency
Dietary, Chronic liver diseaseDietary, Chronic liver disease
Malabsorption, IBSMalabsorption, IBS
Losses in renal diseaseLosses in renal disease
Vitamin D deficiencyVitamin D deficiency
Decreased exposure to sunlightDecreased exposure to sunlight
Renal diseaseRenal disease
DrugsDrugs
CorticosteroidsCorticosteroids
Cyclosporine, anticonvulsants, SedativesCyclosporine, anticonvulsants, Sedatives
Chronic heparin, GnRHChronic heparin, GnRH
19. 14.1.05
Osteoporosis 19
Aim
• To explore the prevalence of
osteoporosis and osteopenia in Post-
Menopausal females (Teachers and
Nurses) and
• To find out the proportion of risk
factors for osteoporosis in two
occupation groups
• To find out Bone Mass Density and
association to known risk factors.
20. 14.1.05
Osteoporosis 20
Methods
• All the postmenopausal teachers from a state
high school from Mingalar Taung Nyunt
Township (n=45) and
• Postmenopausal staffs from Yangon General
Hospital (n=38) were included in the study.
• All the participants were asked to fill up a
questionarrie for risk factors and
• Bone Mass Density (BMD) was measured by
ultrasound densitometer.
22. 14.1.05
Osteoporosis 22
Quantitative Ultrasound
• BUA= broadband ultrasound attenuation
• SOS= speed of sound
• Stiffness= combination of BUA & SOS
• BUA reflect the attenuation of sound
waves as they pass through bone tissue
and are proportionate to the density of
the tissue.
23. 14.1.05
Osteoporosis 23
• QUS also assesses aspects of bone
quality and structure that are not
captured by BMD measurements.
• It is complementary to and additive
with BMD
26. 14.1.05
Osteoporosis 26
Bone Mass, Osteopenia &
Osteoporosis
• Mean BMD for teachers was 64.71 dB/MHZ
(SD 4.8) and that for staff was 64.24
dB/MHZ (SD 4.2).
• Osteopenia (T score less than -1.0 to -2.5)
was seen in
• 31% of teachers (14 out of 45) and
• 31.5% of staffs (12 out of 38).
• Surprisingly, there was no patient with
osteoporosis (T score less than -2.5) in this
study.
28. 14.1.05
Osteoporosis 28
Risk Factors
• low trauma fracture in family was
mentioned by 7.2%,
• high coffee intake (14.5%),
• smoking (2.4%),
• alcohol (1.2%),
• sedentary life (61.4%),
• hyperthyroid (2.7%), and
• history of steroid (8.4%).
29. 14.1.05
Osteoporosis 29
• Milk intake was very low (48% answered
no milk in last week and only 4.8% took
one cup of milk each day).
31. 14.1.05
Osteoporosis 31
Risk factors in Teachers vs Staff
• The presence of risks factors did not
differ significantly between two groups
of teachers and staff.
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Osteoporosis 32
Presence of risk factors vs
osteopenia
• Apart from thin body built and lack of
exercise,
• the presence of risk factors did not
associate significantly with osteopenia
in this study.
33. 14.1.05
Osteoporosis 33
Presence of risk factors in normal
people and osteopenia patients
Risk Normal
(56)
Osteo
penia
(26)
p
Mean body weight 134lb 121 lb 0.04
Exercise days/ week 2.1 0.7 0.01
Coffee >3 cups/day 8 3 0.9
Milk intake (cup)/wk 1 0.9 0.8
Small fish intake days/
wk
2.59 2.5 0.8
34. 14.1.05
Osteoporosis 34
Presence of risk factors in normal people
and osteopenia patients
Risk Normal
(56)
Osteo
penia
(26)
p
Surgical menopause
>1 yr
8 5 0.9
Steroid 6 1 0.49
Taking Calcium
supplement
4 8 0.4
Fruit intake/ week 13 8 0.7
36. 14.1.05
Osteoporosis 36
Indications for Bone
Densitometry
• Early menopause (<45)
• Hypogonadism
• Family history of
osteoporotic fracture
• Radiological evidence
of osteoporosis
• Previous fracture
after minimal trauma
(fall from standing
height)
• Clinical features of OP
(height loss, kyphosis)
*Strong risk factor
Low body weight (<19BMI)
*Steroid (>7.5mg daily for >3month)
*Co.- existing disease
Endocrine
Malabsorption
IBD
RA
*Prolonged immobility
*after OP treatment
37. 14.1.05
Osteoporosis 37
• Since the osteoporosis prevalence range
from 15% at age 60 and 38% at age 80
(Melton 1995), sample size of 82 people
was enough to find the prevalence.
• But failure to find any one with
osteoporosis on screening is not
expected and need larger scale study to
explain.
38. 14.1.0514.1.05 OsteoporosisOsteoporosis 3838
Life style modificationLife style modification
All postmenopausal women should engageAll postmenopausal women should engage
in lifestyle modifications that promotein lifestyle modifications that promote
bone healthbone health
• (1) taking adequate amounts of calcium(1) taking adequate amounts of calcium
(1200 mg/day) either through diet or(1200 mg/day) either through diet or
supplementssupplements
• (2) taking vitamin D (400 to 800 IU(2) taking vitamin D (400 to 800 IU
daily)daily)
• (3) engaging in weight-bearing physical(3) engaging in weight-bearing physical
activity to decrease the risk of fallingactivity to decrease the risk of falling
• (4) smoking cessation(4) smoking cessation
• (5) avoidance of excessive alcohol(5) avoidance of excessive alcohol
intake.intake.
39. 14.1.05
Osteoporosis 39
Conclusion
• The prevalence of osteoporosis is not
high in this study as European studies.
• The presence of risks factors did not
differ significantly between two groups
of teachers and staff.
• Apart from thin body built and lack of
exercise, the presence of risk factors
did not associate significantly with
osteopenia in this study.