bone health

1. Dr Nitish Arora
MS(Ortho), DNB, Fellowship-ASAMI
Former Consultant at St. Stephen's Hospital,
New-Delhi
Former Senior Resident at AIIMS, New-Delhi
AO Trauma-Faculty
ASAMI- Faculty
Consultant Trauma, Limb Reconstruction,
Deformity Correction & Pediatric Orthopedic
Surgeon

5. Collagen- Tensile
strength-
prevention of
fracture
Hydroxyapatite-
stiffness-
deformation under
load

7. Bone health/Cartilage health=Muscle
health

8. Modifiable
Lack of physical
activity/obesity
Indequate peak bone
mass due to lack of
Vit D and calcium rich
foods
Smoking
Alcohol
High caffeine intake
High salt intake
Abuse of antaacids
Not modifiable
Female
Increasing age
Early menopause
Medications and
medical conditions
Genetic factors

9. OBESIT
Y

10. Modifiable
• Lack of physical
activity/obesity
• Indequate peak bone mass
due to lack of Vit D and
calcium rich foods
• Smoking
• Alcohol
• High caffeine intake
• High salt intake
• Abuse of antaacids
Not modifiable
Female
Increasing age
Early menopause
Medications and
medical conditions
Genetic factors

11. Bone loss-
after Peak Bone
mass
Male-0.3%/year
Female-0.5%/year
Post menopausal- 1-
2%/year
Peak Bone Mass

12. PEAK BONE MASS

13. ROLE OF
CALCIUM/
VIT D

14. Not modifiable
Female
Increasing age
Early menopause
Medications and medical
conditions
Genetic factors
Modifiable
• Lack of physical
activity/obesity
• Indequate peak bone mass
due to lack of Vit D and
calcium rich foods
• Smoking
• Alcohol
• High caffeine intake
• High salt intake
• Abuse of antaacids

15.  Alcohol- daily intake of 3 or more units of alcohol increases the
risk of fracture.
 Osteoporosis/fracture- against consuming more than 7
drinks/week, 1 drink being equivalent to 120 mL of wine, 30 mL of
liquor, or 260 mL of beer
 Oral glucocorticoids ≥5 mg/d of prednisone for >3 months (ever)
 Abuse of antacids or some other medication(anticovulsant)
increases the risk of osteoporosis and fracture
 Patients should be advised to limit their caffeine intake to less
than 1 to 2 servings (8 to 12 ounces in each serving) of
caffeinated drinks per day.

16. MANAGEMENT
 Exercise
 A regular weight-bearing
exercise regimen (for example,
walking 30–40 min per session)
along with back and posture
exercises for a few minutes on
most days of the week should
be advocated throughout life.
 Cells have mechanoreceptors-
promotes osteogenic
precursors(bone forming)

17.  Dynamic(not simply static loads) + high intensity + Novel
exercises
Osteogenic effect
 Effect must be large enough and repeated to be clinically
relevant, and the gains must be maintained throughout the
life span to prevent fracture
 Exercise effects must be site specific

18. VITAMIN D
 Sunlight, salmon, codliveroil, egg yolk, sundried mushrooms
or vitamin D fortified foods
 Less than 1 year- 400 i.u/day of vit D
 1- 12 years-800 i.u/day of Vit D
 >12years-1000-1200 i.u/day
 Pregnancy-1000-4000 i.u day
 Elderly- 2000 i.u/day
 Diagnosed Rickets/osteoporosis/osteoporosis
Rickets-children- 3-6 lac I.u bolus divided in 6-8
weeks then maintainence dose
Osteoporosis/osteomalacia- 6 lacs i.u divided in
10 weeks then maintainence dose for a year.

19. CALCIUM
 milk, cheese and other dairy foods
 green leafy vegetables, such as broccoli, cabbage and
okra, but not spinach
 soya beans/Ragi
 tofu
 plant-based drinks (such as soya drink) with added
calcium
 nuts
 bread and anything made with fortified flour
 fish where you eat the bones, such as sardines and
pilchards

20. CALCIUM SUPPLEMENTS
 <1 year-200 mg of elemental calcium
 1-8 year-500 mg of elemental calcium
 8-19 years-1200 mg elemental calcium
 19-60 years-1000 mg of elemental calcium
 >60 years/pregnant/lactating-1200 mg of elemental calcium

21. OSTEOPORO
SIS
Definition

22. Silent disease-until
complicated by fracture
or pain
Fractures occur even
with minor fall

24. MANAGEMENT

25. In women age 65 and older and
men age 70 and older, recommend
BMD testing.
Recommend BMD testing to those
who have suffered a fracture, to
determine degree of disease
severity.

26. Initiate treatment in those with hip or
vertebral (clinical or morphometric)
fractures
Early management of fracture can
bring the patient to its near original
life style.

27. ANTIRESORBTIVE/ANABOLIC
MEDICATION
 With Diagnosed osteoporosis on BMD/DEXA scan
 With already sustained osteoporotic fractures
 Along with calcium and Vit D supplements
 To be started in consultation with a physician and to stopped
whenever asked
 Antiresorbtive-Alendronate/Zolendronic acid/
Ibandronate/Risedronate/Calcitonin
 Anabolic-Teriparatide

28. FRACTURE PREVENTION
CONSISTS OF BONE
HEALTH AND PREVENTION
OF FALLS

35. OSTEOARTHRITIS

38. MANAGEMENT
 W e i g h t
l o s s / c o n t r o l
 E x e r c i s e s
 NSAID’s
 Calcium/Vit D
 Braces
 Intraarticular injections

40. WHO NEEDS SURGERY ????
 You have pain in your knees
 You cannot stand for more than half an hour
 You cannot walk for more than half a kilometer
 You have to take pain killers more than 2 tabs/week
 Failure of all conservative methods of management

42. Total knee
replacement
High Tibial osteotomy
Unicondylar Knee
replacement

43. Questions???