Osteoporosis is musculoskeletal disorder. thiS PPT describes about `defination `atiology `clinical manifestations `types `bone resorption process `pathophysiology `diagnosis `treatment.

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By:Shaik Shaheera
pharmD student.
vignan pharmacy college.

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Osteoporosis:
- Osteoporosis is defined as a progressive skeletal disorder characterized by
low bone mass and microarchitectual deterioration of bone tissue, leading
to a consequent increase in bone fragility & susceptibility to fracture.
- Osteoporosis is a condition characterized by a decrease in the density of
bone, decreasing it’s strength and resulting in fragile bones.
- It leads to abnormally porous bone that is compressible, like a sponge.
- This disorder of the skeleton weakens the bone and results in frequent
fractures of the bones.

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Aetiology:
*Low calcium diet
*Lack of physical exercise
*Family history
*Gender
*Vitamin D deficiency
*Malabsorption
*Aging
*Hyper parathormone levels
*Low oestrogen levels
*Osteoarthritis
*Rheumatoid arthritis
*Drug induced(steroids)
*Endocrinal disorders
*Inflammatory bowel disease
*High RANKL receptors

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Clinical manifestations:
# Bonepain or tenderness
#Fractures or trauma
#Loss of height over time
#Neck or lower back pain due to fractures
#Stooped posture
#Easy fractures

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Types:
 mainly two types of osteoporosis.
1.primary osteoporosis There are
2.secondary osteoporosis
☆primary osteoporosis:
●occurs in hypogonadal individuals (type 1).
●seen in post menopausal women & women with oligo-menorrhoea.
●causes net bone loss and directly leads to loss of gonadal function.
●causes fractures to skeleton especially trabecular bone.
E.g.*Distal forearm & vertebral bodies.
●It is also associated with normal aging process (type 2).
●Associated with progressive decline in supply of osteoblasts and their activity.
●Generally fractures of cortical bone such as, femur; femoral neck; proximal tibia;
pelvis etc.....

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☆Secondary osteoporosis:
●occurs due to endocrine diseases like Hyperparathyroidism; Hypothyroidism;
chronic renal failure; Diabetes mellitus; Hypovitaminosis D; Rheumatoid
arthritis; Drug induced.
●predisposing factors for osteoporosis are pregnancy & lactation.

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:Bone resorption:
Hematopoietic osteoclast progenitor
| M-CSF
osteoclast precursor
| RANKL receptors
mononuclear osteoclast
|M-CSF;IL-1,6;RANKL receptor
quiescent osteoclast
| RANKL receptors;IL-6
Active osteoclast
| coupling
Multiple osteoclast
Acts on bone lining by secreting lysosomal enzymes
|
Lysis of bone due to acid secretions
☆“Bone resorption”☆

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Acts on bone lining through lysosomal enzymes
The secreted acids Causes bone resorption.
Loss of mineral content in bones i.e. low Bone mass density(BMD).
Weak bones and hence become brittle. ‘BONE FRACTURE’
Multiple osteoclasts Low oestrogen levels
Vitamin D deficiency
High RANKL receptor level Aging
More no of osteoclasts

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Diagnosis:
Diagnosis is generally done by
1.DEXA
2.BONE SCANNING(CT)
3.BIOMARKERS(BLOOD TESTS)
4.QUANTITATIVE ULTRASONOGRAPHY(QUS).

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DEXA(DUAL ENERGY X-RAY ABSORPTOMETRY)
It is also called as bone mass density test.
It gives result in the form of T-SCORE.
-VE T-SCORE –LOW BONE MASS
GREATER -VE VALUE ---GREATER RISK OF FRACTURES.

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BONE SCANNING:
It is done generally by injecting dye into bones.
Dye irregularity indicates change in bone mass density, cancer,
trauma, lesions, fractures.
Dye is excreted out through urine.

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Blood biomarkers:
~Calcium levels
~Vitamin D levels
~Thyroid functioning
~parathyroid hormone levels
~Oestrogen levels in women
~serum calcitonin levels
~serum alkaline phosphate levels
~Testosterone levels in men.

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TREATMENT:
Treated by giving 1.calcium supplement
2.Magnesium intake
3.Bisphosphates
4.SERMS

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1.CALCIUM SUPPLEMENT:
Dietary calcium and also additional calcium supplement for proper functioning of bones.
2.MAGNESIUM INTAKE:
Magnesium plays an important role in calcium and bone metabolism.
3.BISPHOSPHATES- E.g. 1st generation
Etidronate
Tiludronate
2nd generation
Pamidronate
Alendronate
Ibandronate
3rd generation
Risedronate

15. z *SIDE EFFECTS:
Stomach upset
Fever
Inflammation of oesophagus
Risk of electrolyte disturbance
Musculoskeletal joint pain
Osteonecrosis of jaw
*CONTRAINDICATIONS:
Hypersensitivity
Hypocalcaemia
Kidney diseases.

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4.SERMS(selective oestrogen receptor modulators):
E.g. Raloxifene
Tamoxifen
Mechanism:They block oestrogen receptors by binding
competitively at their sites, so no room for oestrogen to bind.

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Thank you
Reference: Dipiro
Wikipedia
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