Topic for BAMS

1. OSTEOPOROSIS
PRESENTED BY: ESHA MISHRA
BATCH: 2017-18

2. CONTENTS
• INTRODUCTION
• EPIDIMELOGY
• PATHOPHYSIOOGY
• CLASSIFICATION
• CLINICAL FEATURE
• RISK FACTOR
• INVESTIGATION
• MANAGEMENT

3. OSTEOPOROSIS
• The defining feature of osteoporosis is reduced bone density which a
micro-architectural deterioration of bone tissue and leads to an
increase risk of bone fracture.

4. OSTEOPOROTIC FRACTURE
CAN AFFECT ANY BONE, BUT
THE MOST COMMON SITES
ARE--
 FOREARM
 SPINE(vertebral fracture)
 HIP(most serious)

5. EPIDIMELOGY
1 in 3 women over 50 years suffer from osteoporosis.
1 in 5 men over 50 years suffer from osteoporosis.
15% - 30% men and 30%- 50% women suffer fractures related to
osteoporosis in their life time.
In women it is Three times more common than men
1.low peak bone mass (PBM)
2.hormonal changes at menopause
3.live longer than men.

6. CONSTITUENTS OF BONE

7. PATHOPHYISIOLOGY
 PEAK BONE MASS
 BONE REMODELLING

8. PEAK BONE MASS & OSTEOPOROSIS
 Peak bone mass is the maximum mass of bone achieved by an
individual at skeletal maturity, typically between ages 25 and 35
 After peak bone mass is attained, both men and women lose
bone mass over the remainder of their lifetimes
 Because of the subsequent bone loss, peak bone mass is
an important factor in the development of osteoporosis

9. Determinants Of Peak Bone Mass
GENETIC FACTOR
PHYSICAL ACTIVIY
NUTRIONAL STATUS
GONADAL STATUS
PEAK BONE MASS

10. BONE MODELLING AND REMODELLING
• MODELLING- during growth, skeleton increases in size by apposition of new
bone tissue on outer surface of cortex.
• REMODELLING- It is a cellular process of bone activity by which both
cortical and cancellous bone are maintained.
• OSTEOPOROSIS results from bone loss due to age related changes in bone
re-modelling as well as extrinsic and intrinsic factors that exaggerate this
process.
• Bone re-modelling has two main functions-
1. To repair micro damage within skeleton to maintain skeletal strength.
2. To supply calcium to maintain serum calcium levels.

11. RANK – RANKL RECEPTOR PATHWAY
FOR BONE REMODELLING
RANK L—
1. The cytokine responsible for communication between osteoblasts and
other marrow cells and osteoclasts.( receptor activated nuclear factor
kappa ligand)
2. Secreted by osteoblats and certain cells of immune system.
 RANK—
receptor present on osteoclast.
1. Activation of RANK by RANKL is final common pathway for osteoclast
differentiation and functioning.
2. Osteoprotegerin is humoral decoy for RANK secreted by osteoblasts.

13. CLASSIFICATION OF OSTEOPOROSIS
PRIMARY OSTEOPOROSIS
• Post menopausal osteoporosis
• Age related osteoporosis
• Idiopathic(rare)
SECONDARY OSTEOPOROSIS
• Congenital
• Diet
• Drugs
• Endocrine disorders
• Other systemic disoders

14. CLINICAL FEATURE
• Asymptomatic until fracture occur.
• Also known as silent disease.
• Low back-ache usually mild
• Loss of height.
• Kyphosis.
• Fracture most common: vertebral and hip.

15. RISK FACTOR
[ National Osteoporosis Foundation Physician guidelines for risk
factors for osteoporotic fracture. ]
• Current cigarette smoking
• Low body weight (<127 pounds)
• Alcoholism
• Estrogen deficiency
• Lifelong low calcium intake

16. INVESTIGATIONS
• BONE MINERAL DENSITY TEST
• LABORATORY TEST

17. BONE MINERAL DENSITY TEST
 The most common test.
 Results are reported using T-scores.
 T-scores are relative to how much
higher or lower your bone density is
compared to that of a healthy adult.
T-score :- It is the number of standard
deviation (SD) above or below a reference
value.

18. CATEGORY T-SCORE
NORMAL -1.0 OR ABOVE
OSTEOPENIA(low bone
mass)
-1.0 TO -2.5
OSTEOPOROSIS -2.5 OR LESS
SEVERE OSTEOPORSIS -2.5 OR LESS WITH ONE OR
MORE FRAGILITY FRACTURE

19. LABORATORY TEST
• Blood Calcium levels
• 24-hour urine calcium measurement
• Thyroid function tests
• Parathyroid hormone levels
• Testosterone levels in men
• 25-hydroxyvitamin D test to determine whether the body has enough vitamin D

20. MANAGEMENT
 Non-pharmacological prevention of O.P. & osteoporotic fracture.
 Pharmacological prevention of O.P.
 Role of orthopedician & surgical management.

21.  NON-PHARMACOLOGICAL PREVENTION OF
OSTEOPOROSIS AND OSTEOPOROTIC
FRACTURE.
A.NUTRITION
B.LIFE STYLE MODIFICATIONS
C.PREVENTION OF FALL
D.HIP PROTECTORS

22.  PHARMACOLOGICAL PREVENTION
OF OSTEOPOROSIS
• Men age 50–70 should consume 1000 mg/day of calcium.
• Women age 51 and older and men age 71 and older consume 1200
mg/day of calcium.
• Intakes in excess of 1200 to 1500 mg/day may increase the risk of
developing kidney stones, cardiovascular disease and stroke.

23.  Role of Orthopedicians & Surgical
management
• The goals of surgical treatment of osteoporotic fractures include
• Rapid mobilization and return to normal function and activities
• Avoid too much manipulations
• Progressive physiotherapy

24. COMMON SYMPTOMS OF
R.S.

25.  Cough
 Sneezing
 Sore throat
 Rhinorrhea
 Hoarseness of voice
 Dyspnoea
 Chest pain
 Cyanosis

26. • COUGH– dry or productive
hemoptysis is the expectoration of blood from the respiratory tract
ex. Lung cancer & T.B.
• RHINORREHA– nasal discharge
ex. Flue
• SORE THROAT– pain in throat
ex. Tonsillitis
• HOARSENESS OF VOICE–
ex. Laryngities

27. DYSPNOEA(Breathlessness)
• DEFINATION:
Subjective experience of discomfortable breathing or tightness of breath or
shortness of breath.
• TYPES:
I. With exercise
II. At rest

28. • COMMON CAUSES:
CARDIAC--
 Heart failure
 Mitral regurgitation: rheumatic heart
 hypertension
RESPIRATORY--
 Pneumonias
 Bronchial asthma
 Obstructive lung diseases(COPD)
BLOOD DISEASES--
 Anemia ex. Iron deficiency anemia.

29. THANK YOU..!!