OSTEOPEROSIS_powerpoint.ppt

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OSTEOPEROSIS_powerpoint.ppt

  1. 1. OSTEOPOROSISOSTEOPOROSIS Diagnosis and Treatment of LOW BONE MASS Dr Arthur Handscomb
  2. 2. What is Osteoporosis?What is Osteoporosis? • “Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.”
  3. 3. OSTEOPOROSIS FACTSOSTEOPOROSIS FACTS • OESTEOPOROSIS is a common, serious and frequently undiagnosed medical condition. • There are no obvious symptoms until someone has a fracture. People are living longer. • Estimates place the number of individuals with osteoporosis in North America currently at approximately 50,000,000 with over 1,500,000 “fragility” fractures annually.
  4. 4. DIAGNOSISDIAGNOSIS • Bone Mineral Densitometry (BMD) assessment using Dual Energy X-ray Absorptiometry (DEXA) is the current “gold standard” for measuring bone density and (using standard tables) for determining “Fracture Risk”.
  5. 5. Canadian BMD GuidelinesCanadian BMD Guidelines • Postmenopausal women • With 1 major or 2 minor osteoporosis risk factors (Table 1) • Age 65 or older • Having diseases or on medications that predispose them to bone loss or increased fracture risk
  6. 6. • Men • • Age 50 or older with 1 major or 2 minor • risk factors (Table 1) • • Age 65 or older • • Younger men with low-trauma fractures • • Having diseases or on medications that • predispose to bone loss or increased • fracture risk (Table 2) • • Most men less than age 50 do not need BMD Testing
  7. 7. • Premenopausal women • In the presence of low-trauma fractures • Having conditions (including premature ovarian failure) or on medications that predispose to bone loss or increased fracture risk (Table 2) • Most premenopausal women do not need BMD testing
  8. 8. • Major risk factors • Age 65 or older • Vertebral compression fracture • Fragility fracture after age 40** • Family history of osteoporotic fracture • (especially maternal hip fracture) • Systemic glucocorticoid therapy of at least • 3 months duration • Malabsorption syndrome • Primary hyperparathyroidism • Propensity to fall • Appearance of osteopenia on radiograph • Hypogonadism • Early menopause (before age 45)
  9. 9. • Minor risk factors • Rheumatoid arthritis • History of clinical hyperthyroidism • Long-term anticonvulsant therapy • Weight loss greater than 10% of weight • at age 25 • Weight less than 57 kg • Smoking • Excess alcohol intake • Excess caffeine consumption • Low dietary calcium intake • Long-term heparin therapy
  10. 10. • Postmenopausal women and men over age 50 with at least 1 major or 2 minor risk factors should be considered candidates for bone densitometry • ** Fragility fracture should be regarded as independent evidence of osteoporosis Contraindications for bone Densitometry • Pregnancy • Recent gastrointestinal contrast studies and nuclear medicine tests
  11. 11. Common secondary causes of bone loss • Hypogonadism • Primary hyperparathyroidism • Thyrotoxicosis • Hypercortisolism • Vitamin D deficiency • Malignancy • Malabsorption • Renal disease • Liver disease • Drugs (e.g., glucocorticoids, long-term • anticonvulsants, chemotherapy)
  12. 12. Who should be treated for osteoporosis? • Intervention should be based on fracture risk as determined by a combined assessment of BMD, age and other clinical risk factors for fracture. • Treatment decisions should be based on fracture risk.
  13. 13. Serial BMD Monitoring • Repeat BMD at 1–3 years to monitor therapy • Perform on same machine • Stable or improving BMD confirms response to treatment • If significant bone loss is present, adherence to • therapy (including calcium and vitamin D intake) • should be assessed. If compliance is not a factor, • review management and exclusion of secondary • causes of bone loss
  14. 14. DRUG THERAPYDRUG THERAPY • Biphosphonates • SERMs • Hormone Replacement Therapy • HRT, Calcitonin and Testosterone • Parathyroid Hormone • Iprivalone
  15. 15. TREATMENTTREATMENT • Drug Therapy • Physiotherapy • Exercise Programme • Medical Monitoring • More information: • www.iscd.org • www.osteoporosis.ca

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