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Welcome<br />BICC|27th July, 2010<br />
Osteoporosis: Challenges, When & How to Treat<br />DRAFT Aclasta Brand Book<br />Osteoporosis: Challenges to meet <br />Pr...
Objectives<br /><ul><li>Bone and its component
Bone Homeostasis
Bone remodeling
Definition  and classification of osteoporosis
Prevalence
Risk Factors and presentation
Diagnosis
Consequences
Management principle
Treatment goal</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
Bone and its component<br /><ul><li>Organic  Component:
protein collagen & specialized cells called osteoclasts, osteoblasts, and osteocytes
Inorganic  component:
Mainly as calcium phosphate, in the form of Hydroxyapatite</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 20...
Bone Homeostasis<br /><ul><li>Bone Homeostasis:
the situation when the body requires and achieves an equal amount of bone resorption and bone formation
the amount of bone eroded by osteoclasts is equal to the</li></ul>	amount of bone produced by osteoblasts, thereby produci...
Bone Remodeling<br /><ul><li>The combined processes of breaking down bone and building new bone are called Bone Remodeling.
It is the body’s way of maintaining bone homeostasis.
5 Stages:
Initiation,
Resorption,
Reversal,
Bone formation and
Completion of remodeling. </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
Remodeling: Activation<br />Osteoclast precursor cells are attracted to a bone site and penetrate the bone lining cells. T...
Remodeling: Resorption<br />The osteoclasts erode a cavity by removing mineral and organic components from the bone. The o...
Remodeling: Revarsal<br />Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface...
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Osteoporosis

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This presentation was prepared for a clinical seminar on Osteoporosis organised by Novartis bangladesh.

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Osteoporosis

  1. 1. Welcome<br />BICC|27th July, 2010<br />
  2. 2. Osteoporosis: Challenges, When & How to Treat<br />DRAFT Aclasta Brand Book<br />Osteoporosis: Challenges to meet <br />Prof. Muhammad Shahiduzzaman<br />Prof & Head, <br />Department of Orthopaedics and Traumatology<br />Dhaka Medical College Hospital<br />
  3. 3. Objectives<br /><ul><li>Bone and its component
  4. 4. Bone Homeostasis
  5. 5. Bone remodeling
  6. 6. Definition and classification of osteoporosis
  7. 7. Prevalence
  8. 8. Risk Factors and presentation
  9. 9. Diagnosis
  10. 10. Consequences
  11. 11. Management principle
  12. 12. Treatment goal</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  13. 13. Bone and its component<br /><ul><li>Organic Component:
  14. 14. protein collagen & specialized cells called osteoclasts, osteoblasts, and osteocytes
  15. 15. Inorganic component:
  16. 16. Mainly as calcium phosphate, in the form of Hydroxyapatite</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  17. 17. Bone Homeostasis<br /><ul><li>Bone Homeostasis:
  18. 18. the situation when the body requires and achieves an equal amount of bone resorption and bone formation
  19. 19. the amount of bone eroded by osteoclasts is equal to the</li></ul> amount of bone produced by osteoblasts, thereby producing a stable net mass of bone in the body<br />Homeostasis<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  20. 20. Bone Remodeling<br /><ul><li>The combined processes of breaking down bone and building new bone are called Bone Remodeling.
  21. 21. It is the body’s way of maintaining bone homeostasis.
  22. 22. 5 Stages:
  23. 23. Initiation,
  24. 24. Resorption,
  25. 25. Reversal,
  26. 26. Bone formation and
  27. 27. Completion of remodeling. </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  28. 28. Remodeling: Activation<br />Osteoclast precursor cells are attracted to a bone site and penetrate the bone lining cells. These osteoclast precursor cells then form activated osteoclasts that align themselves in direct contact with mineralized bone matrix. <br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  29. 29. Remodeling: Resorption<br />The osteoclasts erode a cavity by removing mineral and organic components from the bone. The osteoclasts eventually die. This completes the resorption phase. <br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  30. 30. Remodeling: Revarsal<br />Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance. <br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  31. 31. Remodeling: Formation<br />Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance. <br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  32. 32. Remodeling: Resting<br />The lining cells rest on the bone surface until the next cycle of bone remodeling begins. <br />Some osteoblasts become osteocytes.<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  33. 33. Remodeling timeline<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  34. 34. Osteoporosis<br />Challenges of Osteoporosis<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  35. 35. Definition of Osteoporois<br />National Osteoporosis Foundation: <br /><ul><li>a disease characterized by low bone mass an micro-architectural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures.”</li></ul>World Health Organization (1994) :<br /><ul><li>bone mineral density T-score greater than –2.5 standard deviations from the mean peak adult bone mass (ie. a woman in her 30’s).”</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  36. 36. Classification of Osteoporosis<br /><ul><li>Primary osteoporosis
  37. 37. Juvenile osteoporosis.
  38. 38. Idiopathic osteoporosis
  39. 39. Postmenopausal osteoporosis
  40. 40. Age-related, or senile, osteoporosis</li></ul>Secondary osteoporosis<br /><ul><li>Congenital
  41. 41. Diet
  42. 42. Drugs
  43. 43. Endocrine disorder
  44. 44. Other Systemic Disorder</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  45. 45. Osteoporosis<br />Losing bone with years<br />
  46. 46. Prevalence<br />“Osteoporosis, the silent thief of your bone”<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  47. 47. Prevalence…<br />Worldwide, over age of 50<br /><ul><li>1 in 3 women / 1 in 8 men have osteoporosis.
  48. 48. 80 % of those suffering from osteoporosis are women.
  49. 49. Affects 75 million persons in the US, Europe and Japan.
  50. 50. Over 50% of women aged 50 years or older and 20% of men will suffer an osteoporosis-related fracture within their remaining lifetime</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  51. 51. Risk Factors<br /><ul><li>Being female
  52. 52. Older age
  53. 53. Family history of osteoporosis or broken bones
  54. 54. Being small and thin
  55. 55. History of broken bones
  56. 56. Low sex hormones
  57. 57. Low estrogen levels in women, including menopause
  58. 58. Missing periods (amenorrhea)
  59. 59. Low levels of testosterone and estrogen in men</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  60. 60. Risk Factors…<br /><ul><li>Diet
  61. 61. Low calcium intake
  62. 62. Low vitamin D intake
  63. 63. Excessive intake of protein, sodium and caffeine
  64. 64. Inactive lifestyle
  65. 65. Smoking , Alcohol abuse
  66. 66. Certain medications
  67. 67. steroid , anticonvulsants etc
  68. 68. Certain diseases
  69. 69. anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases and others </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  70. 70. Presentation<br /><ul><li>People may not know that they have osteoporosis until they break a bone.
  71. 71. Vertebral (spinal) fractures may initially be felt or seen in the form of
  72. 72. Persistent, unexplained back pain
  73. 73. Loss of height
  74. 74. Spinal deformities such as kyphosis or stooped posture. </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  75. 75. Diagnosis<br /><ul><li>Bone mineral density (BMD) tests can measure bone density in various sites of the body.
  76. 76. BMD test is done to diagnose and predict fracture risk and to monitor therapy.
  77. 77. For patients on pharmacotherapy, it is typically performed 2 years after initiating therapy and every 2 years thereafter; however, more frequent testing may be warranted in certain clinical situations.</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  78. 78. Diagnosis…<br /><ul><li>Dual-energy X-ray Absorptiometry (DXA) Scan
  79. 79. “Gold-standard” for BMD measurement.
  80. 80. Measures “central” or “axial” skeletal sites: spine and hip.
  81. 81. May measure other sites: total body and forearm.
  82. 82. Validated in many clinical trials.
  83. 83. Available in Bangladesh.</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  84. 84. Diagnosis…<br /><ul><li>Dual-energy X-ray Absorptiometry (DXA) Scan</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  85. 85. Complications<br />FRACTURE , <br />The most serious complication of <br />Osteoporosis that leads to<br /><ul><li>Increased morbidity
  86. 86. Increased mortality
  87. 87. Decreased quality of life </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  88. 88. Complications…<br />Wrist fracture<br />men 1 in 40 (2.5%)<br />women 1 in 6 (16%)<br />Spinal fracture<br />men 1 in 20 (5%)<br />women 1 in 6 (16%)<br />Hip fracture<br />men 1 in 17 (6%)<br />women 1 in 6 (17.5%)<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  89. 89. Management principle<br />Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  90. 90. Pharmacologic management<br /><ul><li>Supplements
  91. 91. such as which maintain bone mass Calcium, Vitamin D
  92. 92. Anti-resorptive agents
  93. 93. which inhibit bone resorption Bisphosphonates
  94. 94. Anabolic agents,
  95. 95. which stimulate bone formation and, in turn, increase bone mass.</li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  96. 96. Goal of treatment<br /><ul><li>Prevent further bone loss
  97. 97. Increase or at least stabilize bone density
  98. 98. Prevent further fractures
  99. 99. Relieve deformity (e.g., kyphoplasty)
  100. 100. Relieve pain
  101. 101. Increase level of physical functioning
  102. 102. Increase quality of life </li></ul>Osteoporosis: Challenges to meet| BICC | 27th July, 2010<br />
  103. 103. Thank You<br />

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