Osteoporosis

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Osteoporosis

  1. 1. Osteoporosis Anna Mae Smith, MPAS, PA-C Lock Haven University Physician Assistant Program
  2. 2. Osteoporosis <ul><li>Affects 25 million Americans </li></ul><ul><li>Causes more than 1 million fractures every year in this country — usually in the spine, hip or wrist. </li></ul><ul><li>1/2 of all Caucasian women age 50 and older can expect to have a bone fracture due to osteoporosis </li></ul><ul><li>1/3 of men have some osteoporosis by age 75 </li></ul>
  3. 3. Definition <ul><li>A multifactorial skeletal disease characterized by severe bone loss and disruption of skeletal micro-architecture sufficient to predispose to atraumatic fractures of the… </li></ul><ul><ul><ul><li>vertebral column </li></ul></ul></ul><ul><ul><ul><li>upper femur </li></ul></ul></ul><ul><ul><ul><li>distal radius </li></ul></ul></ul><ul><ul><ul><li>proximal humerus </li></ul></ul></ul><ul><ul><ul><li>pubic rami and ribs </li></ul></ul></ul>
  4. 4. Types of Osteoporosis <ul><li>Type I - Postmenopausal </li></ul><ul><li>Type II - Involutional - occurs in both sexes over 75 y/o…A mixture of Type I & II is common </li></ul><ul><li>Idiopathic - rare form of primary osteo. Cause unknown, occurs in premenopausal women & men( prior to age 75) </li></ul>
  5. 5. Types of Osteoporosis <ul><li>Juvenile - A rare form of variable severity occurring in prepubertal children. Self-limited with cessation of fractures at puberty. Cause unknown. </li></ul>
  6. 6. Types of Osteoporosis <ul><li>Secondary - due to extrinsic factors such as </li></ul><ul><ul><ul><li>eating disorders </li></ul></ul></ul><ul><ul><ul><li>steroid excess </li></ul></ul></ul><ul><ul><ul><li>RA </li></ul></ul></ul><ul><ul><ul><li>chronic liver/kidney disease </li></ul></ul></ul><ul><ul><ul><li>malabsorption syndromes </li></ul></ul></ul><ul><ul><ul><li>hyperparathyroidism </li></ul></ul></ul><ul><ul><ul><li>hyperthyroidism </li></ul></ul></ul><ul><ul><ul><li>hypogonadal states </li></ul></ul></ul><ul><ul><ul><li>idiopathic hypercalciuria </li></ul></ul></ul>
  7. 7. Genetics <ul><li>Familial predisposition </li></ul><ul><li>More common in Caucasians and Orientals than in black and Latino ethnic groups </li></ul>
  8. 8. Incidence <ul><ul><li>Elderly </li></ul></ul><ul><ul><li>Females > Males </li></ul></ul><ul><ul><ul><li>30-40% cumulatively in women </li></ul></ul></ul><ul><ul><ul><li>5-15% in men </li></ul></ul></ul><ul><ul><li>Prevalence of idiopathic and juvenile types unknown </li></ul></ul><ul><ul><li>Secondary osteoporosis cumulatively 5-10%, both sexes </li></ul></ul>
  9. 9. Signs & Symptoms <ul><ul><li>Back ache/pain; acute/chronic </li></ul></ul><ul><ul><li>Kyphosis/scoliosis which leads to ‘pot’ belly </li></ul></ul><ul><ul><li>Atraumatic fractures </li></ul></ul><ul><ul><li>No peripheral bone deformities </li></ul></ul><ul><ul><li>Sclerae not blue/green/grey </li></ul></ul><ul><ul><li>Loss of height </li></ul></ul>
  10. 10. Etiology <ul><ul><li>Postmenopausal (Type I): Hypoestrogenemia </li></ul></ul><ul><ul><li>Involutional (Type II): Unknown </li></ul></ul><ul><ul><li>Idiopathic: Unknown </li></ul></ul><ul><ul><li>Juvenile: Unknown </li></ul></ul><ul><ul><li>Secondary - see slide 5 </li></ul></ul>
  11. 11. Etiology <ul><li>Bone loss occurs with aging </li></ul><ul><li>Osteoporosis occurs most frequently in individuals who fail to achieve optimal skeletal mass during development or lose bone rapidly thereafter </li></ul>
  12. 12. Risk Factors <ul><ul><li>Dietary - </li></ul></ul><ul><ul><ul><li>inadequate calcium </li></ul></ul></ul><ul><ul><ul><li>excessive phosphate/protein </li></ul></ul></ul><ul><ul><ul><li>inadequate vitamin D intake in the elderly </li></ul></ul></ul><ul><ul><li>Physical - immobilization, sedentary lifestyle </li></ul></ul><ul><ul><li>Social - alcohol, cigarettes, caffeine </li></ul></ul><ul><ul><li>Medical - chronic diseases, malabsorption, endocrinopathies </li></ul></ul>
  13. 13. Risk Factors <ul><ul><li>Iatrogenic - corticosteroids, excess thyroid hormone replacement, chronic heparin, chemotherapy, loop diuretics, anticonvulsants, radiation therapy, depro-provera, methotrexate, GnRH agonists </li></ul></ul><ul><ul><li>Genetic/familial - suboptimal bone mass at maturity, &quot;familial fast bone losers&quot; </li></ul></ul>
  14. 14. Differential Diagnosis <ul><ul><li>Multiple myeloma </li></ul></ul><ul><ul><li>Other neoplasia </li></ul></ul><ul><ul><li>Osteomalacia </li></ul></ul><ul><ul><li>Osteogenesis imperfecta tarda (Type I) </li></ul></ul><ul><ul><li>Skeletal hyperparathyroidism (primary and secondary) </li></ul></ul><ul><ul><li>Hyperthyroidism </li></ul></ul><ul><ul><li>Mastocytosis (rare) </li></ul></ul>
  15. 15. Labs <ul><li>CBC - usually normal </li></ul><ul><li>Alk Phosphatase - may be transiently increased after a fracture </li></ul><ul><li>Serum &/or urine protein </li></ul><ul><li>TFT’s & urinary cortisol - normal in primary types </li></ul><ul><li>Serum osteocalcin - if high, indicates high turnover type </li></ul><ul><li>Urine calcium level </li></ul>
  16. 16. Pathological findings <ul><ul><li>Reduced skeletal mass, trabecular bone more so than cortical bone. Loss of trabecular connections. </li></ul></ul><ul><ul><li>Osteoclast and osteoblast number variable </li></ul></ul><ul><ul><li>No evidence of other metabolic bone diseases and no increase in unmineralized osteoid </li></ul></ul><ul><ul><li>Marrow normal or atrophic </li></ul></ul>
  17. 17. Imaging <ul><li>X-ray </li></ul><ul><li>Bone scan </li></ul><ul><li>Bone mineral density (BMD) </li></ul><ul><ul><li>most common is a DEXA scan - lumbar spine, forearm & upper femur </li></ul></ul>
  18. 19. 33 y/o 55 y/o 72 y/o
  19. 20. Treatment <ul><li>Pain - if a fracture occurs, Physical therapy </li></ul><ul><li>May need to consider joint replacement </li></ul><ul><li>Decrease falls </li></ul><ul><li>Keep moving </li></ul>
  20. 21. Diet <ul><li>Weight - reduce if overweight </li></ul><ul><li>Calcium 1500 mg/day </li></ul><ul><li>600-1000 IU of Vitamin D a day </li></ul><ul><li>Avoid excess phosphate or protein intake… certain beverages with phosphoric acid </li></ul>
  21. 22. Drugs <ul><li>HRT </li></ul><ul><li>Calcitonin (miacalcin nasal spray) or injections </li></ul><ul><li>Fosamax – Alendronate </li></ul><ul><ul><li>Actonel </li></ul></ul><ul><li>Didronel - inhibit bone resorption </li></ul><ul><li>Evista/Raloxifene </li></ul><ul><li>Miacalcin nasal spray </li></ul>
  22. 26. Prognosis <ul><ul><li>70% of patients stabilize skeletal manifestations; increase bone mass, increase mobility, and have reduced pain </li></ul></ul><ul><ul><li>20-30% of upper femoral fractures lead to chronic care and/or premature death </li></ul></ul>
  23. 27. <ul><li>http://courses.washington.edu/bonephys/opmovies.html </li></ul>

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