Burden of Osteoporosis by Dr Shahjada Selim

1. Burden of Osteoporosis
Dr Shahjada Selim
Assistant Professor
Department of Endocrinology
Bangabandhu Sheikh Mujib Medical University, Dhaka
Email: selimshahjada@gmail.com, info@shahjadaselim.com

2. Definition of Osteoporosis
World Health Organization (WHO), 1994
Osteoporosis is a
skeletal disorder
characterized by
compromised bone
strength predisposing
to an increased risk
of fracture.
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3. osteoporotic
Osteoporotic bone
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4. Normal bone vs. Osteoporotic bone
• The normal bone shows a pattern of
strong interconnected plates of bone.
• Much of this bone is lost in
Osteoporosis and the remaining bone
has a weaker rod-like structure &
some of the rods are completely
disconnected.
• These bits of disconnected bone may
be measured as bone mass but
contribute nothing to bone strength.

5. Normal has appearance of a honeycomb matrix
(left) .Under a microscope , osteoporotic bone
looks more porous.

6. • Osteoporosis is characterized by
progressive decrease in bony mass that
results in increased bone fragility and
higher fracture risk, which can be primary
or secondary.
Clinician's guide to prevention and treatment of osteoporosis.20104/30/2017 Burden Osteoporosis by Dr Selim 6

7. • Osteoporotic fracture account 0.83% of
global burden of non communicable
diseases.
• Patients may confuse osteoporosis with
degenerative conditions
• Acute pain in vertebral fracture usually
resolve in 4-6 weeks.
Clinician's guide to prevention and treatment of osteoporosis.20104/30/2017 Burden Osteoporosis by Dr Selim 7

8. Cont…
• Fracture spine typically by OP is
generally compression fracture or
wedge fracture.
• Fractures can anywhere in the spine,
rarely above the T7
• Wedge-shaped vertebra on back -
stooped posture called dowager’s
hump.
• Fractures of OP increases
dramatically with ageing, (4 “I”) and
Sarcopenia.
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9.  Osteoporosis, despite being a common
metabolic bone disease, has attracted little
attention and even less action in many
developing countries.
There are several reasons for this state of
neglect.
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10. Definition by DXA scoring
T score Category
> -1 Normal
< -1 to > 2.5 Osteopenia
<-2.5 Osteoporosis
<-2.5 with
fragility fracture
Established/severe
osteoporosis
WHO Criteria
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11. Rosen, Endotext.com, Chap.11
Epidemiology
• 3,00,000 new cases per year
• Osteoporosis affects 65% of Indians aged 50 and
above. Of these, approximately 80% are women.
• 50% of women over age 50 will sustain a fracture
in their lifetime
• The condition is responsible for millions of
fractures annually, mostly involving the lumbar
vertebrae, hip, and wrist.
• Fragility fractures of ribs are also common in men.

12. Contd.
 200 million women worldwide.
 40% of women over 50 have osteopenia.
 7% of women over 50 have osteoporosis.
 Causes >8.9 million fracture worldwide
annually, resulting a osteoporotic fracture
every 3 second.
http://www.iofbonehealth.org,2012.
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13. Prevalence
2000
(in millions)
2015
(in millions)
Osteoporosis 10 41
Osteopenia 14 80

14. 10-Year Probability of Fracture in
Women by Age and T-Score
Data from Kanis JA, et al. Osteoporos Int. 2008;12:989-995.
30.824.519.415.211.89.17.0
28.422.818.314.611.59.07.1
23.919.315.612.610.08.06.3
20.216.213.010.48.26.55.1
16.813.410.78.56.75.34.1
14.111.39.27.45.94.73.8
75
70
65
60
55
50
T-Score
–3.0
T-Score
–2.5
T-Score
–2.0
T-Score
–1.5
T-Score
–1.0
T-Score
–0.5
T-Score
0
Age
(years)
30.824.519.415.211.89.17.0
28.422.818.314.611.59.07.1
23.919.315.612.610.08.06.3
20.216.213.010.48.26.55.1
16.813.410.78.56.75.34.1
14.111.39.27.45.94.73.8
75
70
65
60
55
50
T-Score
–3.0
T-Score
–2.5
T-Score
–2.0
T-Score
–1.5
T-Score
–1.0
T-Score
–0.5
T-Score
0
Age
(years)
30.824.519.415.211.89.17.0
28.422.818.314.611.59.07.1
23.919.315.610.08.06.3
20.216.210.48.26.55.1
16.813.410.78.56.75.34.1
14.19.27.45.94.73.8
75
70
65
60
55
50
T-Score
–3.0
T-Score
–2.5
T-Score
–2.0
T-Score
–1.5
T-Score
–1.0
T-Score
–0.5
T-Score
0
Age
(years)
12.6
13.0
11.3

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16. 0
200,000
400,000
600,000
800,000
1,000,000
1,200,000
1,400,000
1,600,000
Breast
Cancer
Heart
Disease
Osteoporotic
Fractures
Cases/Year
Women’s Health Facts and Figures. Washington, DC: ACOG; 2000.
• Osteoporotic Fracture Incidence Is High
Contd.
16

17. Taiwan, Singapore, and Hong Kong-
400 to 500 per 100,000 women; similar to Caucasian
populations
Japan - > 200 - 300 per 100,000 women
Malaysia and Thailand- 200 - 250 hip fracture per
100,000 women
Korea and China- 100 hip fracture per 100,000 women;
increased over a short period
By 2050 more than 50% of all osteoporotic fracture
will occur in Asia
The Asian Audit 20094/30/2017 Burden Osteoporosis by Dr Selim 17
In Asian….

18. NIH/ORBD National Resource Center. October 2000.
Vertebral
46%
(700,000)
Wrist
16%
(250,000)
Hip
19%
(300,000)
Other
19%
(300,000)
• Distribution of Fractures
Clinical features & Consequences
18

19. • Non- Vertebral/spine fractures
 Almost all - traumatic & easy to diagnose clinically
• Vertebral fractures
 Only 1/3 diagnosed clinically.
 Of clinically diagnosed vertebral fractures, only 14%
follow severe trauma whereas > 83% follow
moderate or no trauma.
 Sudden onset of pain is an useful marker of fracture
Endocrine Metab Clin North Am 1998;27:289-301
J Bone Miner Res 1997;12:663-6754/30/2017 Burden Osteoporosis by Dr Selim 19

20.  About 2/3 of the fractures causes no
symptoms. 1/3 of vertebral fractures, with
acute back pain
 50% of women and 20% of men above 50 will
have an OP related fracture in their lifetime
 85% of OP patients with low back pain is
considered the prevalent musculoskeletal
pain, particularly in elderly.
Endocrine Metab Clin North Am 1998;27:289-301
J Bone Miner Res 1997;12:663-6754/30/2017 Burden Osteoporosis by Dr Selim 20

21. Common Fracture Sites
21
Hip
Spine
Wrist
 Humerus, Ribs, Tibia, Pelvis
Uncommon sites
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24. SITE INCREASE IN
MORTALITY RISK
Vertebrae 8.6
Hip 6.7
Any Clinical Fracture 2.2
Fracture and Mortality Risk

25. Vertebral Fracture Cascade

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31. COMPLICATIONS:-
• Fractures are most frequent and serious
complications of osteoporosis.
• Often occurs in spine and hips – bones that
directly support your weight.
• Hip fractures and wrist fractures from fall are
common.
• Compression fractures can cause severe pain
and require a long recovery

32. Consequence of Fracture
 After the first hip fracture, 30% of patients will fracture
the second hip.
 Nearly 20% of the women who develop a new
vertebral fracture will fracture again within a year.
 5 year survival rate following a vertebral fracture is
equally worse as a Hip fracture.
 It is clear that bone loss cannot be completely
reversed but fracture risk can be decreased by
intervention.
 One year mortality following a hip fracture in men is
twice that of female

33. PREVENTION
Do exercise such as walking , running ,
skipping rope , jogging regularly.
Avoid smoking , it can reduce the level of
estrogen and increases bone loss.
Avoid excessive alcohol.
 Avoid caffeine , which is very harmful.
 Consider hormone therapy.

34. Thanks for your patience
THANKS
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