This document provides information on bone health and related medical conditions. It discusses factors that affect bone density such as diet, exercise, age, and genetics. Key points include that exercise and adequate calcium/vitamin D intake through foods and supplements can help build strong bones and prevent osteoporosis. If diagnosed with osteoporosis based on a bone density test, drug therapies may be recommended in addition to a healthy lifestyle to prevent fractures. The document also briefly outlines the causes and management of osteoarthritis, including exercise, weight control, braces, and surgery in some cases.

1. Dr Nitish Arora
MS(Ortho), DNB, Fellowship-ASAMI
Former Consultant at St. Stephen's Hospital,
New-Delhi
Former Senior Resident at AIIMS, New-Delhi
AO Trauma-Faculty
ASAMI- Faculty
Consultant Trauma, Limb Reconstruction,
Deformity Correction & Pediatric Orthopedic
Surgeon

5. Collagen- Tensile
strength-
prevention of
fracture
Hydroxyapatite-
stiffness-
deformation under
load

7. Bone health/Cartilage health=Muscle
health

8. Modifiable
Lack of physical
activity/obesity
Indequate peak bone
mass due to lack of
Vit D and calcium rich
foods
Smoking
Alcohol
High caffeine intake
High salt intake
Abuse of antaacids
Not modifiable
Female
Increasing age
Early menopause
Medications and
medical conditions
Genetic factors

9. OBESIT
Y

10. Modifiable
• Lack of physical
activity/obesity
• Indequate peak bone mass
due to lack of Vit D and
calcium rich foods
• Smoking
• Alcohol
• High caffeine intake
• High salt intake
• Abuse of antaacids
Not modifiable
Female
Increasing age
Early menopause
Medications and
medical conditions
Genetic factors

11. Bone loss-
after Peak Bone
mass
Male-0.3%/year
Female-0.5%/year
Post menopausal- 1-
2%/year
Peak Bone Mass

12. PEAK BONE MASS

13. ROLE OF
CALCIUM/
VIT D

14. Not modifiable
Female
Increasing age
Early menopause
Medications and medical
conditions
Genetic factors
Modifiable
• Lack of physical
activity/obesity
• Indequate peak bone mass
due to lack of Vit D and
calcium rich foods
• Smoking
• Alcohol
• High caffeine intake
• High salt intake
• Abuse of antaacids

15.  Alcohol- daily intake of 3 or more units of alcohol increases the
risk of fracture.
 Osteoporosis/fracture- against consuming more than 7
drinks/week, 1 drink being equivalent to 120 mL of wine, 30 mL of
liquor, or 260 mL of beer
 Oral glucocorticoids ≥5 mg/d of prednisone for >3 months (ever)
 Abuse of antacids or some other medication(anticovulsant)
increases the risk of osteoporosis and fracture
 Patients should be advised to limit their caffeine intake to less
than 1 to 2 servings (8 to 12 ounces in each serving) of
caffeinated drinks per day.

16. MANAGEMENT
 Exercise
 A regular weight-bearing
exercise regimen (for example,
walking 30–40 min per session)
along with back and posture
exercises for a few minutes on
most days of the week should
be advocated throughout life.
 Cells have mechanoreceptors-
promotes osteogenic
precursors(bone forming)

17.  Dynamic(not simply static loads) + high intensity + Novel
exercises
Osteogenic effect
 Effect must be large enough and repeated to be clinically
relevant, and the gains must be maintained throughout the
life span to prevent fracture
 Exercise effects must be site specific

18. VITAMIN D
 Sunlight, salmon, codliveroil, egg yolk, sundried mushrooms
or vitamin D fortified foods
 Less than 1 year- 400 i.u/day of vit D
 1- 12 years-800 i.u/day of Vit D
 >12years-1000-1200 i.u/day
 Pregnancy-1000-4000 i.u day
 Elderly- 2000 i.u/day
 Diagnosed Rickets/osteoporosis/osteoporosis
Rickets-children- 3-6 lac I.u bolus divided in 6-8
weeks then maintainence dose
Osteoporosis/osteomalacia- 6 lacs i.u divided in
10 weeks then maintainence dose for a year.

19. CALCIUM
 milk, cheese and other dairy foods
 green leafy vegetables, such as broccoli, cabbage and
okra, but not spinach
 soya beans/Ragi
 tofu
 plant-based drinks (such as soya drink) with added
calcium
 nuts
 bread and anything made with fortified flour
 fish where you eat the bones, such as sardines and
pilchards

20. CALCIUM SUPPLEMENTS
 <1 year-200 mg of elemental calcium
 1-8 year-500 mg of elemental calcium
 8-19 years-1200 mg elemental calcium
 19-60 years-1000 mg of elemental calcium
 >60 years/pregnant/lactating-1200 mg of elemental calcium

21. OSTEOPORO
SIS
Definition

22. Silent disease-until
complicated by fracture
or pain
Fractures occur even
with minor fall

24. MANAGEMENT

25. In women age 65 and older and
men age 70 and older, recommend
BMD testing.
Recommend BMD testing to those
who have suffered a fracture, to
determine degree of disease
severity.

26. Initiate treatment in those with hip or
vertebral (clinical or morphometric)
fractures
Early management of fracture can
bring the patient to its near original
life style.

27. ANTIRESORBTIVE/ANABOLIC
MEDICATION
 With Diagnosed osteoporosis on BMD/DEXA scan
 With already sustained osteoporotic fractures
 Along with calcium and Vit D supplements
 To be started in consultation with a physician and to stopped
whenever asked
 Antiresorbtive-Alendronate/Zolendronic acid/
Ibandronate/Risedronate/Calcitonin
 Anabolic-Teriparatide

28. FRACTURE PREVENTION
CONSISTS OF BONE
HEALTH AND PREVENTION
OF FALLS

35. OSTEOARTHRITIS

38. MANAGEMENT
 W e i g h t
l o s s / c o n t r o l
 E x e r c i s e s
 NSAID’s
 Calcium/Vit D
 Braces
 Intraarticular injections

40. WHO NEEDS SURGERY ????
 You have pain in your knees
 You cannot stand for more than half an hour
 You cannot walk for more than half a kilometer
 You have to take pain killers more than 2 tabs/week
 Failure of all conservative methods of management

42. Total knee
replacement
High Tibial osteotomy
Unicondylar Knee
replacement

43. Questions???