ppt. on osteoporosis in rural india

1. Dr. Prakash Sigedar
Consulting Orthopedic Surgeon
Jalna.

2. About Myself.
•Ex- member of I.O.A Presidential Theme Committee.
•E.C. Member – Maharashtra orthopaedic Association.
•I.P.P- Jalna Orthopaedic Association.
•Past President - I.M.A. Jalna.
•Fellow – Poona Orthopaedic Society.
•Recipient of Dr. Suresh Nadkarni Award of I.M.A.
Dr. Prakash. Sigedar. •
Charter member & Editor of Bulletin Rotary Club.
•Tel. : 91-02482-237210.
•Cell. : 9423457010, 9422226012.
•Email. : psigedar@rediffmail.com.
•Fax. : 02482-235773.
visit us at -www.sigedarhospital.com

3. What of bones is a disease characterized by low
 Fragility
is Fragility
bone mass and structural deterioration of bone
tissue , which leads to bone fragility and an increased
susceptibility to fractures.
 Common types-primary &secondary
Normal Bone Fragile Bone
 Senile &
 Post menopausal

4. PROBLEM OVERVIEW
 Fragility is a major public health concern, and the
single most common bone disease. World Health
Organization (WHO), postulates fragility as a global
health problem second to cardiovascular heart
disease. Worldwide, lifetime risk for fragility fractures
in women is 30-50% while in men it is 15-30%.
Fractures due to fragility are more common than
heart attacks, strokes, and breast cancer combined.
Therefore it is important for orthopedicians to be at
frontline in the screening, diagnosis and management
of fragility.
 Seen in both poor and rich people
 In poor reason is nutritional deficiency and in rich

5.  Fragility and fragility fractures are significant public
health issue that grows in importance as the
population ages.
 More than 200 million people worldwide have
fragility of bones
 Bone strength reflects the integration of bone density
and bone quality
 It is called as silent killer disease as no symptoms are
seen and fracture is the first seen most of the times .
 Every post menopausal women is osteoporotic unless
proved otherwise

6. Alarming
Projections
about
osteoporosis

7. Fragility fractures
 Fractures contribute to pain, deformity, loss of height,
and disability
 Who defines fragility (osteoporosis) as a BMD (bone
mineral density) at the hip or spine less than or equal to
2.5 standard deviations below the young normal mean
reference population.
 It is very alarming problem in rural India and needs to be
addressed properly

8. Concept of strong bone
 Trabecular pattern of bone decides how strong bone
is?
 It can be compared with building having strong
structural design.
 Strong bones, strong nation

9. Factors Responsible for
Osteoporosis.
 Obesity  Genetic Preponderance
 Lack of exercise  Diseases like cushing
 Nutritional deficiency syndrome, multiple
 Hormonal imbalance myeloma
 Addictions – Smoking,
 Early menopause in
women
Alcohol
 Over diet consciousness
 Small body build
 Drugs
 Hereditary factors
 White/Thin women
 Surgeries (Hysterectomy)
 Aging
 Nulliparity (never having
had children)

10. Medical conditions associated with
increased risk of osteoporosis
1. Prolonged glucocorticoid therapy
2. Conditions associated with excess glucocorticoid
secretion
3. Amenorrhoea lasting more than 6 months before the
age of 45 years.
4. Primary hyperparathyroidism
5. Chronic liver disease
6. Chronic renal disease
7. Malabsorption (eg. Coeliac disease)
8. Rheumatoid arthritis and other inflammatory
arthropathies (eg. Ankylosing spondylitis)
9. Conditions associated with thyroxine excess

11. Common sites of fragility fractures
 Wrist, hip and spine are the commonest sites of
fragility fractures
 However It may occur to any bone .
 Fragility of bones is the main hurdle in treatment of
patients with fractures in old age

12. Risk factors in rural India
 Poverty
 Illiteracy
 Misbelieves
 Addictions (in male, predominantly alcohol and
smoking)
 Population explosion
 Lack of facilities to check BMD(DEXA which is gold
standard is only available in metros

13. Hurdles in rural India
 Socio- economical problems
 Lack of awareness about fragility fractures
 poor hygiene
 Influence of quacks and bone setters
 Poor implant holding(purchase)
 Other co morbid conditions like diabetes,
hypertension, COPD etc
 Anesthesia fitness problems
 Other age related problems like senile dementia etc
 Financial dependence on children

14. Clinical presentation
 Fragility is mostly a silent killer disease
 Fracture at hip, wrist or spine (wedge compression)
 Recurrent fractures
 Chronic back pain (MPK)
 Cervical lordosis and dorsal kyphosis i. e. “dowager,s
hump” in older women
 Fractures due to trivial trauma, fall
 Loss of more than 2 inches in height
 Low BMD done either routinely or for screening purposes
 Fractures of ICNF, TROCHANTRIC,OR CEVICAL
INJURIES AFTER TRIVIAL TRAUMA
 Compression fractures of vertebrae with trivial trauma

15. Diagnosis of fragility
* Personal and family health history
* Detailed evaluation of risk factors for osteoporosis.
* Physical / Clinical examination
* Age of the patient
* DEXA scan or
quantitative CT scan
*Blood investigations
hormonal assays and
bone markers
DEXA SCAN is gold standard
NOW AVAILABLE IN JALNA

16. Management of fragility fractures
 Diet
 Exercise
 Drugs
 Patient education
 Counseling
 Positive thinking
 Surgical treatment
 Rehabilitation
 Psychological Evaluation
 Prevention of early PMO
 Hormonal Replacement Therapy

17. Managing fragility&reducing
fracture risk
 Bone mass attained in early life is perhaps the most
important determinant for future development of
fragility and fractures
 Along with genetic factors environmental and
modifiable lifestyle factors have significant role
 Prevention is much better than cure
 Primary as secondary prevention is of at most
importance

18. Diet and fragility
 Calcium and vitamin D
 SATVIK,
SANTULIT(balanced), and
SAKAS AAHAR(DIET)
 Milk and milk products
 Soya proteins and soya
isoflavens
 Sea food
 Diet rich in calcium
 Sun bath
 Zinc and other vitamins

19. Fragility and exercise
 Exercise is of at most importance in
preventing fragility and fractures due to it
 Weight bearing exercises which increase
bone density
 Regular weight bearing and muscle
strengthening exercise reduce the risk of falls
and risk of fractures
 Weight bearing exercises includes walking,
jogging and similar activities
 Muscle- strengthening exercises include
weight training and other resistive exercises
 Exercises should be part of our routine since
adolescent age group to restore bone mass

20. Medications in Fragility
 Role of Soya isoflavens (Soya milk, soya
powder)
 Role of nandrolene decanoate
 Role of calcitonin nosal spray
 Role of cholecalciferol sachets
 Role of Zolandronic acid injection
 Role of subcutaneus / intradermal
injections Teriparatide, r DNA origin.
(Forteo)

21. Bone and Joint Decade
(2000-2010)
 WHO’s special drive for osteoporosis awareness and
musculoskeletal disorders.
 Many activities like lectures, camps, propaganda by
electronic and print media for awareness of
osteoporosis.20th oct. is world osteoporosis day
 Many countries of world are involved in this
programme.
 Has got extension 2010 to 2020.
 20th oct. is observed as “world osteoporosis day every
year

22. Concept of menopause clinic
 This is very important step to tackle PMO.
 This clinic includes gynecologist, orthopedic
surgeon, dietician, physiotherapist and
psychologist.
 This is the need of time to take care of PMO.

24. Our Contribution
 Conducted almost more than 60 camps for free BMD
check up in last 15 years
 More than 10000 patients screened for fragility
 Ultrasound based calcaneal method was used most of
the times
 More stress on health education and public awareness
along with treatment
 Display of DVDS on fragility awareness in out door
waiting hall for patient education

25. Our Contribution
 Councelling, reassurance,
 Publication of pamplets, articles in newspapers, books
in local language regarding fragility prevention and
treatment
 Comprehensive approach of treatment like diet,
exercise, drugs
 Team effort is important(dietician, physiotherapist,
psychologist, counselor, social worker, orthopedic
surgeon etc

26. Our Contribution
 Health education should start from school level
because early age bone mass is important
determinant
 Lectures at school, college level on health education
and awareness of fragility of bones is important
 De addiction movement- at least ask your every
patient about any addiction in history taking and ask
them to quit it

28. Recommendations
 Every district hospital should have facility of DEXA scan
 Team of experts in treating fragility fractures and all
concerned facilities should be available at district govt.
hospital
 Fragility and fragility fractures should be taken by govt.
on Priority as national problem
 Sufficient funds should be given to manage this problem
 Awareness programs should be started by govt. in this
regard
 Involvement of NGO’S should be encouraged

29. Take home mesage
 Fragility fractures is an important issue
 It should be addressed in proper way to get expected
results
 Comprehensive treatment approach is must
 Health education and public awareness is must
 Prevention is much better than cure
 Better patient care through education and research

30. We are sure the change is possible with comprehensive approach

31. THANK YOU !
Thank You for
your kind
Attention.