Webinar on Osteoporosis by Hinduja Hospital
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Hinduja hospital conducts regular webinars and tweetinars for online users where they can seek advice from expert doctors of hinduja hospital for free. Above is the webinar conducted by hinduja hospital on Osteoporosis where issues like osteoporosis symptoms, osteoporosis prevention, osteoporosis treatment were discussed successfully by Spine Consultant, Dr. Uday Pawar. To know more about such upcoming webinars and tweetinars from hinduja hospital, visit http://www.hindujahospital.com/communityportal/
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Webinar on Osteoporosis by Hinduja Hospital
- 1. Osteoporosis Dr. Uday Pawar Junior Spine Consultant DNB Orthopaedic Hinduja Hospital, Mahim, Mumbai http://www.hindujahospital.com/dr-uday-pawar/
- 2. With age comes wisdom……….. and Osteoporosis
- 3. What is osteoporosis ? Normal Osteoprosis
- 4. Jargon buster……… • Softening of bones ……. • A reduction in the quantity and quality of bones
- 5. What is osteoporosis • A condition rather than a disease • Silent until complications arise • Spine, hip & wrist fractures
- 6. WHO criteria for diagnosis of Osteoporosis Kanis et al. J Bone Miner Res 1994; 9:1137-41 T-score Normal - 1.0 and above Osteopaenia - 1.0 to - 2.5 Osteoporosis - 2.5 and below Severe (established) osteoporosis - 2.5 and below, plus one or more osteoporotic fracture(s)
- 9. 1. Osteoporosis ≠ Calcium deficiency • So, calcium is NOT the treatment of osteoporosis • Bone mineral v/s bone mass
- 10. 2. Osteoporosis is a generalized disease • affects all the bones
- 11. 3. Treating osteoporosis • Prevention is the only treatment of osteoporosis • Hence early diagnosis is the most important step in treating osteoporosis !
- 12. Size of the Problem in India • 26 million (2003) 36 million by 2013 • 1 out of 8 males and 1 out of 3 females suffers from osteoporosis • The high incidence among men and the lower age of peak incidence compared to Western countries • Peak incidence of osteoporosis – Western countries-70-80 years of age – India –50-60 years International Osteoporosis Foundation
- 13. The Magnitude Of The Problem In women > 50 years, the lifetime risk of: • Vertebral fracture is 1/3 • Hip fracture is 1/5 NICE guidance 160 October 2008
- 14. Osteoporotic Fractures in Women: Comparison with Other Diseases 1 500 000* 0 500 1000 1500 2000 Osteoporotic Fractures * annual incidence all ages † annual estimate women 29+ ‡ annual estimate women 30+ § 1996 new cases, all ages 513 000† 228 000‡ 184 300§ 750 000 vertebral 250 000 other sites 250 000 forearm 250 000 hip Heart Attack Stroke Breast Cancer Annualincidencex1000 Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society
- 15. Osteoporosis affects entire skeleton • Osteoporosis is responsible for >1.5 million vertebral and non-vertebral fractures per year • Spine, hip, and wrist fractures are most common
- 16. Morbidity associated with Fractures
- 17. Osteoporosis: Classification • Primary Osteoporosis Type 1- Post menopausal osteoporosis Type 2- Senile/Age related osteoporosis • Secondary Osteoporosis Secondary to various causes 17
- 18. Consequences Reduced quality of life
- 19. How is osteoporosis diagnosed Diagnosis is made on the basis of- • Detailed medical history • Examination • Blood and other tests
- 20. Early diagnosis of Osteoporosis • Clinical parameters – ‘at risk’ subject – Bone pains – Generalized tiredness – Progressive kyphosis • Investigations – Radiographs – DEXA – QCT, MRI, Bone scan – Blood markers
- 21. Clinical Risk Fractures (CRF) Predictors of low bone mass- • Female • Advanced age • Low bone mineral density • Gonadal hormone deficiency ( estrogen or testosterone ) • White race • Low body weight & BMI • Family history of osteoporosis • Low calcium intake • Smoking / excessive alcohol intake • Low level of physical activity • Chronic glucocorticoid use • Prior fragility fracture National Osteoporosis Foundation (NOF)
- 22. Clinical Presentation • Severe backache after minor injury • Pain worse on sneezing, coughing , standing erect, changing positions. • Limited to wheelchair • Stooped Posture • Weakness in legs
- 23. X-rays • Osteopenia • Loss of height of vertebral body • Wedging
- 24. Osteoporosis – RadiographicOsteoporosis – Radiographic Differential DiagnosisDifferential Diagnosis • Osteomalacia • Hyperparathyroidism • Hypercortisolism • Hyperthyroidism • Renal insufficiency • Chronic immobilization
- 25. • Osteogenesis imperfecta • Hepatic insufficiency • Diabetes mellitus • Multiple myeloma • Metastatic disease • Drug induced Osteoporosis other causesOsteoporosis other causes
- 26. Assessment of bone mineral density by DXA Current gold standard for diagnosis of osteoporosis BMD (g/cm2 ) = Bone mineral content (g) / area (cm2 ) Diagnosis based on comparing patient’s BMD to that of young, healthy individuals of same sex
- 29. • Blood count , CRP • Calcium, Phosphate, Alkaline Phosphatase (AP) • Kidney function studies • Basal Thyroid and parathyroid. • Protein-immunoelectrophoresis. • Vit D (25 and 1.25) Laboratory tests* NOTES: - * These are in addition to routine labs tests. - These are screening labs, more may be indicated based on these results
- 30. Preventing Osteoporosis alciumalciumCC DDVitaminVitamin xercisexerciseEE FFPreventPrevent allsalls ain weightain weightGG StopStop mokingmokingSS
- 31. Modifiable Risk Factors Vit D Calcium Exercise Quit Alcohol Quit Smoking
- 32. Non-modifiable Risk Factors • Older age • Female gender • Ethnic background • Small bone structure • Family history of osteoporosis or osteoporosis-related fracture in a parent or siblings • Previous fracture • Menopause/hysterectomy • Some medicines like steroids, anti-epileptics • Rheumatoid arthritis • Reduced levels of Gonadal hormones in men
- 33. Treatments of osteoporosis • Calcium and vitamin D • HRT • SERMs (raloxifene) • Calcitonin • Bisphosphonates – ibandronateibandronate – etidronateetidronate – alendronatealendronate – risedronaterisedronate • PTH (1–34) • Fluoride • Strontium ranelate • Combination Hormonal agentsHormonal agents Anti-resorptiveAnti-resorptive agentsagents Anabolic agentsAnabolic agents Dual mechanism ofDual mechanism of actionaction SERMs = selective oestrogen receptor modulatorsSERMs = selective oestrogen receptor modulators PTH = parathyroid hormonePTH = parathyroid hormone
- 34. How much and which Calcium?? • 1000-1500mg “elemental calcium” Type of calcium Elemental Calcium Calcium carbonate 40% Calcium gluconate 9% Calcium lactate 13% Calcium citrate 20-30% Calcium acetate 30% Micro cryst HA complex 100% ◦ May be difficult to attain those levels. ◦ To try a combination of diet and medicines ◦ Can’t give more than 500mg elemental calcium as tabs at a single dose
- 35. Bisphoshonates • Etidronate, Alendronate, Risendronate, Ibandronate, Zolendronate – Anti resorptive agents – Reduce osteoclasis
- 36. Bisphoshonates • Induce apoptosis (self destruction) in the osteoclasts • Thus it reduces bone resorption
- 37. Bisphoshonates • On this ‘preserved’ lattice – mineralization takes place • Thus ‘better mineralized’ bone is formed and DEXA improves
- 38. Teriparatide (PTH) • In small / pulse doses, is a powerful stimulant for bone formation • The only drug that can induce osteogenesis
- 39. Teriparatide • Teriparatide stimulates formation of new bone matrix / framework
- 40. Teriparatide • On this denser, better structured matrix, mineralization takes place giving rise to an overall stronger bone
- 41. BoneStrength (Mass+Quality) Time Effect of Anabolic vs Anti-resorptives on Bone Strength Anabolic ‘Laying down new bone’ Anti-resorptive ‘reducing bone resorption’
- 42. Treatment with PTH (woman 69 years) Dempster DW et al, J Bone Miner Res, 2001;16:1846-1853 Before CtTh: 0.32 mm CD: 2.9 mm3 After CtTh: 0.42 mm CD: 4.6 mm3 1 5 10 1520 25 30 Ser Val Ser Glu Ile Gln Leu Met His Asn Leu Gly LysHisLeuAsnSerMetGluArgValGlu Trp Leu Arg Lys Lys Leu Gln Asp Val His Asn Phe
- 43. Take home points… • No longer a problem of the WEST • Awareness essential amongst general public • Prevention is the best treatment • Moms and grandmoms vulnerable group
- 44. OPD Schedule: Tue- 1500 to 1600 hours, Thu- 0900 to 1100 hours, Sat- 1100 to 1300 hours Appointment Helpline: 022-39818181/67668181/24451515 For any Queries, please write us on: info@hindujahospital.com Thank You
Editor's Notes
- Treatment and prevention (7) One of the most important preventive strategies is to encourage the achievement of optimal peak bone mass in the young, since this has a major impact on bone mass and the risk of osteoporosis after the menopause. Although peak bone mass is largely determined by genetics and diet (calcium and vitamin D intake), it can also be influenced by physical activity, smoking and alcohol consumption. It is, therefore, important to encourage both children and adolescents to adopt a healthy lifestyle.
- Treatment and prevention (8) For those patients at particularly high risk of osteoporosis, or who have developed osteoporosis, there are a number of pharmacological interventions available for the prevention and management of osteoporosis. The aim of these interventions should be to reduce the frequency of fractures, which are responsible for the high levels of morbidity associated with the disease.