This document discusses a study on the prevalence of osteoporosis and osteopenia among postmenopausal teachers and nurses, revealing a surprisingly low occurrence of osteoporosis but notable percentages of osteopenia. It outlines various risk factors, diagnostic categories, and methods used for measuring bone mass density, highlighting the importance of lifestyle modifications for bone health. The findings suggest further research is needed to understand the low prevalence rates observed in the study's sample.

1. 14.1.05 Osteoporosis 1
Osteoporosis, prevalence
and risk.
Chit Soe, Aye Aye Khaing,
Pandora Aung Gyi

2. 14.1.05 Osteoporosis 2
Introduction

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Rank Cause
1 Lower respiratory infections
2 Diarrheal diseases
3 Peripheral conditions
4 Unipolar major depression
5 Ischemic heart disease
6 Cerebrovascular disease
7 Tuberculosis
8 Measles
9 Road Traffic accidents
10 Congenital abnormalities
Worldwide Disease Projection
Estimated 1990 Projected 2020
Rank Cause
1 Ischemic heart disease
2 Unipolar major depression
3 BJD (Road traffic accidents)
4 Cerebrovascular disease
5 COPD
6 Lower respiratory infections
7 Tuberculosis
8 War
9 Diarrheal diseases
10 HIV
Neil B, Chapman N, Patel A. Eur Heart J 2002;4(suppl F):F2-F6.

4. 14.1.05 Osteoporosis 4
To target 5 Areas
• 1. Rheumatoid Arthritis
• 2. Osteoporosis
• 3. Low Back Pain
• 4. OA knee
• 5. Limb trauma

5. 14.1.0514.1.05 OsteoporosisOsteoporosis 55
Epidemic of the millenniumsEpidemic of the millenniums
OsteoporosisOsteoporosis
 The lifetime risk of vertebral fractureThe lifetime risk of vertebral fracture
has been estimated to be 15.4%has been estimated to be 15.4%
after age 45 yearsafter age 45 years
 but this most likely largelybut this most likely largely
underestimates the true risk. (12-underestimates the true risk. (12-
30% in diff. studies)30% in diff. studies)
 The demand on the health careThe demand on the health care
system is therefore increasing, assystem is therefore increasing, as
are costs for societyare costs for society

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Most costly silentMost costly silent
Epidemic of the HistoryEpidemic of the History

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Low Trauma FracturesLow Trauma Fractures

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Mechanisms of osteoporosisMechanisms of osteoporosis

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New findings inNew findings in
recent yearsrecent years

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 BMP=Bone Morphogenic ProteinBMP=Bone Morphogenic Protein
 SOST=SclerostinSOST=Sclerostin
 RANK=Receptor Activator of Nuclear Factor KappaRANK=Receptor Activator of Nuclear Factor Kappa
 OPG=OsteoprotegerinOPG=Osteoprotegerin

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WHO Diagnostic Categories forWHO Diagnostic Categories for
Osteoporosis (1994)Osteoporosis (1994)
 NormalNormal -BMD not more than 1 SD below-BMD not more than 1 SD below
the young adultthe young adult
 OsteopeniaOsteopenia -BMD between 1 and 2.5 SD-BMD between 1 and 2.5 SD
 OsteoporosisOsteoporosis -BMD more than 2.5 SD-BMD more than 2.5 SD
below the young adult mean value.below the young adult mean value.
 Severe osteoporosisSevere osteoporosis -BMD value more-BMD value more
than 2.5 SD in thethan 2.5 SD in the presence of 1presence of 1
oror more fragility fractures.more fragility fractures.

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BMDBMD

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How do you interpret a boneHow do you interpret a bone
mass report?mass report?
 The bone mass report includes threeThe bone mass report includes three
values at each skeletal site analyzed:values at each skeletal site analyzed:
absolute bone mass in gm/cm2, T-absolute bone mass in gm/cm2, T-
score, and Z-score.score, and Z-score.
 The T-score is the number ofThe T-score is the number of
standard deviations (SDs) that astandard deviations (SDs) that a
patient's value lies above or belowpatient's value lies above or below
the mean peak value for youngthe mean peak value for young
adults.adults.

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 Any T-score between -1 and -2.5 isAny T-score between -1 and -2.5 is
termed osteopenia and any valuetermed osteopenia and any value
below -2.5 is consideredbelow -2.5 is considered
osteoporosis.osteoporosis.
 The Z-score is the number of SDsThe Z-score is the number of SDs
that a patient's value lies above orthat a patient's value lies above or
below the mean value for age-below the mean value for age-
matched adults.matched adults.

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Risk factors for osteoporosisRisk factors for osteoporosis
 GeneticGenetic
 Race, Low body weight, Family HistoryRace, Low body weight, Family History
 Osteogenesis imperfecta, Homocystinuria,Osteogenesis imperfecta, Homocystinuria,
GaucherGaucher
 SmokingSmoking
 ImmobilizationImmobilization
 Alcohol useAlcohol use
 EndocrineEndocrine
 Hyperthyroidism, HyperparathyroidismHyperthyroidism, Hyperparathyroidism
 Cushing's syndrome, Androgen loss,Cushing's syndrome, Androgen loss,
Hypogonadism, Menopause (natural or surgical)Hypogonadism, Menopause (natural or surgical)

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Risk factors for osteoporosis (con)Risk factors for osteoporosis (con)
 Calcium deficiencyCalcium deficiency
 Dietary, Chronic liver diseaseDietary, Chronic liver disease
 Malabsorption, IBSMalabsorption, IBS
 Losses in renal diseaseLosses in renal disease
 Vitamin D deficiencyVitamin D deficiency
 Decreased exposure to sunlightDecreased exposure to sunlight
 Renal diseaseRenal disease
 DrugsDrugs
 CorticosteroidsCorticosteroids
 Cyclosporine, anticonvulsants, SedativesCyclosporine, anticonvulsants, Sedatives
 Chronic heparin, GnRHChronic heparin, GnRH

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Risk factors for osteoporosis #Risk factors for osteoporosis #
 FallsFalls
 Visual diseases (glaucoma, cataracts,Visual diseases (glaucoma, cataracts,
refractive errors)refractive errors)
 Postural hypotensionPostural hypotension
 Muscle weakness (disuses, myopathy)Muscle weakness (disuses, myopathy)
 ArthritisArthritis
 Neurologic (Parkinson's, multipleNeurologic (Parkinson's, multiple
sclerosis, previous strokes)sclerosis, previous strokes)

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Aim
• To explore the prevalence of
osteoporosis and osteopenia in Post-
Menopausal females (Teachers and
Nurses) and
• To find out the proportion of risk
factors for osteoporosis in two
occupation groups
• To find out Bone Mass Density and
association to known risk factors.

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Methods
• All the postmenopausal teachers from a state
high school from Mingalar Taung Nyunt
Township (n=45) and
• Postmenopausal staffs from Yangon General
Hospital (n=38) were included in the study.
• All the participants were asked to fill up a
questionarrie for risk factors and
• Bone Mass Density (BMD) was measured by
ultrasound densitometer.

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Quantitative Ultrasound
• BUA= broadband ultrasound attenuation
• SOS= speed of sound
• Stiffness= combination of BUA & SOS
• BUA reflect the attenuation of sound
waves as they pass through bone tissue
and are proportionate to the density of
the tissue.

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• QUS also assesses aspects of bone
quality and structure that are not
captured by BMD measurements.
• It is complementary to and additive
with BMD

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Combination of DEXA and USGCombination of DEXA and USG
J Bone Miner Res 1995:10:353J Bone Miner Res 1995:10:353

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ResultsResults

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Bone Mass, Osteopenia &
Osteoporosis
• Mean BMD for teachers was 64.71 dB/MHZ
(SD 4.8) and that for staff was 64.24
dB/MHZ (SD 4.2).
• Osteopenia (T score less than -1.0 to -2.5)
was seen in
• 31% of teachers (14 out of 45) and
• 31.5% of staffs (12 out of 38).
• Surprisingly, there was no patient with
osteoporosis (T score less than -2.5) in this
study.

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Prevalence of Osteoporosis
0
5
10
15
20
25
30
35
Normal Osteopenia Osteoporosis
Teacher
Med Staff
31% 31.5%

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Risk Factors
• low trauma fracture in family was
mentioned by 7.2%,
• high coffee intake (14.5%),
• smoking (2.4%),
• alcohol (1.2%),
• sedentary life (61.4%),
• hyperthyroid (2.7%), and
• history of steroid (8.4%).

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• Milk intake was very low (48% answered
no milk in last week and only 4.8% took
one cup of milk each day).

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• Only 2 participants were taking HRT
(2.4%) and
• 14.5% were taking calcium supplement.

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Risk factors in Teachers vs Staff
• The presence of risks factors did not
differ significantly between two groups
of teachers and staff.

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Presence of risk factors vs
osteopenia
• Apart from thin body built and lack of
exercise,
• the presence of risk factors did not
associate significantly with osteopenia
in this study.

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Presence of risk factors in normal
people and osteopenia patients
Risk Normal
(56)
Osteo
penia
(26)
p
Mean body weight 134lb 121 lb 0.04
Exercise days/ week 2.1 0.7 0.01
Coffee >3 cups/day 8 3 0.9
Milk intake (cup)/wk 1 0.9 0.8
Small fish intake days/
wk
2.59 2.5 0.8

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Presence of risk factors in normal people
and osteopenia patients
Risk Normal
(56)
Osteo
penia
(26)
p
Surgical menopause
>1 yr
8 5 0.9
Steroid 6 1 0.49
Taking Calcium
supplement
4 8 0.4
Fruit intake/ week 13 8 0.7

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Discussion

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Indications for Bone
Densitometry
• Early menopause (<45)
• Hypogonadism
• Family history of
osteoporotic fracture
• Radiological evidence
of osteoporosis
• Previous fracture
after minimal trauma
(fall from standing
height)
• Clinical features of OP
(height loss, kyphosis)
*Strong risk factor
Low body weight (<19BMI)
*Steroid (>7.5mg daily for >3month)
*Co.- existing disease
Endocrine
Malabsorption
IBD
RA
*Prolonged immobility
*after OP treatment

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• Since the osteoporosis prevalence range
from 15% at age 60 and 38% at age 80
(Melton 1995), sample size of 82 people
was enough to find the prevalence.
• But failure to find any one with
osteoporosis on screening is not
expected and need larger scale study to
explain.

38. 14.1.0514.1.05 OsteoporosisOsteoporosis 3838
Life style modificationLife style modification
 All postmenopausal women should engageAll postmenopausal women should engage
in lifestyle modifications that promotein lifestyle modifications that promote
bone healthbone health
• (1) taking adequate amounts of calcium(1) taking adequate amounts of calcium
(1200 mg/day) either through diet or(1200 mg/day) either through diet or
supplementssupplements
• (2) taking vitamin D (400 to 800 IU(2) taking vitamin D (400 to 800 IU
daily)daily)
• (3) engaging in weight-bearing physical(3) engaging in weight-bearing physical
activity to decrease the risk of fallingactivity to decrease the risk of falling
• (4) smoking cessation(4) smoking cessation
• (5) avoidance of excessive alcohol(5) avoidance of excessive alcohol
intake.intake.

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Conclusion
• The prevalence of osteoporosis is not
high in this study as European studies.
• The presence of risks factors did not
differ significantly between two groups
of teachers and staff.
• Apart from thin body built and lack of
exercise, the presence of risk factors
did not associate significantly with
osteopenia in this study.

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