This document discusses osteoporosis, including its definition, prevalence, risk factors, clinical presentation, diagnosis, and treatment options. Some key points:
- Osteoporosis is a systemic skeletal disorder characterized by low bone mass and deterioration of bone tissue, leading to increased fracture risk. It is most prevalent in postmenopausal women and the elderly.
- Risk factors include older age, female sex, family history, smoking, low calcium intake, and medications like steroids. Common fractures are of the spine, hip, and wrist.
- Diagnosis involves assessing risk factors, physical exam for signs like height loss, and bone mineral density testing via DEXA scan. Treatment focuses on lifestyle
This is a short patient education presention on Arthroscopy or Key hole surgery. It gives brief outline of the procedure.
Arhroscopy or key hole surgery is surgical procedure in which joints like knee, shoulder , elbow, ankle, hip joints could be examined for diagnosis and some times as used to provide definitive treatment. This surgical pocedure can be carried out as outpatient or inpatient basis. The main advantage of this procedure is it is minimally invasive, faster recovery, small scars.
Definition of Osteoporosis - Prevalence - Risk factors for Osteoporosis - Diagnosis of Osteoporosis - Clinical manifestations- Laboratory investigations - DEXA - T and Z score - Management of Osteoporosis - Prevention
This is a short patient education presention on Arthroscopy or Key hole surgery. It gives brief outline of the procedure.
Arhroscopy or key hole surgery is surgical procedure in which joints like knee, shoulder , elbow, ankle, hip joints could be examined for diagnosis and some times as used to provide definitive treatment. This surgical pocedure can be carried out as outpatient or inpatient basis. The main advantage of this procedure is it is minimally invasive, faster recovery, small scars.
Definition of Osteoporosis - Prevalence - Risk factors for Osteoporosis - Diagnosis of Osteoporosis - Clinical manifestations- Laboratory investigations - DEXA - T and Z score - Management of Osteoporosis - Prevention
Osteoporosis is a progressive systemic skeletal disease characterized by low bone mass and microarchitecture deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
Osteoporosis is a progressive systemic skeletal disease characterized by low bone mass and microarchitecture deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.
Operative treatment of osteoporotic spinal fracturesAlexander Bardis
Osteoporosis is a systemic disease, which results in :
progressive bone mineral loss
concurrent changes in bony architecture
leaving the spinal column vulnerable to compression fractures, usually after minimal or no trauma.
Incision or transection of bone.
Uses:-
to correct deformity.
to change shape of bone.
to redirect load trajectories in a limb so as to influence joint function.
OSTEOPOROSIS:A Barebone guide to diagnosis and managementGovindRankawat1
“Progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”
True Definition: bone with lower density and higher fracture risk
WHO: utilizes Bone Mineral Density as definition (T score <-2.5)
Osteoporosis is silent because there are no symptoms initially.
The most common are fractures of the spine, hip, and wrist.
Osteoporosis is not an inevitable part of aging, but is a disease that can be prevented and treated, provided it is detected early.
The main goal of treating osteoporosis is to prevent such fractures in the first place.
Bare bone term used for “necked bone with necked eye”
“There is clearly a problem of underdiagnosis and undertreatment of osteoporosis and we want to raise awareness about the risk factors for osteoporosis so that those who need treatment get treatment”.
Learning Objectives
Utilize recent recommendations for osteoporosis prevention and treatment and how to apply them in practice.
Explain controversies surrounding pharmacologic osteoporosis therapy including side effects and the risk/benefit ratio of therapy.
Determine when and how to utilize the current pharmacologic therapies including anabolic versus anti-resorptive approaches and how to transition or discontinue treatment
Osteoporosis only causes symptoms when it is far advanced.
Symptoms include loss of height, deformed spine (“dowager’s hump”), unexplained back pain, and fractures.
It is best to detect problems at an early stage, when treatment is most effective.
The best test for detecting osteoporosis is bone densitometry, done with a technique called “Dual-energy X-ray Absorptiometry” or DXA.
Know everything about Osteoporosis- prevention and management.
Did You Know?
The incidence of hip fracture is 1 woman to 1 man in India
Know more such facts and useful information on prevention of Osteoporosis.
Osteopenia refers to decreased bone mass.
Osteoporosis refers to osteopenia (reduced bone strength/mass) that is severe enough to increase the risk of fracture.
According to WHO, osteoporosis is defined as bone mineral density that falls 2.5 standard deviation below mean for young healthy adult of same sex and race.
Osteoporosis associated fractures :
These are adulthood fractures of any bones (chiefly hip and vertebral fractures) in the setting of trauma less than or equal to fall from standing height with exception of fingers, toes, face and skull.
Drugs associated with osteoporosis
Alcohol
Glucocorticoids
Anticoagulants
Anticonvulsants
Chemotherapy
Excess thyroxine
Endocrine disorders
Cushing syndrome
Hyperparathyroidism
Thyrotoxicosis
Diabetes mellitus (both type I and II)
Acromegaly
CATEGORIZATION OF OSTEOPOROSIS
A.Primary
Idiopathic
Postmenopausal
Senile/age related
B. Secondary (Diseases)
Hypogonadal state, endocrine disorders, nutritional and gastrointestinal disorders, rheumatologic disorders, hematological disorders/malignancy, inherited disorders and others.
Usually asymptomatic until fracture occurs
Vertebral and hip fracture common by simple fall
Loss of height due to multiple vertebral fracture and other deformities like lordoisis, kyphoscoliosis.
Fracture of femur neck, pelvis or spine causes deep vein thrombosis and pulmonary embolism, pneumonia.
INVESTIGATIONS FOR OSTEOPOROSIS
DXA (Dual energy X-ray absorptiometry)
Quantitative CT
Ultrasound
Urea, creatinine and electrolytes
Liver function test and albumin
Renal function test
Full blood count, ESR
Serum calcium and phosphate
Serum vitamin D and alkaline phosphate
Serum PTH
Thyroid function test
Testosterone, estrogen and gonadotropins
Serum cortisol
Bone biopsy
Plain radiography not diagnostic
Following non pharmacological approaches are taken:
Exercise
Appropriate calcium and vitamin D intake (Calcium 1000mg/day and vitamin D 800 IU/daily)
Cessation of smoking
Limit/ Quit alcohol intake
Get up and go exercise
Hip protectors to reduce the risk of fracture.
Pharmacological agents
Bisphosphonates ( decrease osteoclast activity)
Postmenopausal hormone replacement therapy
Denusumab (anti- RANKL antibody)
Anti- sclerostin antibodies
Cathepsin k antibodies
Osteoporosis in elderly causes and managementGovindRankawat1
“Progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk”
True Definition: bone with lower density and higher fracture risk
WHO: utilizes Bone Mineral Density as definition (T score <-2.5)
Osteoporosis is silent because there are no symptoms initially.
The most common are fractures of the spine, hip, and wrist.
Osteoporosis is not an inevitable part of aging, but is a disease that can be prevented and treated, provided it is detected early.
The main goal of treating osteoporosis is to prevent such fractures in the first place.
Similar to Osteoporosis surgical Spine tips and tricks (20)
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
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Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Evaluation of antidepressant activity of clitoris ternatea in animals
Osteoporosis surgical Spine tips and tricks
1. OSTEOPOROSIS
IS IT A SURGICAL PROBLEM?
Dr.Ghazwan A. Hasan
Medical City Complex
2016
2. OSTEOPOROSIS:
• The Nightmare Of Post-menopause/ Old Age.
• The leading cause of disability and morbidity in elderly.
• The Disease of aging.
• The Silent Disease.
3. DEFINITION
Osteon is bone and porosis is hole in Greek.
Osteoporosis is a systemic skeletal disorder characterized by
low bone mass, micro architectural deterioration of bone tissue
leading to bone fragility , and consequent increase in fracture
risk .
5. OSTEOPOROSIS AFFECTS ENTIRE SKELETON
Osteoporosis is responsible for >36.8 million vertebral and non-vertebral fractures per
year in USA
Spine, hip, and wrist fractures are most common.
Vertebral fractures are the most common type of osteoporotic fracture and responsible
for 42–48% of the variation in kyphosis in patients with osteoporosis
6. PREVALENCE
Osteoporosis is the most prevalent bone disease in the world, 44 million
Americans have or are at risk of osteoporosis.
According to the International Osteoporosis Foundation, 1 in 3 women over 50
may experience osteoporotic fractures, and 1 in 5 men .
Affect : 25% people over 70 y.
50% people over 80 y.
Female to male ratio 6:1
7. PREVALENCE OF OSTEOPOROSIS WILL INCREASE WITH AN INCREASING
AGING POPULATION
Paiement GD, Perrier L. In: Comprehensive Management of Menopause. 1994:32-38. US Census Bureau. 2000.
0
5
10
15
20
%
Projected
Population
>65 Years
1900
1950
1985
2020
8. OSTEOPOROTIC FRACTURE INCIDENCE IS HIGH
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.
9. 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
10. HIGH ECONOMIC BURDEN
Estimated $13.8 billion/year
Outpatient
($1.3)
Hospitalization
($8.6)
Nursing
Home
($3.9)
Ray NF et al. J Bone Miner Res. 1997;12:24-35.
11. TYPES OF OSTEOPOROSIS
2 TYPES :-
a) PRIMARY OSTEOPOROSIS
I. Type-1 : Postmenopausal osteoporosis
II. Type-2 : Age – associated osteoporosis
b) SECONDARY OSTEOPOROSIS
Loss of bone is caused by an identifiable agent or disease process such as inflammatory disorder ,
bone marrow cellularity disorder and corticosteroid use.
13. NON-MODIFIABLE/FIXED 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.
15. CLINICAL SIGNS AND SYMPTOMS
Fractures caused by osteoporosis are often painful.
Osteoporosis is often called the ‘Silent disease’ as many people don’t
recognize they have it until a fracture occurs.
Back pain: Episodic, acute , low thoracic/high lumbar pain.
Compression fracture of the spine.
16. VERTEBRAL FRACTURES
Most common fractures (46%)
Insidious
Progressive
Often unrecognized
Associated with
Deformity, height loss, back pain
Morbidity and mortality
Predict future vertebral and non-vertebral fractures
17. Most serious clinical event
Morbidity is high
50% do not regain independence
50% do not regain previous mobility
Mortality is high
1 in 5 patients die within 1 year
Patients not treated for osteoporosis
NIH Consensus Development Panel. JAMA. 2001;285:785-795.
Hip Fracture
18. Low BMD
Maternal history of fracture after 50 years
Fracture after 50 years
Age 65 years
Low body weight (125 lb)
Smoking
Corticosteroid use
Other secondary causes
Black DM et al. Osteoporosis Int. 2001;12:519-528.
All postmenopausal women with the following:
Risk of Fracture
19. Klotzbuecher CM et al. J Bone Miner Res. 2000;15:721-739.
Future Fractures (Fold Increase)
Existing Fracture
Wrist
Vertebral
Hip
Hip
1.9
2.3
2.3
Vertebral
1.7
4.4
2.5
Wrist
3.3
1.4
-
A Fracture Begets a Future Fracture
20. • History
Risk factor assessment
Medical history
Family history
Social history (smoking, alcohol)
Evaluation of fall risk
Physical
Height loss >1.5 inches
Kyphosis
Tests
BMD
X-ray of thoracic/lumbar spine
Bone turnover markers
Laboratory tests as necessary
AACE Guidelines. Endocr Pract. 2001;7:293-312.
Clinical Evaluation
21. PHYSICAL EXAMINATION
Height loss
Body weight
Kyphosis
Humped back
Tooth loss
Skinfold thickness
Grip strength
22. In case of vertebral fracture:
Wall- occiput distance
Rib-pelvis distance
23. BMD
Dual energy x-ray absorptiometry (DEXA) is the best current test to
measure bone density.
The ability of the BMD to predict hip # is better than the
measurement of BP to predict stroke.
24.
25. T-Score* Classification
> -1.0 Normal
-1.0 to -2.5 Osteopenia
< -2.5 or lower Osteoporosis
< -2.5 + fracture Severe osteoporosis
WHO DIAGNOSTIC CRITERIA
The WHO Study Group. Geneva, 1994
*T-score = number of standard deviations (SDs) below or above the peak bone mass
in young adults.
26. BMD TESTS OTHER THAN DEXA
Quantitative CT vertebral scanning.
Single photon and dual photon absorptiometry.
Peripheral DEXA.
27. INDICATION OF BMD
All postmenopausal women <65 yr who have one or more additional risk factors for
osteoporosis, besides menopause.
All women >65 yr regardless of additional risk factors
Osteopenia on a radiograph.
Estrogen-deficient women.
Women on estrogen replacement therapy.
Diagnosing low bone mass in glucocorticoid-treated individuals(Prednisolone at 7.5mg
daily for 6m.)
Asymptomatic primary or secondary hyperparathyroidism.
28. Previous low trauma fragility #
Premature menopause <45y.
Prolonged secondary amenorrhoea (>1.y.)
Primary or secondary hypogonadism
Chronic disorders asso. With osteoporosis
A meternal h/o hip #
Alow BMI
Indication of BMD
29. Initial investigations include:
1. ESR
2. Bone profile: serum calcium, phosphate, albumin
3. Alkaline phosphatase
4. Renal function
5. Plain X-rays - lateral thoraco-lumbar spine or hip
LABORATORY TESTS
30. DIFFERENTIAL DIAGNOSES
Other Problems to Be Considered
1. Bony metastases.
2. Multiple myeloma.
3. Primary hyperparathyroidism.
4. Secondary hyperparathyroidism.
5. Osteomalacia.
6. Renal osteodystrophy.
7. Paget disease of bone.
34. Calcium intake.
Diet and/or supplementation: 1200 mg/day
Vitamin D supplementation
Diagnose and treat deficiency/insufficiency.
Supplement: 400-800 IU/day.
Regular load-bearing and muscle-strengthening exercise (no weight lifting if
BMD in spine is low).
Fall prevention advice.
Home safety evaluation.
Nonpharmacologic Approaches
35. NORMAL CALCIUM REQUIREMENT
Age Calcium/day (mg)
Birth-6 months 210
6 months-1 year 270
1-3 500
4-8 800
9-18 1300
19-50 1000
51-70 1200
36. VITAMIN D
Doses:
400IU per day until 60
600-800 IU per day after 60
50,000 IU-D2Every 2-4 weeks
To treat deficiency-50,000 D2IU every week for 2 to 4 m.
37. Orthoses is also used in osteoporotic spine .
It promote extension of spine.
Hip protectors :-
Hip protectors are an external hip protection system
that aims to reduce the hip facture.
42. KYPHOPLASTY
Attempt to restore vertebral body height and reduce kyphosis by using
inflatable balloon tamp.
Orthopedic surgery 1998.
More expensive, often with general anesthesia.
Height restoration (may be only 3-4 mm).
Less risk of cement leak.
43. BACKGROUND DATA (PRIOR TO RECENT STUDIES OF
CONTROVERSY…)
Multiple small studies of VP demonstrating greater pain reduction, less
analgesic use, and greater mobility compared to medical management
(initially and at few months).
meta-analyses show reduction in pain.
Minimal complications.
44. BACKGROUND (CONT)
KP with similar history: multiple small studies demonstrating benefit
with quicker reduction in pain and mobilization compared to medical
treatment
KP and VP: no studies clearly demonstrated any benefit 1-2 years later
when compared to medical treatment
45. KP VS VP: WHICH IS BETTER?
KP: goal to restore height/reduce kyphosis, but may only increase by 2-4 mm (no
sig difference with VP).
KP with less cement leak (< 1% vs 3 % or more with VP), although most leaks not
symptomatic.
Pain and other outcomes similar.
Most likely similar, although patients referred for KP often have more severe
fractures.
47. TIPS AND TRICKS FOR INSTRUMENTATION IN OSTEOPOROSIS
Increase the screws length, diameter and design.
Bicortical Insertion.
(S. W. Breeze, B. J. Doherty, P. S. Noble, A. Leblanc, and M. H. Heggeness, “A
biomechanical study of anterior thoracolumbar screw fixation,” Spine, vol. 23, no. 17, pp.
1829–1831, 1998.)
Triangulations (Bilaterally), Screw Coupling
(P. S. D. Patel, D. E. T. Shepherd, and D. W. L. Hukins, “The effect of screw insertion angle and
thread type on the pullout strength of bone screws in normal and osteoporotic cancellous
bone models,” Medical Engineering and Physics, vol. 32, no. 8, pp. 822–828, 2010.)
Undertaping the screws( Pilot Hole size)
(S. Battula, A. J. Schoenfeld, V. Sahai, G. A. Vrabec, J. Tank, and G. O. Njus, “The effect of pilot
hole size on the insertion torque and pullout strength of self-tapping cortical bone screws in
osteoporotic bone,” Journal of Trauma, vol. 64, no. 4, pp. 990– 995, 2008.)
48. TIPS AND TRICKS FOR INSTRUMENTATION IN OSTEOPOROSIS
Use of Laminar Hook.
(A. Cordista, B. Conrad, M. Horodyski, S. Walters, and G. Rechtine, “Biomechanical evaluation of pedicle screws
versus pedicle and laminar hooks in the thoracic spine,” Spine Journal, vol. 6, no. 4, pp. 444–449, 2006.)
Cement Augment screws.
(L.-H. Chen, C.-L. Tai, D.-M. Lee et al., “Pullout strength of pedicle screws with cement augmentation in severe osteo- porosis: a
comparative study between cannulated screws with cement injection and solid screws with cement pre-filling,” BMC Musculoskeletal
Disorders, vol. 12, article 33, 2011.)
Expandable Pedicular screws.
(S. D. Cook, S. L. Salkeld, T. Stanley, A. Faciane, and S. D. Miller, “Biomechanical study of pedicle screw fixation in
severely osteoporotic bone,” Spine Journal, vol. 4, no. 4, pp. 402–408, 2004.)
Double Pedicle Screws
(L. Jiang, V. Arlet, L. Beckman, and T. Steffen, “Double pedicle screw instrumentation in the osteoporotic spine: a
biomechani- cal feasibility study,” Journal of Spinal Disorders and Techniques, vol. 20, no. 6, pp. 430–435, 2007.)
49. SCREW DESIGN
Conclusions
Pedicle screw with an outer cylindrical and inner conical configuration with a V-
shaped thread may have maximum pullout strength, regardless of bone density.
52. CEMENT AUGMENTED SCREWS
Type of Augment. ( PMMA,, HA, or CaP)
Amount of cement ( 1.0 cc in Dorsal, 1.5 cc in Lumbar )
(P. E. Par ́e, J. L. Chappuis, R. Rampersaud et al., “Biomechanical evaluation of a novel fenestrated pedicle screw augmented with
bone cement in osteoporotic spines,” Spine, vol. 36, no. 18, pp. E1210–E1214, 2011.)
53. The use of cement- augmented screw is a valuable option for these fragile patients and can be associated with
percutaneous techniques in order to be as less invasive as possible, with comparable results to conventional
procedures and less morbidities.
Conclusion
54. Solid screws with retrograde cement pre-filling offer improved initial fixation
strength when compared to that of cannulated screws with cement injection
through perforation for both the conically and cylindrically shaped screw.
55. PMMA-augmented pedicle screw instrumentation combined with balloon-assisted
kyphoplasty could be an option to address unstable vertebral fractures in “a
minor-invasive way”.
56. EXPANDABLE PEDICULAR SCREWS.
Conclusion:
The results of this study have shown that
expandable pedicle screws can be efficacious
in cases in which pedicle screw fixation is
difficult and adds a valuable tool to the
growing armamentarium of spinal
instrumentation.
57. CONCLUSIONS
►Osteoporosis is still underdiagnosed.
►Inevitable consequence of aging in both sexes.
►Accelerated following menopause, disease and drugs.
►Early detection and intervention is mandatory.
►Conservative treatment should be done by Orthopedic not only by physician
58. CONCLUSIONS
► Surgery is needed when indicated.
► Different surgical options are available.
► Surgical Technique, Screw design, Supplement options affect the result.
► Surgery is not substitution for medical management.