Osteoporosis is a bone disorder characterized by low bone density and compromised bone strength, predisposing patients to fractures. It occurs when bone resorption by osteoclasts exceeds bone formation by osteoblasts, disrupting the normal bone remodeling process. Key risk factors include increasing age, estrogen deficiency, family history, and lack of physical activity. Diagnosis is made through dual-energy x-ray absorptiometry scans, which measure bone mineral density and compare it to healthy young adults. Treatment focuses on lifestyle changes like calcium supplementation and exercise to prevent fractures and stabilize remaining bone mass.

1. TOPIC - OSTEOPOROSIS
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By – MASTER RISHI MAHESHWARI
PharmD IVth year

2. COMPOSITION OF BONE
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3. BONE GROWTH AND LOSS WITH AGE.
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4. Bone homeostasis is a dynamic equilibrium by the regulatory actions of three key bone cells, osteoclasts,
osteoblasts and osteocytes. Bone homeostasis remains intact as long as the activities of these cells are well-
adjusted, and thus net bone mass is maintained.
The amount of bone eroded by osteoclasts is equal to the amount of bone produced by osteoblasts, thereby
producing a stable net mass of bone in the body.
BONE HOMEOSTASIS
BONE HOMEOSTASIS
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5. Osteoporosis is a bone disorder characterized by low bone density, impaired bone architecture, and
compromised bone strength predisposing to fracture.
What is osteoporosis?
Bones that commonly break include the vertebrae in the spine, the bones of the forearm, and the hip.
The word "osteoporosis" is from the Greek terms for "porous bones".
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6. As defined by the World Health Organization (WHO), osteoporosis is present when BMD is 2.5 SD or
more below the average value for young healthy individual(a T-score of <−2.5 SD). A second, higher
threshold describes “low bone mass” or osteopenia as a T-score that lies between −1 and −2.5 SD.
WHO DEFINE OF OSTEOPOROSIS
The T-score
The T-score on bone density report shows how much bone mass differs from the bone mass of an
average healthy 30 year old adult. A bone density test is like any other medical test or measurement. The
results for the entire population will be distributed around an average score (the mean).
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7. The Z-score
A Z-score compares the bone density to the average bone density of people of your own age and gender.
For example, if you are a 60-year-old female, a Z-score compares your bone density to the average bone density of
60-year-old females
A Z-score is helpful in diagnosing secondary osteoporosis and is always used for children, young adults, women
who are pre-menopausal, and men under age 50.
Osteoporosis becomes more common with age. About 15% of Caucasians in their 50s and 70% of those over 80 are
affected. It is more common in women than men. In the developed world, depending on the method of diagnosis, 2%
to 8% of males and 9% to 38% of females are affected. Rates of disease in the developing world are unclear. About
22 million women and 5.5 million men in the European Union had osteoporosis in 2010. In the United States in
2010, about 8 million women and between 1 to 2 million men had osteoporosis. White and Asian people are at
greater risk.
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8. PATHOPHYSIOLOGY
It is result of prolonged imbalance of BONE REMODELING.
- Bone remodeling occurs through an individual’s
lifetime.
- In normal adults , the activity of Osteoclasts (bone
resorption) is balanced by that of Osteoblasts(bone
formation).
- Normal bone remodeling in the adult result in
gradually increase bone mass until the early 30 s
With ageing the peak bone mass is gradually decreased
and
1) CALCITONIN which inhibit bone resorption and
promote bone formation. (decrease)
2) ESTROGEN which inhibit bone breakdown
(decrease) in women.
3) PTH increase bone turnover and resorption.
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9. RISK FACTORS
• Female>>> more than Male
• Increasing Age.
• Inadequate intake of calcium and vitamin D.
• Estrogen deficiency or menopause
• Family history.
• Lack of physical activity.
• Low weight and BMI.
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10. CAUSES OF OSTEOPOROSIS
IDIOPATHIC AGE- RELATED (most common)
1) Young adults
2) Postmenopausal (TYPE-1)
3) Senile (TYPE-2)
OSTEOPOROSIS SECONDARY TO DISEASE STATES:
1) Metabolic conditions
e.g.- calcium deficiency, vit D. deficiency , malnutrition , scurvy.
2) Endocrine conditions
E.g. – Hyperparathyroidism.
3) Renal disease
4) Gastrointestinal-liver disease
E.g.- leukemia
7) Drugs-
E.g.- Phenobarbital , Thyroid hormone
8) Lifestyle-
E.g.- Nutrition , inactivity etc.
9) Miscellaneous
E.g.- Rh. Arthritis.
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11. SIGNS AND SYMPTOMS
Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone fractures.
Osteoporotic fractures occur in situations where healthy people would not normally break a bone;
they are therefore regarded as fragility fractures. Typical fragility fractures occur in the vertebral
column, rib, hip and wrist.
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12. DIAGNOSIS
The diagnosis of osteoporosis can be made using conventional radiography and by measuring the bone mineral
density (BMD).The most popular method of measuring BMD is dual-energy X-ray absorptiometry.
In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into
potentially modifiable underlying causes; this may be done with blood tests. Depending on the likelihood of
an underlying problem, investigations for cancer with metastasis to the bone, multiple myeloma, Cushing's
disease and other above-mentioned causes may be performed.
CONVENTIONAL RADIOGRAPHY
Conventional radiography is useful, both by itself and in conjunction with CT or MRI, for detecting
complications of osteopenia (reduced bone mass; pre-osteoporosis), such as fractures; for differential
diagnosis of osteopenia; or for follow-up examinations in specific clinical settings, such as soft tissue
calcifications, secondary hyperparathyroidism, or osteomalacia in renal osteodystrophy. However,
radiography is relatively insensitive to detection of early disease and requires a substantial amount of bone
loss (about 30%) to be apparent on X-ray images.
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13. DUAL-ENERGY X-RAY
Dual-energy X-ray
Dual-energy X-ray absorptiometry (DEXA scan) is considered the gold standard for the diagnosis of osteoporosis.
Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that
of a young (30–40-year-old, healthy adult women reference population. This is translated as a T-score. But because
bone density decreases with age, more people become osteoporotic with increasing age. The World Health
Organization has established the following diagnostic guidelines:
The International Society for Clinical Densitometry takes the position that a diagnosis of osteoporosis in men under
50 years of age should not be made on the basis of densitometric criteria alone. It also states, for premenopausal
women, Z-scores (comparison with age group rather than peak bone mass) rather than T-scores should be used, and
the diagnosis of osteoporosis in such women also should not be made on the basis of densitometric criteria alone.
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14. BIOMARKERS
Chemical biomarkers are a useful tool in detecting bone degradation. The enzyme cathepsin K breaks down
type-I collagen, an important constituent in bones. Prepared antibodies can recognize the resulting fragment,
called a neoepitope, as a way to diagnose osteoporosis. Increased urinary excretion of C-telopeptides, a
type-I collagen breakdown product, also serves as a biomarker for osteoporosis.
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15. PREVENTION AND MANAGEMENT
The main goal of treatment is to prevent development of osteoporosis and to stabilize remaining bone
mass.
1) A Calcium rich diet esp. in childhood-
- Adolescents may need 1200mg and postmenopausal women may need 1500mg daily.
- Milk , cheese and yogurt are rich in calcium.
- Vitamin- D.
2) No smoking
3) Regular physical activities.
4) Alcohol, caffeine intake should be avoided.
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16. DRUG THERAPY
1)Calcitonin – A synthetic thyroid hormone usually prescribe as a daily nasal spray to reduce factors that
cause loss of calcium and increase reabsorption of calcium in the GIT.
2) Selective Estrogen receptor modulators.
3) Hormone Replacement Therapy- To increase serum estrogen levels, which in turn decrease the rate of
bone resorption.
4)Bisphosphonates are useful in decreasing the risk of future fractures in those who have already sustained a
fracture due to osteoporosis.
5)Alendronate decreases fractures of the spine but does not have any effect on other types of fractures.
6)Teriparatide (a recombinant parathyroid hormone) has been shown to be effective in treatment of women
with postmenopausal osteoporosis.
7) Alendronic acid/cholecalciferol can be taken to treat this condition in post-menopausal women.
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17. GOALS
- Relieving pain
- Improve self-care
- Improve nutritional status.
- Improve physical mobility.
- Prevent injury. (no new fractures).
- Improving bowel elimination.
- Promoting understanding of osteoporosis and the treatment regimen.
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18. INTERVENTION
- Consumes adequate dietary calcium and vit D.
- Encourage to increase level of exercise.
- Modify lifestyle choices : avoid smoking , alcohol, carbonated beverages.
- Maintain optimal body wt.
- Creates safe home environment.
- Adheres to prescribe screening and monitoring procedures.
- Take prescribed medication as instruction.
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19. •ANY QUESTIONS ?
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20. THANK YOU
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