The document discusses the roles of calcium and alfacalcidol in osteoporosis cases. It states that calcium is important for life functions as 99% of calcium is stored in bones. Sufficient calcium intake is recommended to prevent osteoporosis, such as 1000-1500 mg per day for women. Alfacalcidol, a form of vitamin D, helps regulate calcium levels and is used as secondary prevention in osteoporosis treatment through medications.
The document discusses preventing osteoporosis and the role of genetics in bone health. It notes that moderate and vigorous physical activity can increase bone density, especially in older women, but genetics still explain 40-75% of the variation in bone mineral content, density, and size between individuals. Many factors related to bone health like parathyroid hormone levels, vitamin D metabolism, bone formation markers, and calcium excretion are highly influenced by genetics as well.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased risk of fracture. It is defined as a progressive decrease in bone mass, resulting in fragile bones that are prone to breaking. Common fracture sites are the hips, spine, and wrists. Osteoporotic fractures can lead to severe pain, disability, and increased risk of mortality. Preventive measures include exercise, avoiding smoking and excessive alcohol, and considering hormone therapy.
This document discusses a preliminary study conducted on US Navy recruits with multiple stress fractures who underwent CT bone densitometry scans. The study found that 58% of recruits with multiple stress fractures had osteopenia, and osteopenia was more common in Asian/Pacific Islander recruits and male recruits. The study concludes that CT bone densitometry may be a useful tool to identify insufficiency as a contributing factor to stress fractures in military recruits, as many cases of osteopenia were identified that otherwise would have been overlooked. However, more research is still needed to fully understand risk factors and how to treat recruits identified as osteopenic.
Osteoporosis is a disease where bones become brittle and weak, increasing the risk of fractures. It is caused by low bone density due to lack of calcium and other minerals in bones. Symptoms include back pain and loss of height. Risk factors include age, gender, family history, and medications like corticosteroids. It is diagnosed through tests like DXA scans and treated through lifestyle changes, medications, and hormone therapy.
Osteoporosis is a disease characterized by low bone mass and structural defects that cause bone fragility and increased fracture risk. It is defined by the WHO as a bone density 2.5 standard deviations below the mean for young adults of the same sex. Bone is composed of a collagen matrix, mineral salts like calcium and phosphate, and bone cells including osteoblasts, osteocytes, and osteoclasts that are involved in bone formation and resorption. Diagnosis involves x-rays, bone mineral density tests, and laboratory tests of calcium, vitamin D, and biochemical markers of bone turnover. Treatment focuses on reducing risk factors, adequate nutrition, exercise, and pharmacologic therapies like bisphosphonates, SERMs,
Stratégie internet Cas par mohammed alami expert SEO SEM SMOMohammed ALAMI ✅
Mohammed ALAMI expert en référencement Google (search engine optimization - SEO) et passionné de marketing internet pour les moteurs de recherche (search engine marketing - SEM) et stratégie des médias sociaux (social media optimization - SMO), est diplômé de l'UDEM (université de Montréal) et HEC : Maîtrise en commerce électronique. Ses compétences couvrent également les outils Web analytiques (ex : Google Analytics et Xiti), planification stratégique (plan e-Marketing). Mohammed ALAMI a occupé le poste de consultant en stratégie internet à CGI de Mai 2010 à Avril 2011, au sein de CGI Montréal secteur Financier groupe Service Affaires Électroniques (SAE). Actuellement il agit en tant que consultant indépendant en SEO/SEM/SMO et planification stratégique.
Recrutement 2.0 et recrutement social sont les nouveaux termes largement galvaudés mais à juste titre puisque la procédure a changé en intégrant les technologies 2.0.
Over the course of its 35-year history, the Staten Island Basketball League has thrived under the leadership of Commissioner Craig Raucher. Players in the pick-up style, fee-based league range in age from 25 to 65 with an average age of 45. Many of them are experienced high school and college players who never lost their love for the game. Craig Raucher, an executive in the transportation sector, has devoted countless hours of his free time to developing what many players have described as “basketball heaven” for mature sportsmen craving both the excitement of intense competition and the comfort of indoor hardwood court.
The document discusses preventing osteoporosis and the role of genetics in bone health. It notes that moderate and vigorous physical activity can increase bone density, especially in older women, but genetics still explain 40-75% of the variation in bone mineral content, density, and size between individuals. Many factors related to bone health like parathyroid hormone levels, vitamin D metabolism, bone formation markers, and calcium excretion are highly influenced by genetics as well.
Osteoporosis is a skeletal disorder characterized by compromised bone strength and increased risk of fracture. It is defined as a progressive decrease in bone mass, resulting in fragile bones that are prone to breaking. Common fracture sites are the hips, spine, and wrists. Osteoporotic fractures can lead to severe pain, disability, and increased risk of mortality. Preventive measures include exercise, avoiding smoking and excessive alcohol, and considering hormone therapy.
This document discusses a preliminary study conducted on US Navy recruits with multiple stress fractures who underwent CT bone densitometry scans. The study found that 58% of recruits with multiple stress fractures had osteopenia, and osteopenia was more common in Asian/Pacific Islander recruits and male recruits. The study concludes that CT bone densitometry may be a useful tool to identify insufficiency as a contributing factor to stress fractures in military recruits, as many cases of osteopenia were identified that otherwise would have been overlooked. However, more research is still needed to fully understand risk factors and how to treat recruits identified as osteopenic.
Osteoporosis is a disease where bones become brittle and weak, increasing the risk of fractures. It is caused by low bone density due to lack of calcium and other minerals in bones. Symptoms include back pain and loss of height. Risk factors include age, gender, family history, and medications like corticosteroids. It is diagnosed through tests like DXA scans and treated through lifestyle changes, medications, and hormone therapy.
Osteoporosis is a disease characterized by low bone mass and structural defects that cause bone fragility and increased fracture risk. It is defined by the WHO as a bone density 2.5 standard deviations below the mean for young adults of the same sex. Bone is composed of a collagen matrix, mineral salts like calcium and phosphate, and bone cells including osteoblasts, osteocytes, and osteoclasts that are involved in bone formation and resorption. Diagnosis involves x-rays, bone mineral density tests, and laboratory tests of calcium, vitamin D, and biochemical markers of bone turnover. Treatment focuses on reducing risk factors, adequate nutrition, exercise, and pharmacologic therapies like bisphosphonates, SERMs,
Stratégie internet Cas par mohammed alami expert SEO SEM SMOMohammed ALAMI ✅
Mohammed ALAMI expert en référencement Google (search engine optimization - SEO) et passionné de marketing internet pour les moteurs de recherche (search engine marketing - SEM) et stratégie des médias sociaux (social media optimization - SMO), est diplômé de l'UDEM (université de Montréal) et HEC : Maîtrise en commerce électronique. Ses compétences couvrent également les outils Web analytiques (ex : Google Analytics et Xiti), planification stratégique (plan e-Marketing). Mohammed ALAMI a occupé le poste de consultant en stratégie internet à CGI de Mai 2010 à Avril 2011, au sein de CGI Montréal secteur Financier groupe Service Affaires Électroniques (SAE). Actuellement il agit en tant que consultant indépendant en SEO/SEM/SMO et planification stratégique.
Recrutement 2.0 et recrutement social sont les nouveaux termes largement galvaudés mais à juste titre puisque la procédure a changé en intégrant les technologies 2.0.
Over the course of its 35-year history, the Staten Island Basketball League has thrived under the leadership of Commissioner Craig Raucher. Players in the pick-up style, fee-based league range in age from 25 to 65 with an average age of 45. Many of them are experienced high school and college players who never lost their love for the game. Craig Raucher, an executive in the transportation sector, has devoted countless hours of his free time to developing what many players have described as “basketball heaven” for mature sportsmen craving both the excitement of intense competition and the comfort of indoor hardwood court.
1. Adult stem cells isolated from fat (h-ASC) have shown promising results in treating various diseases and improving health. They have been tested for over 9 years in canine clinics with remarkable results and early human trials show benefits for conditions like heart and lung disease.
2. h-ASC are abundant, inexpensive, and simple to produce autologously via liposuction. They may provide hope for currently untreatable diseases and have anti-aging properties. NASA is studying their potential for treating astronaut health issues in space.
3. However, legal and regulatory issues regarding stem cells and their classification have limited clinical availability in the US despite their autologous nature and positive results in other countries. Further research
This document provides information about osteosarcoma, including:
- It is a primary malignant bone tumor most common in children and adolescents.
- Signs and symptoms include bone pain, swelling, decreased joint motion, and pathological fractures.
- Diagnosis involves imaging like x-rays, CT, MRI along with biopsy.
- Staging uses systems like Enneking staging which considers tumor grade and compartmentalization.
- Treatment involves chemotherapy, surgery such as wide resection and reconstruction with prosthetics or grafts, and sometimes radiation. Prognosis has improved to a 5-year survival rate of 60-85% with current therapies.
The document discusses osteosarcoma, a type of bone cancer. It provides background on the history and terminology of osteosarcoma, risk factors, common sites in the body, clinical presentation, diagnostic tools, staging systems, and treatments. Osteosarcoma most commonly affects the distal femur and proximal tibia in children and adolescents. Diagnosis involves imaging tests and biopsy. Treatment involves chemotherapy, surgery such as wide resection and reconstruction, and sometimes radiation. Prognosis has improved in recent decades with 5-year survival rates now around 60-85%.
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
DDH (Developmental Dysplasia of Hip).pptxRakesh Singha
Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability.Diagnosis can be confirmed with ultrasonography in the first 4 months and then with radiographs after femoral head ossification occurs (~ 4-6 months).
Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia.
Dr. Tom Crenshaw - Swine Lamness and Clinical Diagnosis of Skeletal IntegrityJohn Blue
Swine Lamness and Clinical Diagnosis of Skeletal Integrity - Dr. Tom Crenshaw, Department of Animal Science, University of Wisconsin, from the 2013 Allen D. Leman Swine Conference, September 14-17, 2013, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2013-leman-swine-conference-material
Perthes' disease is a condition caused by avascular necrosis of the femoral head in children, typically ages 5-10. It results from a temporary loss of blood supply to the hip bone. On x-rays, there are characteristic stages of necrosis, fragmentation as the bone dies and is reabsorbed, and healing as new bone forms. Classification systems exist to describe the severity and prognosis based on how much of the femoral head is involved. Mild cases affect only part of the head, while more severe cases involve most or all of the head, resulting in deformity and a poorer prognosis.
Pemakaian antibiotika pra bedah pada fraktur terbukakindal140289
The document discusses the use of antibiotics for open fractures. It recommends using cefazolin as the ideal antibiotic for prophylaxis due to Staphylococcus being the most common pathogen in open fractures. It provides alternatives like erythromycin, vancomycin, or combinations if the wound is very dirty. Proper administration is a single high dose pre-operatively by intravenous route. The principles of treating open fractures include assuming contamination, preventing infection through debridement, antibiotics, and early wound stabilization and coverage.
This document discusses biochemical markers that can be used to monitor bone formation and resorption. It notes that these markers may provide preferable alternatives to densitometry in some clinical settings. The document reviews the history of using biochemical markers in orthopedics and describes markers of bone formation mediated by osteoblasts and bone resorption mediated by osteoclasts. It also discusses factors like hormones, local stresses, and the environment that can impact bone turnover.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document outlines details from a seminar on osteotomies around the hip presented by Dr. Vaibhav Gandhi at Gandhi Medical College, Bhopal. It includes definitions of osteotomy procedures, classifications based on anatomic location and indications, as well as overviews and details of specific osteotomies such as the Salter, Pemberton, triple innominate, Ganz, and shelf (Staheli) procedures. Force diagrams and biomechanical principles relating to the hip are also discussed.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the etiology and pathogenesis of oral submucous fibrosis (OSMF). It states that areca nut, betel quid and gutka chewing leads to the deposition of alkaloids, tannins and metals in the oral mucosa from areca nut. This causes fibrosis by upregulating TGF-β and collagen production, as well as reducing vascularity and inducing inflammation. Genetic predisposition and autoimmunity may also play a role in OSMF development.
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
May 4 Answer SheetExercise 11. Parietal bone.2. Sphenoid .docxwkyra78
May 4 Answer Sheet
Exercise 1:
1. Parietal bone.
2. Sphenoid bone.
3. Temporal bone.
4. Occipital bone.
5. Lacrimal bone.
6. Zygomatic bone.
7. Mandible.
8. Nasal Bone.
9. Maxilla.
10. Lambdoidal suture.
Exercise 2:
1. Vertex.
2. Opisthocranion.
3. Basion.
4. Orale.
5. Staphylion.
6. Superior border of the eye.
7. Second Molar.
Palatal Index: Width/Length x 100=
Exercise 3:
Genus and species:
Supporting Bones and/or craniometric points:
Exercise 4:
Genus and species: Homo sepien.
Supporting Bones and/or craniometric points: Small orthognathic faces, small brow ridges, small font and back teeth and a small chin on the front of the mandible. The cranial shape was tall and rounded with a vertical forehead, and a large cranial capacity (averaging at least 1.350 cc),
Exercise 5:
1) People with darker skin colors demonstrate “Allen’s Rule” which recognizes that elongated shape has a larger surface area and when applied to limb proportions suggests that elongate limbs are well adapted to hot climates because of the greater surface area. Having an increased amount of surface area allows for greater venting of body heat.
2) Central Africa is home to people with darkest skin colors. Having darker skin provides greatest protection from ultraviolet radiation. Over generations populations who live in this area have adapted by producing more melanin. Melanin is a pigment which gives skin its brownish color. The more melanin, the darker the skin color, therefore, the more protection against the sun’s UV rays.
3) Hypoxia is a condition where you can’t take in enough oxygen required to meet the metabolic needs of your body.
4) Based on what I know about the evolution forces behind human variation is that those who had a mutation that helped them metabolize alcohol faster were naturally selected over those who could not metabolize it as fast. Since the East Asian population have a culture of consuming the fermented rice drinks, those who could metabolize it faster survived better (due to metabolic advantages) as compared to those who could not metabolize it fast but consumed the same amount of fermented drink.
Since the people with the mutation had better survival than the ones without the mutation, more offspring will be added to the population from the parents having the mutation. Thus, this mutated allele common in East Asian regions. Also, to talk about the relationship between rice cultivation and this mutated gene, it is evident that more the rice cultivation will be there, more people will consume the fermented drink that will be produced from rice. And only those having the mutation will have better survival due to metabolic advantages. So, we can say that higher rice cultivation will result in increase in the allele frequency of the mutated gene; the people with no mutation will eventually die or may not be able to reproduce due to adverse effects of alcohol and this will result in reduction of normal allele frequency.
Later Gen.
May 4 Answer SheetExercise 11. Parietal bone.2. Sphenoid .docxendawalling
May 4 Answer Sheet
Exercise 1:
1. Parietal bone.
2. Sphenoid bone.
3. Temporal bone.
4. Occipital bone.
5. Lacrimal bone.
6. Zygomatic bone.
7. Mandible.
8. Nasal Bone.
9. Maxilla.
10. Lambdoidal suture.
Exercise 2:
1. Vertex.
2. Opisthocranion.
3. Basion.
4. Orale.
5. Staphylion.
6. Superior border of the eye.
7. Second Molar.
Palatal Index: Width/Length x 100=
Exercise 3:
Genus and species:
Supporting Bones and/or craniometric points:
Exercise 4:
Genus and species: Homo sepien.
Supporting Bones and/or craniometric points: Small orthognathic faces, small brow ridges, small font and back teeth and a small chin on the front of the mandible. The cranial shape was tall and rounded with a vertical forehead, and a large cranial capacity (averaging at least 1.350 cc),
Exercise 5:
1) People with darker skin colors demonstrate “Allen’s Rule” which recognizes that elongated shape has a larger surface area and when applied to limb proportions suggests that elongate limbs are well adapted to hot climates because of the greater surface area. Having an increased amount of surface area allows for greater venting of body heat.
2) Central Africa is home to people with darkest skin colors. Having darker skin provides greatest protection from ultraviolet radiation. Over generations populations who live in this area have adapted by producing more melanin. Melanin is a pigment which gives skin its brownish color. The more melanin, the darker the skin color, therefore, the more protection against the sun’s UV rays.
3) Hypoxia is a condition where you can’t take in enough oxygen required to meet the metabolic needs of your body.
4) Based on what I know about the evolution forces behind human variation is that those who had a mutation that helped them metabolize alcohol faster were naturally selected over those who could not metabolize it as fast. Since the East Asian population have a culture of consuming the fermented rice drinks, those who could metabolize it faster survived better (due to metabolic advantages) as compared to those who could not metabolize it fast but consumed the same amount of fermented drink.
Since the people with the mutation had better survival than the ones without the mutation, more offspring will be added to the population from the parents having the mutation. Thus, this mutated allele common in East Asian regions. Also, to talk about the relationship between rice cultivation and this mutated gene, it is evident that more the rice cultivation will be there, more people will consume the fermented drink that will be produced from rice. And only those having the mutation will have better survival due to metabolic advantages. So, we can say that higher rice cultivation will result in increase in the allele frequency of the mutated gene; the people with no mutation will eventually die or may not be able to reproduce due to adverse effects of alcohol and this will result in reduction of normal allele frequency.
Later Gen.
Skeletal dysplasia refers to a heterogeneous group of disorders involving abnormalities of bone or cartilage growth and texture, which occur due to genetic mutations. Some key features of certain skeletal dysplasias discussed in the document include shortening and bowing of long bones seen in achondroplasia and thanatophoric dysplasia, narrow thorax and short ribs in short rib polydactyly syndrome, and characteristic facial features and disproportionate short stature in achondroplasia. Prenatal assessment focuses on evaluating long bone lengths and proportions while postnatal assessment involves detailed physical and radiological examination to identify specific skeletal abnormalities.
1362562807 surgical anatomy of diabetic footdfsimedia
This document provides an overview of the surgical anatomy of the diabetic foot. It discusses the bones, joints, muscles, ligaments, arteries, nerves and biomechanics of the normal foot and how diabetes can affect these structures. Key points include how high pressure areas can lead to foot ulcers, how conditions like Charcot foot and hammertoes change the foot's biomechanics, and the importance of proper footwear for diabetics. The foot is described as an engineering marvel that efficiently transmits weight, and this efficiency is lost with neuropathy from diabetes.
Osteoporosis is a bone disorder characterized by low bone density and mass, leading to an increased risk of fractures. It is a growing epidemic, with over 75 million cases in the US, Europe and Japan expected to increase further. Risk factors include age, gender, family history, lifestyle factors like smoking, sedentary lifestyle, and certain medical conditions or medications. Diagnosis involves clinical evaluation, bone density scans, and biochemical markers. Treatment focuses on lifestyle changes like exercise, calcium intake, and vitamin D; medications include hormones, biphosphonates, and teriparatide injections in severe cases. Preventing osteoporosis requires modifiable lifestyle changes and responsible self-care.
1. Adult stem cells isolated from fat (h-ASC) have shown promising results in treating various diseases and improving health. They have been tested for over 9 years in canine clinics with remarkable results and early human trials show benefits for conditions like heart and lung disease.
2. h-ASC are abundant, inexpensive, and simple to produce autologously via liposuction. They may provide hope for currently untreatable diseases and have anti-aging properties. NASA is studying their potential for treating astronaut health issues in space.
3. However, legal and regulatory issues regarding stem cells and their classification have limited clinical availability in the US despite their autologous nature and positive results in other countries. Further research
This document provides information about osteosarcoma, including:
- It is a primary malignant bone tumor most common in children and adolescents.
- Signs and symptoms include bone pain, swelling, decreased joint motion, and pathological fractures.
- Diagnosis involves imaging like x-rays, CT, MRI along with biopsy.
- Staging uses systems like Enneking staging which considers tumor grade and compartmentalization.
- Treatment involves chemotherapy, surgery such as wide resection and reconstruction with prosthetics or grafts, and sometimes radiation. Prognosis has improved to a 5-year survival rate of 60-85% with current therapies.
The document discusses osteosarcoma, a type of bone cancer. It provides background on the history and terminology of osteosarcoma, risk factors, common sites in the body, clinical presentation, diagnostic tools, staging systems, and treatments. Osteosarcoma most commonly affects the distal femur and proximal tibia in children and adolescents. Diagnosis involves imaging tests and biopsy. Treatment involves chemotherapy, surgery such as wide resection and reconstruction, and sometimes radiation. Prognosis has improved in recent decades with 5-year survival rates now around 60-85%.
Presentation contain etiology, blood supply of femoral head & neck,pathogenesis ,classification system ,clinical features,diagnosis,managment, pelvic & femoral osteotomies in detail
DDH (Developmental Dysplasia of Hip).pptxRakesh Singha
Developmental Dysplasia of the Hip is a disorder of abnormal development resulting in dysplasia, subluxation, and possible dislocation of the hip secondary to capsular laxity and mechanical instability.Diagnosis can be confirmed with ultrasonography in the first 4 months and then with radiographs after femoral head ossification occurs (~ 4-6 months).
Treatment varies from Pavlik bracing to surgical reduction and osteotomies depending on the age of the patient, underlying etiology, and the severity of dysplasia.
Dr. Tom Crenshaw - Swine Lamness and Clinical Diagnosis of Skeletal IntegrityJohn Blue
Swine Lamness and Clinical Diagnosis of Skeletal Integrity - Dr. Tom Crenshaw, Department of Animal Science, University of Wisconsin, from the 2013 Allen D. Leman Swine Conference, September 14-17, 2013, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2013-leman-swine-conference-material
Perthes' disease is a condition caused by avascular necrosis of the femoral head in children, typically ages 5-10. It results from a temporary loss of blood supply to the hip bone. On x-rays, there are characteristic stages of necrosis, fragmentation as the bone dies and is reabsorbed, and healing as new bone forms. Classification systems exist to describe the severity and prognosis based on how much of the femoral head is involved. Mild cases affect only part of the head, while more severe cases involve most or all of the head, resulting in deformity and a poorer prognosis.
Pemakaian antibiotika pra bedah pada fraktur terbukakindal140289
The document discusses the use of antibiotics for open fractures. It recommends using cefazolin as the ideal antibiotic for prophylaxis due to Staphylococcus being the most common pathogen in open fractures. It provides alternatives like erythromycin, vancomycin, or combinations if the wound is very dirty. Proper administration is a single high dose pre-operatively by intravenous route. The principles of treating open fractures include assuming contamination, preventing infection through debridement, antibiotics, and early wound stabilization and coverage.
This document discusses biochemical markers that can be used to monitor bone formation and resorption. It notes that these markers may provide preferable alternatives to densitometry in some clinical settings. The document reviews the history of using biochemical markers in orthopedics and describes markers of bone formation mediated by osteoblasts and bone resorption mediated by osteoclasts. It also discusses factors like hormones, local stresses, and the environment that can impact bone turnover.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
This document outlines details from a seminar on osteotomies around the hip presented by Dr. Vaibhav Gandhi at Gandhi Medical College, Bhopal. It includes definitions of osteotomy procedures, classifications based on anatomic location and indications, as well as overviews and details of specific osteotomies such as the Salter, Pemberton, triple innominate, Ganz, and shelf (Staheli) procedures. Force diagrams and biomechanical principles relating to the hip are also discussed.
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and
offering a wide range of dental certified courses in different formats.for more details please visit
www.indiandentalacademy.com
The document discusses the etiology and pathogenesis of oral submucous fibrosis (OSMF). It states that areca nut, betel quid and gutka chewing leads to the deposition of alkaloids, tannins and metals in the oral mucosa from areca nut. This causes fibrosis by upregulating TGF-β and collagen production, as well as reducing vascularity and inducing inflammation. Genetic predisposition and autoimmunity may also play a role in OSMF development.
This document provides information about Perthes' disease, including:
- It is characterized by avascular necrosis of the femoral head in children.
- Risk factors include being male and between ages 5-10 years old.
- Imaging studies like x-rays are used to diagnose and monitor the stages of avascular necrosis, fragmentation, ossification, and remodeling.
- Differential diagnosis depends on whether the condition is unilateral or bilateral.
- Treatment aims to prevent deformity through nonsurgical or surgical methods depending on the severity.
May 4 Answer SheetExercise 11. Parietal bone.2. Sphenoid .docxwkyra78
May 4 Answer Sheet
Exercise 1:
1. Parietal bone.
2. Sphenoid bone.
3. Temporal bone.
4. Occipital bone.
5. Lacrimal bone.
6. Zygomatic bone.
7. Mandible.
8. Nasal Bone.
9. Maxilla.
10. Lambdoidal suture.
Exercise 2:
1. Vertex.
2. Opisthocranion.
3. Basion.
4. Orale.
5. Staphylion.
6. Superior border of the eye.
7. Second Molar.
Palatal Index: Width/Length x 100=
Exercise 3:
Genus and species:
Supporting Bones and/or craniometric points:
Exercise 4:
Genus and species: Homo sepien.
Supporting Bones and/or craniometric points: Small orthognathic faces, small brow ridges, small font and back teeth and a small chin on the front of the mandible. The cranial shape was tall and rounded with a vertical forehead, and a large cranial capacity (averaging at least 1.350 cc),
Exercise 5:
1) People with darker skin colors demonstrate “Allen’s Rule” which recognizes that elongated shape has a larger surface area and when applied to limb proportions suggests that elongate limbs are well adapted to hot climates because of the greater surface area. Having an increased amount of surface area allows for greater venting of body heat.
2) Central Africa is home to people with darkest skin colors. Having darker skin provides greatest protection from ultraviolet radiation. Over generations populations who live in this area have adapted by producing more melanin. Melanin is a pigment which gives skin its brownish color. The more melanin, the darker the skin color, therefore, the more protection against the sun’s UV rays.
3) Hypoxia is a condition where you can’t take in enough oxygen required to meet the metabolic needs of your body.
4) Based on what I know about the evolution forces behind human variation is that those who had a mutation that helped them metabolize alcohol faster were naturally selected over those who could not metabolize it as fast. Since the East Asian population have a culture of consuming the fermented rice drinks, those who could metabolize it faster survived better (due to metabolic advantages) as compared to those who could not metabolize it fast but consumed the same amount of fermented drink.
Since the people with the mutation had better survival than the ones without the mutation, more offspring will be added to the population from the parents having the mutation. Thus, this mutated allele common in East Asian regions. Also, to talk about the relationship between rice cultivation and this mutated gene, it is evident that more the rice cultivation will be there, more people will consume the fermented drink that will be produced from rice. And only those having the mutation will have better survival due to metabolic advantages. So, we can say that higher rice cultivation will result in increase in the allele frequency of the mutated gene; the people with no mutation will eventually die or may not be able to reproduce due to adverse effects of alcohol and this will result in reduction of normal allele frequency.
Later Gen.
May 4 Answer SheetExercise 11. Parietal bone.2. Sphenoid .docxendawalling
May 4 Answer Sheet
Exercise 1:
1. Parietal bone.
2. Sphenoid bone.
3. Temporal bone.
4. Occipital bone.
5. Lacrimal bone.
6. Zygomatic bone.
7. Mandible.
8. Nasal Bone.
9. Maxilla.
10. Lambdoidal suture.
Exercise 2:
1. Vertex.
2. Opisthocranion.
3. Basion.
4. Orale.
5. Staphylion.
6. Superior border of the eye.
7. Second Molar.
Palatal Index: Width/Length x 100=
Exercise 3:
Genus and species:
Supporting Bones and/or craniometric points:
Exercise 4:
Genus and species: Homo sepien.
Supporting Bones and/or craniometric points: Small orthognathic faces, small brow ridges, small font and back teeth and a small chin on the front of the mandible. The cranial shape was tall and rounded with a vertical forehead, and a large cranial capacity (averaging at least 1.350 cc),
Exercise 5:
1) People with darker skin colors demonstrate “Allen’s Rule” which recognizes that elongated shape has a larger surface area and when applied to limb proportions suggests that elongate limbs are well adapted to hot climates because of the greater surface area. Having an increased amount of surface area allows for greater venting of body heat.
2) Central Africa is home to people with darkest skin colors. Having darker skin provides greatest protection from ultraviolet radiation. Over generations populations who live in this area have adapted by producing more melanin. Melanin is a pigment which gives skin its brownish color. The more melanin, the darker the skin color, therefore, the more protection against the sun’s UV rays.
3) Hypoxia is a condition where you can’t take in enough oxygen required to meet the metabolic needs of your body.
4) Based on what I know about the evolution forces behind human variation is that those who had a mutation that helped them metabolize alcohol faster were naturally selected over those who could not metabolize it as fast. Since the East Asian population have a culture of consuming the fermented rice drinks, those who could metabolize it faster survived better (due to metabolic advantages) as compared to those who could not metabolize it fast but consumed the same amount of fermented drink.
Since the people with the mutation had better survival than the ones without the mutation, more offspring will be added to the population from the parents having the mutation. Thus, this mutated allele common in East Asian regions. Also, to talk about the relationship between rice cultivation and this mutated gene, it is evident that more the rice cultivation will be there, more people will consume the fermented drink that will be produced from rice. And only those having the mutation will have better survival due to metabolic advantages. So, we can say that higher rice cultivation will result in increase in the allele frequency of the mutated gene; the people with no mutation will eventually die or may not be able to reproduce due to adverse effects of alcohol and this will result in reduction of normal allele frequency.
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Peranan kalsium dan alfacalcidol pada kasus osteoporosis
1. PERANAN KALSIUM DANPERANAN KALSIUM DAN
ALFACALCIDOL PADA KASUSALFACALCIDOL PADA KASUS
OSTEOPOROSISOSTEOPOROSIS
OLEHOLEH
Dr. Azharuddin, SpBO-K.Spine, FICSDr. Azharuddin, SpBO-K.Spine, FICS
Divisi Bedah Orthopaedi FK Unsyiah/BPK-RSUZA Banda AcehDivisi Bedah Orthopaedi FK Unsyiah/BPK-RSUZA Banda Aceh
20042004
2. PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
““Strong bones build strong lives and strong lives buildStrong bones build strong lives and strong lives build
strong futures….we must do all we can to make thatstrong futures….we must do all we can to make that
strength a reality for all”strength a reality for all”(IOF PATRON,IOF WORLD CONGRESS ON(IOF PATRON,IOF WORLD CONGRESS ON
OSTEOPOROSIS)OSTEOPOROSIS)
3. PENDAHULUANPENDAHULUAN
Osteoporosis:Osteoporosis:
Penyakit yang ditandai dengan rendahnyaPenyakit yang ditandai dengan rendahnya
“massa tulang”disertai perubahan“massa tulang”disertai perubahan
microarsitektur jar. Tulang shg tulang menjadimicroarsitektur jar. Tulang shg tulang menjadi
rapuh/keropos yg mempunyai konsekwensirapuh/keropos yg mempunyai konsekwensi
meningkatnya resiko patah tulang (who 1991 )meningkatnya resiko patah tulang (who 1991 )
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
4. PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
Normal boneNormal bone Osteoporosis boneOsteoporosis bone
5. ““Gold standard “pengukuran massa tulangGold standard “pengukuran massa tulang
(BMD)(BMD)
DEXA (Dual Energy x rayDEXA (Dual Energy x ray
Densitometry)Densitometry)
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
6. PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
BMD in osteoporoticBMD in osteoporotic
womanwoman
BMD in normalBMD in normal
womanwoman
7. ADA 4 KATAGORI DIAGNOSIS “MASSAADA 4 KATAGORI DIAGNOSIS “MASSA
TULANG” DGN ALAT “DEXA”TULANG” DGN ALAT “DEXA”
1. NORMAL : within -1 SD1. NORMAL : within -1 SD
2. OSTOEPENIA : 1 SD to – 2,5 SD of T score2. OSTOEPENIA : 1 SD to – 2,5 SD of T score
3. OSTEOPOROSIS : 2,5 SD or more below the young3. OSTEOPOROSIS : 2,5 SD or more below the young
adult meanadult mean
4. SEVERE OSTEOPOROSIS : 2,5 SD within existing a4. SEVERE OSTEOPOROSIS : 2,5 SD within existing a
fracture.fracture.
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
8. INTEPRETASI HASIL PEM.DEXAINTEPRETASI HASIL PEM.DEXA
T Score Degree of bone loss Risk of fractureT Score Degree of bone loss Risk of fracture
0 to – 1 None None0 to – 1 None None
-1 to -2 Moderate Small-1 to -2 Moderate Small
-2 to -3 Severe Moderate-2 to -3 Severe Moderate
Below -3 Very severe SevereBelow -3 Very severe Severe
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
9. BONE STRENGTH=BONE QUALITY &BONE STRENGTH=BONE QUALITY &
BONE QUANTITYBONE QUANTITY
““BONE QUALITY”:BONE QUALITY”:
- arsitektur- arsitektur
- turn over- turn over
- damage accumulation- damage accumulation
- degree of unmineralization&properties of collagen- degree of unmineralization&properties of collagen
BONE QUALITY: - bone size(macroarsitektur)BONE QUALITY: - bone size(macroarsitektur)
- bone density(microarchitecture)- bone density(microarchitecture)
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
10. ALAT BANTU DIAGNOSISALAT BANTU DIAGNOSIS
1. DEXA----gold standard WHO1. DEXA----gold standard WHO
2. ULTRASOUND-----utk screening saja2. ULTRASOUND-----utk screening saja
3. QCT3. QCT
4. PLAIN X RAY…….Spine AP/LAT4. PLAIN X RAY…….Spine AP/LAT
PEM. LABORATORIUMPEM. LABORATORIUM
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
11. PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
Ultrasound bone measurement of calcaneumUltrasound bone measurement of calcaneum
12. DIAGNOSIS OSTEOPOROSISDIAGNOSIS OSTEOPOROSIS
1. HISTORY: mulai keluhan,nyeri punggung,1. HISTORY: mulai keluhan,nyeri punggung,
”deformity”,BW, height, riwayat menstruasi.”deformity”,BW, height, riwayat menstruasi.
2. PEM. FISIK:2. PEM. FISIK:
- BW & Height (BMI)- BW & Height (BMI)
- Spine- Spine
- Extremities: ROM,Deformity- Extremities: ROM,Deformity
3. LAB.3. LAB.
4. IMAGING4. IMAGING
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
13. INDIKASI PEM BMD ?????INDIKASI PEM BMD ?????
YG MEMILIKI RIWAYAT OSTEOPOROSISYG MEMILIKI RIWAYAT OSTEOPOROSIS
DALAM KELUARGADALAM KELUARGA
PERNAH MEMAKAI OBATPERNAH MEMAKAI OBAT
STEROID,ANTI TIROID, ANTASIDASTEROID,ANTI TIROID, ANTASIDA
YANG LAMAYANG LAMA
KURANG AKTIVITAS FISIK&OLAHKURANG AKTIVITAS FISIK&OLAH
RAGARAGA
MENOPAUSE PREMATUREMENOPAUSE PREMATURE
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
14. PUNYA KEBIASAAN MEROKOK,PUNYA KEBIASAAN MEROKOK,
ALKOHOLIKALKOHOLIK
BERAT BADAN KURANG DARI NORMALBERAT BADAN KURANG DARI NORMAL
SDG DLM MASA MENJELANGSDG DLM MASA MENJELANG
MENOPAUSEMENOPAUSE
MONITORING EFEKTIVITAS TERAPIMONITORING EFEKTIVITAS TERAPI
OSTEOPOROSISOSTEOPOROSIS
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
15. LOKASI TERSERING FRAKTURLOKASI TERSERING FRAKTUR
OSTEOPOROSISOSTEOPOROSIS
SPINE FRACTURESPINE FRACTUREPROXIMAL FEMUR FRPROXIMAL FEMUR FRCOLLES FRCOLLES FR
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
16. MANAGEMEN OSTEOPOROSISMANAGEMEN OSTEOPOROSIS
1. PENCEGAHAN, goal :1. PENCEGAHAN, goal :
a. “Development of strong bone”(to achievea. “Development of strong bone”(to achieve
max. peak bone mass at the end of themax. peak bone mass at the end of the
33rdrd
decade”decade”
b. “Prevent of bone loss”b. “Prevent of bone loss”
c. “Avoid risk of fracture”c. “Avoid risk of fracture”
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
17. 4 GROUP FAKTOR SBG PENYEBAB4 GROUP FAKTOR SBG PENYEBAB
OSTEOPOROSISOSTEOPOROSIS
I. GENETIK/KELUARGAI. GENETIK/KELUARGA
NUTRISINUTRISI
AKTIFITAS FISIKAKTIFITAS FISIK
GAYA HIDUP(Alkohol, Rokok)GAYA HIDUP(Alkohol, Rokok)
RIWAYAT PENYAKIT&OBAT TertentuRIWAYAT PENYAKIT&OBAT Tertentu
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
18. II. BONE LOSS AT POST MENOPAUSEII. BONE LOSS AT POST MENOPAUSE
III. BONE LOSS WITH AGEIII. BONE LOSS WITH AGE
IV. RISKIV. RISK
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
19. ADA 2 TYPE PENCEGAHANADA 2 TYPE PENCEGAHAN
OSTEOPOROSISOSTEOPOROSIS
I. PENCEGAHAN PRIMER :I. PENCEGAHAN PRIMER :
* Nutrisi yg baik,cukup kalsium & vit D* Nutrisi yg baik,cukup kalsium & vit D
* Aktivitas Fisik ( load exercise & balance, prevent* Aktivitas Fisik ( load exercise & balance, prevent
from failing )from failing )
* Life style ( hindari alkohol, merokok,obat2 tt )* Life style ( hindari alkohol, merokok,obat2 tt )
II. PENCEGAHAN SEKUNDERII. PENCEGAHAN SEKUNDER
Terapi spesifik utk osteoporosis dg obat2anTerapi spesifik utk osteoporosis dg obat2an
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
20. PERANAN KALSIUMPERANAN KALSIUM
^ KALSIUM :^ KALSIUM :
- Penting, ion kalsium sangat penting utk fungsi- Penting, ion kalsium sangat penting utk fungsi
kehidupan selkehidupan sel
- Dalam darah selalu diregulasi oleh hormon- Dalam darah selalu diregulasi oleh hormon
- 99% KALSIUM BERADA DALAM TULANG- 99% KALSIUM BERADA DALAM TULANG
- KALSIUM KARBONAT adalah kalsium- KALSIUM KARBONAT adalah kalsium
pilihan(penyerapannya yg tertinggi; 40%)pilihan(penyerapannya yg tertinggi; 40%)
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
21. KANDUNGAN ELEMEN KALSIUMKANDUNGAN ELEMEN KALSIUM
CALCIUM SALT %OF ELEMENTAL CALSCALCIUM SALT %OF ELEMENTAL CALS
Calcium carbonate 40 %Calcium carbonate 40 %
Calcium phosphate, tribaric 37 %Calcium phosphate, tribaric 37 %
Calcium citrate 21 %Calcium citrate 21 %
Calcium lactate 13 %Calcium lactate 13 %
Calcium gluconate 9 %Calcium gluconate 9 %
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
23. REGULASI DARI METABOLISMEREGULASI DARI METABOLISME
KALSIUMKALSIUM
Konsentrasi Kalsium ekstra selular dikontrolKonsentrasi Kalsium ekstra selular dikontrol
oleh hormon : PTH, VIT D,dan Calcitoninoleh hormon : PTH, VIT D,dan Calcitonin
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
24. PERANAN ALFACALCIDOLPERANAN ALFACALCIDOL
ALFACALCIDOL :ALFACALCIDOL :
* PRECUSOR METABOLIT AKTIF VIT D* PRECUSOR METABOLIT AKTIF VIT D
* SUATU FAKTOR PENTING DLM* SUATU FAKTOR PENTING DLM
HOMEOSTASIS CALCIUMHOMEOSTASIS CALCIUM
* SANGAT CEPAT DIKONFERSI KE BTK* SANGAT CEPAT DIKONFERSI KE BTK
BIOLOGI AKTIF DARI VIT D, 1,25-BIOLOGI AKTIF DARI VIT D, 1,25-
dihidrovit D3 ( 1,25-(OH)2 D3 di dlm leverdihidrovit D3 ( 1,25-(OH)2 D3 di dlm lever
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
25. ALFACALCIDOLALFACALCIDOL
* Sangat unggul untuk mengobati “involutional &* Sangat unggul untuk mengobati “involutional &
glucocorticoid induce osteoporosis”glucocorticoid induce osteoporosis”
* Memiliki efek mencegah bone loss pada* Memiliki efek mencegah bone loss pada
“Corticosteroid induce osteoporosis”“Corticosteroid induce osteoporosis”
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
26. EFEKTIFITAS KLINISEFEKTIFITAS KLINIS
ALFACALCIDOLALFACALCIDOL
RENAL OSTEODYSTROPHY:RENAL OSTEODYSTROPHY:
(“All skeletal disorder” yg terjadi pada px RENAL(“All skeletal disorder” yg terjadi pada px RENAL
FAILURE spt : osteitis fibrosa, osteomalacia,FAILURE spt : osteitis fibrosa, osteomalacia,
osteosclerosis & growth retardation.osteosclerosis & growth retardation.
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
27. KESIMPULANKESIMPULAN
A. Kenali 4 faktor penyebab osteoporosis :A. Kenali 4 faktor penyebab osteoporosis :
I. GENETIK, NUTRISI,AKTIFITAS FISIK,I. GENETIK, NUTRISI,AKTIFITAS FISIK,
GAYA HIDUP, PENYAKIT2 & OBAT2 ttt.GAYA HIDUP, PENYAKIT2 & OBAT2 ttt.
II. “BONE LOSS” PASCA MENOPAUSEII. “BONE LOSS” PASCA MENOPAUSE
III.”BONE LOSS WITH AGE”III.”BONE LOSS WITH AGE”
IV. RESIKO-RESIKOIV. RESIKO-RESIKO
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
28. KESIMPULANKESIMPULAN
B. TO REACH MAXIMUM PEAK BONEB. TO REACH MAXIMUM PEAK BONE
MASS :MASS :
* Intake kalsium dan vit D yang cukup sejak dini* Intake kalsium dan vit D yang cukup sejak dini
* Load exercise & balance life style* Load exercise & balance life style
* Hindari obat2 “induce osteoporosis”* Hindari obat2 “induce osteoporosis”
* Terapi2 spesifik spt: bifosfonat, SERM, HRT,dll* Terapi2 spesifik spt: bifosfonat, SERM, HRT,dll
* “Avoid risk of fall”* “Avoid risk of fall”
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS
29. C. KASUS-KASUS RENALC. KASUS-KASUS RENAL
OSTEODISTROFIOSTEODISTROFI ::
Pertimbangkan pemakaian ALFACALCIDOLPertimbangkan pemakaian ALFACALCIDOL
PERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSISPERANAN KALSIUM DAN ALFACALCIDOL PADA KASUS OSTEOPOROSIS