risk factors, diagnosis and treatment

1. By Dr Afiqi Fikri
MMMC
Risk factors
Diagnosis
Treatment

2. Osteoporosis is a condition characterized
by a decrease in the density of bone,
decreasing its strength and resulting in
fragile bones.
It leads to abnormally porous bone that
is compressible, like a sponge.
Normal bone is composed of protein,
collagen, and calcium, all of which give
bone its strength.

3. This disorder of the skeleton weakens the
bone and results in the frequent fractures in
the bone.
The spine, hips, ribs, and wrists are common
areas of bone fractures from osteoporosis.

4. CLASSIFICATION
 Osteoporosis may be either primary or secondary.
 Primary or physiological osteoporosis has been divided into two
main types by some as
1. Postmenopausal osteoporosis (Type I)
2. Age-related (senile) osteoporosis (Type II)
 The most common forms of osteoporosis are senile and
post-menopausal osteoporosis
 Age-related osteoporosis affects men & womenof 70 years or
older.

5. RISK FACTORS FOR FRACTURE
OSTEOPOROSIS
Nonmodifiable :
• 1.Personal history of fracture
as an adult.
2. History of fracture in first-
degree relative.
3. Female sex
4. Advanced age
5. Caucasian race
6. Dementia
Potentially modifiable:
1.Current cigarette smoking
2. Low body weight [<58
kg (127 lb)].
3.Estrogen deficiency
4.Low calcium intake
5.Alcoholism
6. Poor health/frailty .
7. Inadequate physical activity.
8. Recurrent falls

6. DIAGNOSIS
• LABS
25 hydroxyvitamin D level
low 25 hydroxy cholecalciferol levels (25
hydroxy vit D) in patients sustaining low
energy fractures

7. DIAGNOSIS
1) Radiographs
• indications
• suspicion of fracture
• loss of height
• pain in thoracic or lumbar spine
• recommended views
• lateral spine radiograph
• AP pelvis or hip
• findings
• thinned cortices
• loss of trabecular bone
• kyphosis
• codfish vertebra
• sensitivity and specificity
• usually not helpful unless > 30% bone loss
Imaging

8. DIAGNOSIS
2) Dexa Scan (Dual Energy X-ray Absorptiometry)
usually performed in
• lumbar spine: measures BMD from L2 to L4 and compiles scores
• hip: measure BMD from femoral neck, trochanter, and
intertrochanter region and compiles scores
sensitivity and specificity
• most accurate with the least radiation exposure
Imaging

9. DIAGNOSIS
1) Biopsy
• after tetracycline labeling
• indications
• may be helpful to rule out osteomalacia
2) Histology
Studies

10. TREATMENT
Nonoperative
Lifestyle modification & vitamins
• Indications : calcium and Vitamin D
• Age >50 yrs: 1200 to 1500 mg/d calcium
• 800-1,000 IUs Vit. D

11. TREATMENT
Nonoperative
Pharmacologic treatment
Indications: 2008 National Osteoporosis Foundation Guidelines for
Pharmacologic Treatment of Osteoporosis suggests that
pharmacologic treatment be considered for postmenopausal women
and men >= 50yrs old with:
 hip/vertebral fracture
 T score between -1.0 and -2.5 at the femoral neck/spine
and
• 10-year risk of hip fracture ≥ 3% or
• 10-year risk of major osteoporosis-related fracture ≥
20% by FRAX calculation
 T score -2.5 or less at the femoral neck/spine.

12. TREATMENT
Nonoperative
Pharmacologic Agents
Calcium and Vitamin D
Bisphosphonates
Conjugated Estrogen-progestin hormone replacement
(HRT)
Estrogen-only replacement (ERT)
Salmon calcitonin (Fortical or Miacalcin)
Raloxifene (Evista)
Teriparatide (Forteo)

13. TREATMENT
Nonoperative
Bisphosphonates
• 1st line therapy
• Mechanism: accumulate at sites of bone remodeling and are incorporated
into bone matrix
• are released into acid environment once bone is resorbed, and are then
taken up by osteoclasts
• S/E: Esophagitis, dysphagia, gastric ulcers, osteonecrosis of the jaw
(ONJ), atypical subtrochanteric fractures

14. TREATMENT
Nonoperative
Conjugated Estrogen-progestin hormone replacement
(HRT)
• in women with Type I (within 6 years of menopause)
• Decreased the risk of hip fracture, but it also led to small
increases in a woman's risk of breast cancer, CAD and heart
attack, stroke, PE, DVT, and Alzheimer's disease

15. TREATMENT
Nonoperative
Estrogen-only replacement (ERT)
• indicated for women with prior hysterectomy
• Decreased the risk of hip fracture, but it also led to small
increases in a woman's risk of breast cancer, CAD and heart
attack, stroke, PE, DVT, and Alzheimer's disease
• S/E: Taking unconjugated estrogen (alone) increases the risk of
endometrial hyperplasia / uterine cancer)

16. TREATMENT
Operative
Osteoporotic vertebral compression
fracture
Femoral neck fracture
Distal radius fracture

17. THANK YOU