Delhi public school

2019 - 2020
Biology Investigatory Project
“OSTEOPOROSIS”

NAME– SARTHAK BAJPAI

CLASS - XII A

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Acknowledgement

I express my sincere gratitude towards our

honorable principle Ms. Neha Sharma for
her most valued support, encoragment and
suggestions. I am also thankful to my bio
educator Ms Sweeti Sharma for her
remarkable guidance and valuable
supervision throughout the project work.
Name of student: - Sarthak Bajpai

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 CERTIFICATE

This is to certify that Mr. Sarthak Bajpai of class

XII –A Delhi Public School, Gwalior has
successfully completed the biology investigatory
project title “OSTEOPOROSIS” under the
guidance of Ms. Sweeti Sharma I certify that this
project is up to my I expectation and as per the
guidance of issued by CBSE

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 INDEX
1. INTRODUCTION

2. RISK FACTORS

3. SYMPTOMS

4. PATHOPHYSIOLOGY

5. DIAGNOSIS

6. COMPLICATIONS

7. PRENVENTION

8. TREATMENT

9. CASE STUDY

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 WHAT IS OSTEOPOROSIS
● Osteoporosis is the weakening of bones in the body. It is
caused by lack of calcium deposited in the bones. This
lack of calcium causes the bones to become brittle. They
break easily.
● Osteoporosis means "porous bones." Our bones are
strongest at about age 30, and then begin to lose
density.
● Bone is living, growing tissue. It is made mostly of
collagen, a protein that provides a soft framework, and

calcium phosphate, a mineral that adds strength and

hardens the framework.
● This combination of collagen and calcium makes bone
both flexible and strong, which in turn helps bone to
withstand stress

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● Osteoporosis occurs when there is imbalance between
the bone formation and bone resorption which usually
occurs in later stages of life.
 Osteoporosis causes bones to become weak and brittle
— so brittle that a fall or even mild stresses such as
bending over or coughing can cause a fracture.
Osteoporosis-related fractures most commonly occur in
the hip, wrist or spine
● Osteoporosis develops when bone density decreases.
The body reabsorbs more bone tissue and produces less
to replace it.
● The most common injuries in people with osteoporosis
are:
● broken wrist
● broken hip
● broken spinal bones (vertebrae)

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 RISK FACTORS
Factors that will increase the risk of developing
osteoporosis are:
1. Female gender, Caucasian or Asian race, thin and small
body frames, and a family history of osteoporosis.
(Having a mother with an osteoporotic hip fracture
doubles your risk of hip fracture.)
2. Cigarette smoking, excessive alcohol and caffeine
consumption, lack of exercise, and a diet low in calcium.
3. Poor nutrition and poor general health.
4. Malabsorption (nutrients are not properly absorbed
from the gastrointestinal system) from conditions such
as Celiac Sprue.
5. Low oestrogen levels such as occur in menopause or
with early surgical removal of both ovaries. Another
cause of low oestrogen level is chemotherapy, such as
for breast cancer. Chemotherapy can cause early
menopause due to its toxic effects on the ovaries.
6. Amenorrhea (loss of the menstrual period) in young
women also causes low estrogen and osteoporosis.
Amenorrhea can occur in women who undergo
extremely vigorous training and in women with very
low body fat (example: anorexia nervosa).

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7. Chronic diseases such as rheumatoid arthritis and
chronic hepatitis C, an infection of the liver.
8. Immobility, such as after a stroke, or from any condition that
interferes with walking.
9. Hyperthyroidism, a condition wherein too much thyroid
hormone is produced by the thyroid gland (as in Grave's
disease) or is caused by taking too much thyroid hormone
medication
10. Hyperparathyroidism, a disease wherein there is
excessive parathyroid hormone production by the
parathyroid gland (a small gland located near the
thyroid gland). Normally, the parathyroid hormone
maintains blood calcium levels by, in part, removing
calcium from the bone. In untreated
hyperparathyroidism, excessive parathyroid hormone
causes too much calcium to be removed from the bone,
which can lead to osteoporosis.
11. Vitamin D deficiency. Vitamin D helps the body
absorb calcium. When vitamin D is lacking, the body
cannot absorb adequate amounts of calcium to prevent
osteoporosis. Vitamin D deficiency can result from lack
of intestinal absorption of the vitamin such as occurs in
celiac sprue and primary biliary cirrhosis.
12. Certain medications can cause osteoporosis. These
include heparin (a blood thinner), anti-seizure
medications phenytoin (Dilation) and Phenobarbital,

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 and long term use of corticosteroids (such
as Prednisone). .

When to visit a doctor

Common symptoms include:
● Sudden, severe back pain
● Back pain that gets worse when standing or walking,
but gets a bit better when you lie down
● Back pain when bending or twisting
● Loss of height
● Curved or stooped shape to your spine
● Recurrent fractures
● Postmenopausal women

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PATHOPHYSIOLOGY OF OSTEOPOROSIS
osteoporosis occurs when there is imbalance between
new bone formation and old bone resumption. Two
essential minerals for normal bone formation are
calcium and phosphate.

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 H OW IS OSTEOPOROSIS DIAGNOSED AND
EVALUATED ?
To diagnose osteoporosis and assess your risk of
fracture and determine your need for treatment,
your doctor will most likely order a bone density
scan.
This exam is used to measure bone mineral density
(BMD). It is most commonly performed using dual-
energy x-ray absorptiometry (DXA or DEXA) or
bone densitometry. The amount of x-rays absorbed
by tissues and bone is measured by the DXA
machine and correlates with bone mineral density.
The following procedures can be performed to
determine bone fractures due to osteoporosis:

1. Bone x-ray: Bone x-ray produces images of bones within

the body, including the hand, wrist, arm, elbow,
shoulder, foot, ankle, leg (shin), knee, thigh, hip, pelvis
or spine. It aids in the diagnosis of fractured bones,
which are sometimes a result of osteoporosis.
2. CT scan of the spine: CT scanning of the spine is
performed to assess for alignment and fractures. It can
be used to measure bone density and determine
whether vertebral fractures are likely to occur.
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3. MRI of the spine: Magnetic resonance imaging of the
spine is performed to evaluate vertebral fractures for
evidence of underlying disease, such as cancer, and to
assess if the fracture is old or new. New fractures
usually demonstrate a better response to treatment by
vertebroplasty and kyphoplasty

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 C OMPLICATIONS OF OSTEOPOROSIS
In addition to making you more susceptible to
breaks and fractures, osteoporosis can lead to other
complications:

● L IMITED MOBILITY

Osteoporosis can be disabling and limit

your physical activity. A loss of activity can cause
you to gain weight. It can also increase stress on
your bones, in particular your knees and hips.
Gaining weight can also increase your risk of other
problems, such as heart disease and diabetes.

● D EPRESSION

Less physical activity can lead to a loss of

independence and isolation. Activities you once
enjoyed may be too painful now. This loss, added to
the possible fear of fractures, can bring
on depression. A poor emotional state can further
hinder your ability to manage health issues. A
positive, forward-thinking outlook is helpful when
approaching any medical issue.

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● P AIN

Fractures caused by osteoporosis can be severely

painful and debilitating. Fractures of the spine can
result in:
1. a loss of height
2. a stooping posture
3. persistent back and neck pain
● H OSPITAL ADMISSION

Some people with osteoporosis can break a bone

and not notice it. However, most broken bones need
hospital care. Surgery is often needed for this
procedure, which may require an extended hospital
stay and additional medical costs.

● N URSING HOME CARE

Many times, a hip fracture will require long-term

care in a nursing home. If a person is bedridden
while receiving long-term care, there’s a higher
likelihood, they may experience:
1. cardiovascular complications
2. more exposure to infectious diseases
3. an increased susceptibility to various other
complications

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 PREVENTION
● G ET THE R IGHT A MOUNT OF C ALCIUM

When it comes to calcium, more is not always

better. You should strive to hit the daily intake
recommendation:

1,000 mg for women 50 and younger

1,200 MG FOR WOMEN 51 AND OLDER

● D ON ’ T F ORGET V ITAMIN D
Vitamin D helps your body absorb calcium and use
it to strengthen your bones. When your skin is
exposed to sunlight, your liver and kidneys are
responsible for making vitamin D
Your goal should be:

600 international units (IU) of vitamin D per day if

you are 70 or younger
800 IU if you are 71 or older

● Children and adolescents should:

Ensure a nutritious diet with adequate calcium

intake .
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 Avoid protein malnutrition and under-nutrition.
Maintain an adequate supply of vitamin D.
Participate in regular physical activity.
Avoid the effects of second-hand smoking.

● A DULTS SHOULD :
Ensure a nutritious diet and adequate calcium
intake

Avoid under-nutrition, particularly the effects of

severe weight-loss diets and eating disorders
Maintain an adequate supply of vitamin D
Participate in regular weight-bearing activity

Avoid smoking and heavy drinking

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 Treatment
Treating osteoporosis involves treating and preventing
fractures, and using medicines to strengthen bones
M EDICINES FOR OSTEOPOROSIS
A number of different medicines are used to treat
osteoporosis (and sometimes osteopenia).
 B ISPHOSPHONATES
Bisphosphonates slow the rate that bone is broken
down in your body. This maintains bone density
and reduces your risk of a broken bone.
There are a number of different bisphosphonates,
including:
 alendronic acid
 ibandronic acid
 risedronic acid
 zoledronic acid
They're given as a tablet or injection.
Always take bisphosphonates on an empty stomach
with a full glass of water. Stand or sit upright for
30 minutes after taking them. You'll also need to
wait between 30 minutes and 2 hours before eating
food or drinking any other fluids.

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 Bisphosphonates usually take 6 to 12 months to
work and you may need to take them for 5 years
or longer.
The main side effects associated with
bisphosphonates include:
 irritation to the food pipe
 swallowing problems
 stomach pain

 Selective oestrogen receptor modulators

(SERMs)
SERMs are medicines that have a similar effect on
bone as the hormone oestrogen. They help to
maintain bone density and reduce the risk of
fracture, particularly of the spine.
Raloxifene is the only type of SERM available for
treating osteoporosis. It's taken as a daily tablet.
Side effects associated with raloxifene include:
 hot flushes
 leg cramps
 a potential increased risk of blood clots

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  P ARATHYROID HORMONE
Parathyroid hormone is produced naturally in the
body. It regulates the amount of calcium in bone.
Parathyroid hormone treatments (such as
teriparatide) are used to stimulate cells that create
new bone. They're given by injection.
 Calcium and vitamin D supplements
Calcium is the main mineral found in bone, and
having enough calcium as part of a healthy,
balanced diet is important for maintaining healthy
bones.

Vitamin helps the body absorb calcium. All

adults should have 10 micrograms of vitamin D a
day.

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 HRT (hormone replacement
therapy)

HRT is sometimes taken by women who are going

through the menopause, as it can help control
symptoms.

HRT has also been shown to keep bones strong and

reduce the risk of breaking a bone during
treatment.

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 CASE STUDY-1

 Name of the Patient - Mrs. MEENA DIXIT

 Age- 65 years
 Sex- Female
 Name of Doctor- Dr. D.K. Gupta
 Symptoms
1. Pain in Right Knee
2. Swelling in Rt. Knee
 Investigations
1. Calcium: 8.0 mg/ (borderline)
2. Vita D-3: 10.9ng/ml (Low)
3. BMD 748 g/cm3 (Low)
4. X-ray of RT knee joint Shows
Osteoporotic changes
 Diagnosis
Arthritis of RT Knee

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 Treatment-
 Medications
Ultracet tab.
D. rise sachet
Tab celol

 Physiotherapy
Oxalgin gel locally
 Slow walking
 Knee Exercises
 Quadriceps exercises
 Freeze Precautions Advised Avoid brisk walking
 Use Western toilet
 Exposure to sun advised
 Intake of calcium rich diet.
 Flexion knee brace to be used.

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 CASE STUDY - 2

 Name of the Patient : Mrs. Manju mishra

 Age-65
 Sex- female
 Name of Doctor -Dr. Sameer Gupta
 Symptoms-
 History of fall
 Swelling and extreme pain of left
 Wrist joint.
 Investigations-
 Calcium: 7.8 mg/(low) (low)
 Vit D-3: 9.3.ng/ml (Low)
 BMD: 922 g/cm3 (Normal)
 X-ray of RT wrist joint - Colles
 Diagnosis -
Fracture Colles fracture with osteoporosis

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 Treatment-
 Plaster for 6 weeks with
use of sling
 Medications
 Diclofenac tab.
 Shelcal tab.
 60 k. tab.

 Physiotherapy -
 After removal of plaster

 Precautions Advised-
 Movement of fingers even on plaster.
 Avoid heavy weight by hand

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 CASE STUDY - 3

 Name of the Patient -Mr. Arun Sharma

 Age- 58
 Sex -Male
 Name of Doctor -Dr. Lahariya
 Symptoms-
 Pain in neck
 Dizziness, Giddiness
 Investigations-
 Calcium: 7.5 mg/ (low)
 ii) Vit D-3: 5.9ng/ml (Very Low)
 iii) BMD 698 g/cm (Low)

 Diagnosis- Cervical Spondylosis

 Treatment-
 Medications
 Crocin tab.
 Maxical tab
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  Sunde Sachet
 Myelin OD
 Physiotherapy-
 :Neck exercises
 Precautions Advised-
 use thin pillow while sleeping.
 Hard bed to be used.
 Neck exercises.
 Wear cervical collar during day.

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 CASE STUDY- 4

 Name of the Patient- Mrs. Rani Qureshi

 Age-62 years
 Sex-Female
 Name of Doctor-Dr D.K. Gupta
 Symptoms
 Severe backache radiating to both arms and legs.
 Investigation
 Calcium: 8.7 mg/ (normal)
 Vit D 3: 25.8ng/ml (Low)
 BMD 828 ng/ml (Low)
 X-ray of spine
Degenerative changes in L3- L4 spine
 Diagnosis- Slipped Disc

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 Treatment Medications
 Tramadol tab.
 Celol D-3 tab.
 Bed rest during acute pain
 Physiotherapy
In acute pain no exercise
After the pain is recovered the
Patient can do exercises
1. Hamstring stretch
2. Knee to chest stretch
3. Back extension exercise
 Precautions Advised
 During acute back ache no exercise is allowed. Only
bedrest.
 Avoid bending, lifting and prolonged sitting during
acute pain

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