Beat the Break:

Menopause, Osteoporosis & Fracture

BICC|27th July, 2010

Osteoporosis: Challenges,
Osteoporosis:
When & How to
Challenges to meet
Treat

Prof. Muhammad Shahiduzzaman

Prof & Head,

Department of Orthopaedics and Traumatology
Dhaka Medical College Hospital

DRAFT Aclasta Brand Book

 Bone Homeostasis & Bone remodeling

 Prevalence, Risk factor and presentation

of osteoporosis.

 Management principal &Treatment goal

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Organic Component:
 protein collagen & specialized
cells called osteoblasts,
osteoclasts, and osteocytes

 Inorganic component:
 Mainly as calcium phosphate,
in the form of Hydroxyapatite

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Bone Homeostasis:
 the situation when the body
requires and achieves an equal
amount of bone resorption and
Homeostasis
bone formation

 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
Osteoporosis: Challenges to meet| BICC | 27th July, 2010
 The combined processes of breaking down bone and
building new bone are called Bone Remodeling.

 It is the body’s way of maintaining bone homeostasis.

 5 Stages:
 Initiation,
 Resorption,
 Reversal,
 Bone formation
 Completion of remodeling.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Osteoclast precursor cells are attracted to a bone site and
penetrate the bone lining cells. These osteoclast precursor cells
then form activated osteoclasts that align themselves in direct
contact with mineralized bone matrix.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

The osteoclasts erode a cavity by removing mineral and organic
components from the bone. The osteoclasts eventually die. This
completes the resorption phase.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Cells of unknown origin prepare the bone surface for new bone
formation by smoothing the surface of the cavity and
depositing a thin layer of a cement-like substance.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Osteoblasts appear at the site of resorption and begin to
replace bone by synthesizing new bone matrix (osteoid). The
bone matrix is then mineralized, primarily with calcium and
phosphorus

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

The lining cells rest on the bone surface until the next cycle of
bone remodeling begins.

Some osteoblasts become osteocytes.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Osteoporosis: Challenges to meet| BICC | 27th July, 2010
Challenges of Osteoporosis

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

National Osteoporosis Foundation:
 a disease characterized by low bone
mass an micro-architectural
deterioration of bone tissue, leading
to bone fragility and an increased
susceptibility to fractures.”

World Health Organization (1994) :

 bone mineral density T-score greater
than –2.5 standard deviations from
the mean peak adult bone mass (ie. a
woman in her 30’s).”

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Primary osteoporosis
• Juvenile osteoporosis.
• Idiopathic osteoporosis
• Postmenopausal
osteoporosis
• Age-related, or senile,
osteoporosis
• Secondary osteoporosis
• Congenital
• Diet
• Drugs
• Endocrine disorder
• Other Systemic Disorder

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Losing bone with years
Osteoporosis, “the silent thief of your bone”

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

Worldwide, over age of 50
 1 in 3 women / 1 in 8 men have osteoporosis.

 80 % of those suffering from osteoporosis are women.

 Affects 75 million persons in the US, Europe and Japan.

 Over 50% of women aged 50 years or older and 20% of men

will suffer an osteoporosis-related fracture within their
remaining lifetime

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Being female
 Older age
 Family history of osteoporosis or broken bones
 History of broken bones
 Low sex hormones
• Low estrogen levels in women, including menopause
• Missing periods (amenorrhea)
• Low levels of testosterone and estrogen in men

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Diet
• Low calcium intake
• Low vitamin D intake
• Excessive intake of protein,
sodium and caffeine
 Inactive lifestyle
 Smoking , Alcohol abuse
 Certain medications
• steroid , anticonvulsants etc
 Certain diseases
• anorexia nervosa, rheumatoid
arthritis, gastrointestinal diseases
and others

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 People may not know that they have
osteoporosis until they break a bone.
 Vertebral (spinal) fractures may
initially be felt or seen in the form of
 Persistent, unexplained back pain
 Loss of height
 Spinal deformities such as
kyphosis or stooped posture.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Bone mineral density (BMD) tests can measure bone
density in various sites of the body.

 BMD test is done to diagnose and predict fracture risk

and to monitor therapy.

 For patients on pharmacotherapy, it is typically performed

2 years after initiating therapy and every 2 years
thereafter; however, more frequent testing may be
warranted in certain clinical situations.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Dual-energy X-ray Absorptiometry (DXA) Scan

• “Gold-standard” for BMD measurement.

• Measures “central” or “axial” skeletal sites: spine and
hip.
• May measure other sites: total body and forearm.
• Validated in many clinical trials.
• Available in Bangladesh.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Dual-energy X-ray Absorptiometry (DXA) Scan
Classification T-score
Normal -1 or greater
Osteopenia Between -1 and -2.5
Osteoporosis -2.5 or less
-2.5 or less
Severe Osteoporosis
and fragility fracture

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 FRACTURE ,
The most serious complication of
Osteoporosis that leads to

 Increased morbidity
 Increased mortality
 Decreased quality of life

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Wrist fracture
men 1 in 40 (2.5%)
women 1 in 6 (16%)

Spinal fracture
men 1 in 20 (5%)
women 1 in 6 (16%)

Hip fracture
men 1 in 17 (6%)
women 1 in 6 (17.5%)

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Decreased fracture risk

Life style modification Therapeutic Intervention

Minimizing risk factors Slowing/stopping

Minimizing factors that
Contribute to fall
bone loss
Maintaining or increasing
bone density and strength
Maintaining or improving
bone micro-architecture

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Supplements
such as which maintain bone mass Calcium, Vitamin D

 Anti-resorptive agents
which inhibit bone resorption eg. Bisphosphonates

 Anabolic agents,
which stimulate bone formation and, in turn, increase
bone mass.

Osteoporosis: Challenges to meet| BICC | 27th July, 2010

 Prevent further bone loss
 Increase or at least stabilize bone density.
 Relieve pain and prevent fracture.
 Increase level of physical functioning, thus

Osteoporosis: Challenges to meet| BICC | 27th July, 2010