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
 Bone and its component
 Bone Homeostasis
 Bone remodeling
 Definition and classification ofosteoporosis
 Prevalence
 Risk Factors and presentation
 Diagnosis
 Consequences
 Management principle
 Treatment goal

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

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

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

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 ofbone 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 BoneRemodeling.

 Itis the body’s way of maintaining bone homeostasis.

 5 Stages:
 Initiation,
 Resorption,
 Reversal,
 Bone formation and
 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 bonematrix.

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

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

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 SystemicDisorder

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

Losing bone withyears
“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 arewomen.

 Affects 75 million persons in the US, Europe andJapan.

 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 brokenbones
 Being small andthin
 History of brokenbones
 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 Dintake
• 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 abone.
 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 measurebone
density in various sites of thebody.

 BMD test is done to diagnose and predict fracture risk

and to monitortherapy.

 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 clinicalsituations.

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

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

• “Gold-standard” for BMDmeasurement.

• Measures “central” or “axial”skeletal sites: spine and
hip.
• May measure other sites: total body andforearm.
• 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 complicationof
Osteoporosis that leadsto

 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/stoppin

g bone loss

• Minimizing factors Maintaining or increasing

that Contribute to bone density and strength
fall
Maintaining or improving
bone microarchitecture

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

 Supplements
 such as which maintain bone massCalcium, Vitamin D

 Anti-resorptive agents
 which inhibit bone resorption 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 bonedensity
 Prevent further fractures
 Relieve deformity (e.g., kyphoplasty)
 Relieve pain
 Increase level of physicalfunctioning
 Increase quality of life

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