OSTEOPOROSIS

UNIVERSITY OF HEALTH SCIENCES

FACULTY OF MEDICINE
IM BUNTHOEUN
2016
 OBJECTIVES

• Review the physiology of bone

• Define osteoporosis

• Describe the etiology of osteoporosis

• Explain the pathophysiology of osteoporosis

• Describe clinical manifestations of osteoporosis

 DEFINITION

- Osteoporosis is defined as low bone mass. The bone is

normal in composition but reduced in amount.

- A slow loss of mineral from bone is a normal part of the

aging process

- Bone strength is influenced by bone density and bone

quality .
 ETIOLOGY

• Gonadal sex steroid deficiency

• Certain other medications:

- Corticosteroids
- Thyroid hormone,
- Anticonvulsant,
- Chronic heparin therapy ,
- Immobilization, alcohol abuse, and smoking
Bone mass in women
 ETIOLOGY

PRIMARY OSTEOPOROSIS DRUG INDUCED

Aging Corticosteroids
Juvenile Alcohol
Idiopathic (young adults) Thyroid hormone
Chronic heparin
CONNECTIVE TISSUE DISEASES Anticonvulsant
Osteogenesis imperfecta
Homocystinuria ENDOCRINE
Marfan syndrome Hypogonadism
Hypercortisolism
HEMATOLOGIC Hyperthyroidism
Multiple myeloma Hyperparathyroidism
IMMOBILIZATION
 PATHOGENESIS

• Bone remodeling:
- Resorption of bone by osteoclasts and
- New deposition of bone by osteoblasts
• Post menopausal osteoporosis:
- Accelerated bone resorption, and decreased bone
formation
- 5-20% of spinal trabecular bone mineral is lost yearly
- After 5- 15 years, decrease of the rate of bone loss
 PATHOGENESIS

- Increase of the expression of receptor activator of

nuclear factor kappa-B ligand (RANK-L) and

- Decrease of the expression of osteoprotegerin (OPG)

 Imbalance of Lay down bone matrix
remodeling cycle Bone formation
by osteoblasts

Bone resorption Slower remineralization phase

Break down bone New sites for

matrix

Bone turnover Slow mineralization

> bone formation phase Asymptomatic

Disturbance of More bone in a Bone mass

bone structure weakened state

Irreversible Risk of fragility Osteoporosis

weakening of bone fractures
Primary
Secondary
 PATHOGENESIS

• The pathogenesis of age related bone loss

- Low turnover states: decreased osteoblastic activity
- High turnover states: resemble accelerated phase of
postmenopausal bone loss.
- Deficiency of calcium and1,25 (OH)2 D
 Aged related bone loss

Dietary calcium Vit D synthesis

Calcium absorption

Plasma calcium PTH secretion Estrogen deficiency

Bone formation Bone turnover and resorption

Bone loss
 PATHOGENESIS

• In secondary osteoporosis associated with:

- Glucocorticoid administration, or alcoholism: a marked
reduction in bone formation

- Immobilization with marked uncoupling of bone

resorption and bone formation
 CLINICAL MANIFESTATIONS

• Asymptomatic
• Fractures: the spine, the hip, and the wrist
• Deformity
- Height loss of spine
- Kyphosis

• The complication: hip fracture

• Risk factors for fracture: bone density, bone quality,
and falls
CLINICAL MANIFESTATIONS
 CLINICAL MANIFESTATIONS

• The diagnosis:
- X ray
- Dual energy X ray absorptiometry :quantitative
measurement of bone density
 REFERENCES

• S Silbernagl Florian LANG (2000), Atlas de poche de

physiopathology.
• Stephen J. McPhee et al (2014), Pathophysiology of
disease: an introduction to clinical medicine
• Thomas J. Nowak, et al, 2014. Essentials of
Pathophysiology. Concepts of Altered Health States