Osteoporosis

Prevention
Prof. Mohamed Hasan Husein
What is disease prevention?

Is a branch of medicine

Focuses on the prevention of disease

In individuals and communities

 Types of Chronic disease
prevention
• Primordial: Prevention of risk factors
• Primary: Early detection and prompt
treatment

• Secondary: Early treatment to prevent

complications and permanent pathological
damage

• Tertiary: Rehabilitation
 Osteoporosis
Definition
Osteoporosis or "porous bone"
Is a disease of the skeletal system
Characterized by:
• Low bone mass
• Deterioration of bone tissue.
• Increase risk of bone fractures typically in
the wrist, hip, and spine.
 Osteoporosis Epidemiology
• 1 in 3 women and 1 in 12 men over the age of 50
worldwide have osteoporosis.
• It is responsible for millions of fractures annually,
mostly involving the lumbar vertebrae, hip, and
wrist.
• Fragility fractures of ribs are also common in men.

• Osteoporosis is a major public health threat in

USA it afflicts 55% of Americans aged 50 and
above.
• Of these, approximately 80% are women.
 Risk of osteoporosis development
In Spite of:
• Both Sexes
• All Ages
• Every Ethnic group
Can develop osteoporosis.

Yet some are at more risk than others.

 Osteoporosis Risk Factors

Risk Factors can be classified as follows:

1. Non-modifiable
2. Potentially modifiable
3. Specific diseases and disorders
4. Medications
 Non-modifiable Risk Factors
1. Advanced age
2. Female sex
3. Estrogen deficiency following menopose
(Causes rapid reduction of bone miniral density)
4. Decrease in testosterone levels has a less
pronounced effect than estrogen
5. European and Asian ethnic origin
6. Family history of osteoporosis or fracture
7. Heritability and genitics (at least 30 genes
associated with osteoporosis development)
8. Previous fracture
 Modifiable Risk Factors
1. Calcium deficiency
2. Vitamin D deficinecy
3. Increased Parathyroid hormone
4. Malnutrition
5. Under weight
6. Inactivity
7. Excess physical activity
8. Heavey metales (eg Cadmium)
9. Smoking
10.Soft drinks, Caffien, and excess Alcohol
 Diseases and disorders as
Risk Factors
1. Imobilization disorders (eg fracture, space flight)
2. Hpergonadal states (eg Anorexia nervousa)
3. Premature ovarian failer
4. Endocrine disorders that can induce bone loss
(eg Cushing’s syndrome) Inactivity
5. Conditions of malabsorption
6. Hematologic disorders (eg sickle cell disease)
7. Several inherited disorders (eg osteogeniss
imperfecta)
8. Patients with rheumatologic disorders
9. Renal insuffeciency
10. Severe liver diseases
 Medications as Risk Factors

1. Steroids and Glucocorticoids

2. Barbiturates and Antiepileptics
3. L-Thyroxin overreplacement
4. Hypogonadism inducing drugs
5. Anticoagulants
6. Thiazolidines used for diabetes
7. Chronic Lithium therapy
Primordial Osteoporosis prevention

Prevent modifiable risk factors specially:

1. Calcium deficiency avoidance

2. Weight-Bearing physical activities

 Calcium needs by AGE
Amount mg/day Ages
210 Birth–6 months
270 months–1 year 6
500 3–1
800 8–4
1300 13–9
1300 18–14
1000 30–19
1000 50–31
1200 70–51
1200 or older 70
Source: Dietary Reference Intakes for Calcium, National Academy of Sciences, 1997
Recommended daily Calcium intake
among pregnant women

Amount mg/day Ages

1300 18–14
1000 50–19
 Good sources of calcium
• Dairy products—low fat or nonfat milk,
cheese, and yogurt
• Dark green leafy vegetables—bok choy
and broccoli
• Calcium fortified foods—orange juice,
cereal, bread, soy beverages, and tofu
products
• Nuts—almonds

Vitamin D helps in the absorption

of calcium
Weight-Bearing Physical Activity

• Walking, Jogging, or running

• Tennis or Racquetball
• Stair climbing
• Jumping rope
• Basketball
• Soccer
• Weight lifting
• Dancing
Weight-Bearing Physical Activity

• Adults: spend 30 minutes of moderate

physical activity on most days of the week

• Childen: spend 60 minutes of moderate

physical activity on most days of the week
 Primary Prevention

Screening for Early Case finding

AND

Immediate treatment
 How to screen?
• Dual energy X-ray absorpitometry (DXA).
• Bone miniral density less than 2.5 standard
deviation below that of a young reference
population is diagnostic of osteoporosis.
WHO Definitions:
T-score is the number of standard deviation for a
density below the mean of reference population
• T-score -1.0 or greater is "normal"
• T-score between -1.0 and -2.5 is "low bone
mass" (or “osteopenia")
• T-score -2.5 or below is osteoporosis
 Who is to screen?
• All women 65 years of age or older

• Women at 60 to 64 years of age who are

at increased risk.

• Highe risk person with lower body weight

(weight < 70 kg), with less evidence for
smoking or family history of low weight.
 Secondary prevention
• Medication

• Diet Calcium and Vitamin D

• Exercise
 Tertiary prevention
Prevention of these complications
Hip fracture complicated by:
• Deep venous thrombosis, pulmonary embolism or
pneumonia.
• Need total assistance to mobilize
• The 6-month mortality rate following is approximately
13.5%.

Vertebral fractures complicated by:

• Can lead to severe chronic pain of neurogenic origin
• Deformity.
• Multiple vertebral fractures can lead to such severe hunch
back (Kyphosis) causes pressure on internal organs and
can impair one's ability to breathe.

• Reduction of health related Quality of life