OSTEOPOROSIS

Osteoporosis is defined as a skeletal disorder

characterized by compromised bone strength
predisposing to an increased risk of fracture.

Osteoporosis Prevention, Diagnosis, and Therapy.

NIH Consens Statement 2000 March 27-29; 17(1): 1-36.
 BONE STRENGTH

BONE DENSITY + BONE QUALITY

Bone density is expressed as grams of mineral per
area or volume and in any given individual is
determined by peak bone mass and amount of
bone loss.
 PBM

Male
Bone Mass

Menopause

Female

20 40 60 80
Age ( year )
Bone quality refers to architecture, turnover,
damage accumulation (e.g., microfractures) and
mineralization.
 PATHOGENESIS

• Three main mechanism :

- Inadequate Peak Bone Mass/PBM
- Excessive bone resorption
- Inadequate bone formation.
 DIAGNOSIS

• DEXA --- still “GOLD STANDART”

• FRAX
• QUS --- only for “SCREENING PURPOSES”
 FRACTURE

• Is a break in the bones structural integrity due to

force that exceeds its strength.

• Stronger bone ---- greater force

• Osteoporotic bone ---- normal force
( Insufficience Fracture)
 PRINCIPLE IN FRACTURE
TREATMENT

• Pain control.
• Stable fixation that allow early mobilization.
• Avoid / treat complication and other co-morbid.
• Return to the premorbid functional level.
 PROBLEMS

• COST
• MORBIDITY
• MORTALITY
PREVENTIVE BETTER THAN CURATIVE
 PREVENTIVE
According to Woolf A.D (1998)

1. During embriologic life: 3. Adult life

• Adequate Ca. intake
2. Newborn to puberty:
• Adequate nutritional intake.
• Excercise
• Adequate Ca. intake
• Exercise
• Sunlight exposure
4. Premenopausal
• Adequate Ca. intake
• Exercise
• Sunlight exposure
• Medication
ESTABLISH OSTEOPOROSIS

• Reducing Risk Factors

• Exercise
• Adequate Ca. intake
• Medication
• Fall prevention
 RISK FACTORS

• Ones You Can't Change:

 Being a woman
 Getting older
 Being Caucasian or Asian; however, African
American and Hispanic women are also at risk
 Having a family history of Osteoporotic fractures
 RISK FACTORS
• Ones You Can Change:
 Low estrogen levels in women; low testosterone levels in
men
 Anorexia
 Lifetime diet low in calcium and vitamin D
 Use of medications such as steroids or some anticonvulsants
 Inactive lifestyle or prolonged bed rest
 Cigarette smoking
 Excessive use of alcohol
 EXCERCISE

• Physical activity is clearly beneficial, not just

because of its positive influence on bone mass but
also because those who exercise regularly have
improved balance and strength and are less likely
to fall.
 Ca. INTAKE

Age Recommended Intake

1-3 500 mg
4-8 800 mg
9-18 1300 mg
19-50 1000 mg
51 and older 1200 mg
Source: Dietary Reference Intakes for Calcium, Phosphorus, Magnesium, Vitamin D,
and Fluoride. Institute of Medicine, Washington D.C.: National Academy Press, 1997
 MEDICATION
• Vitamin D / D3 / K
• HRT
• Selective Estrogen Receptor Modulator (SERM)
• Calcitonin
• Biphosphonate
• Parathyroid Hormone (PTH)
• Growth Hormone
• Fitofarmaka
 FALL PREVENTION
• General
 Uniform good lighting at all times in all areas
 Ensure that light switches are reached easily, especially from bed
 Eliminate throw rugs and thick carpets; tack down other carpets
 No slippery surfaces, (highly polished, wet, or icy floors)
 Remove all obstacles from walking paths, (electric and telephone cords,
toys, pet dishes, low furniture)
 Ensure that chairs, sofas, beds, and toilet seats are stable and of proper
height to ease standing up and sitting down
 Reduce risk-taking behavior, such as standing on chairs
 Place commonly used items within easy reach
TERIMA KASIH