Osteoporosis

Dr. Faik AltıntaşYeditepe Üniversitesi Tıp Fakültesi

Ortopedi ve Travmatoloji AD

OsteoporosisS.E. 84 y o femaleRight hip pain after minor trauma in

householdCould not walk after the fall and had agony6 hours after fall, administrated to the

hospital

Osteoporosis

Osteoporosis

OsteoporosisOsteoporosis is a disease of

bone that leads to an increased risk of fracture

In osteoporosis The bone mineral density

(BMD) is reducedBone microarchitecture is

disruptedThe amount and variety of

non-collagenous proteins in bone is altered

OsteoporosisPrimary Osteoporosis

More than 95% of osteoporosis in women Most cases occur in postmenopausal womenPostmenopausal, involutional, senile, and age-

related osteoporosis are synonimsCause of osteoporosis is a lack of estrogenEstrogen deficiency increases bone breakdown and

results in rapid bone lossBone loss is even greater if calcium intake or vitamin

D levels are low. Low vitamin D levels result in calcium deficiency and increased activity of the parathyroid glands (secreting parathyroid hormone), which can also stimulate bone breakdown

Bone production also decreases

OsteoporosisSecondary Osteoporosis

Chronic kidney failureHormonal disorders (especially

Cushing's disease, hyperparathyroidism, hyperthyroidism, hypogonadism, and diabetes mellitus)

Drugs (corticosteroids, barbiturates, and anticonvulsants)

OsteoporosisBreaks usually occur in the hip, spine and wristHip and spine fractures are a major

concernHip fractures almost always require

surgery and hospitalizationSpine fractures have serious

consequences such as loss of height, severe back pain, and deformity

Osteoporosis

When you are young your body makes new bone faster than it breaks down old bones

As you get older, this process slows down and you start losing bone density

The risk for osteoporosis depends on how much bone mass you attained to age 30 and how fast you lose it

As part of the aging process, bones begin to break down faster than they are formed.

Accelerates after menopause. Estrogen is the hormone that protects against bone loss

Osteoporosis

Certain people are more likely to develop this disease than others

FemaleThin and/or small frameAdvanced ageFamily history of osteoporosisPost menopause

OsteoporosisAnorexia nervosa or bulimiaDiet low in calciumUse of certain medicationsLow testosterone levels in menAn inactive lifestyleCigarette smokingExcessive use of alcohol, coffeeBeing Asian or Caucasian

Osteoporosis Symptoms

At first, osteoporosis causes no symptoms because bone density loss occurs very gradually

Some people never develop symptoms.Eventually bone density may decrease enough for

bones to collapse or fractureSevere sudden pain or gradually developing aching

bone pain and deformitiesVertebral crush fractures ,the weakened vertebrae

may collapse spontaneously or after a slight injuryChronic back pain , an abnormal curvature of the

spine (a “dowager‘s hump”)

OsteoporosisDiagnosis

Suspect osteoporosis in the following peopleAll women age 65 or olderWomen aged 50 to 65 who have risk factors for osteoporosisAll men and women who have had a previous osteoporotic fracture (a

fracture caused by little or no force), even if the fracture occurred at a young age

Adults age 65 or older who have unexplained back painPeople whose bones appear thin on x-rays

Bone density testing , the dual-energy x-ray absorptiometry (DEXA), which measures bone density at the sites at which major fractures are likely to occur: the spine and hip.

Blood tests may be performed to measure calcium and vitamin D levels Further testing may be needed to rule out treatable conditions for secondary

osteoporosis

OsteoporosisDual energy X-ray absorptiometry (DXA,

formerly DEXA)Gold standard for the diagnosis of osteoporosis Osteoporosis is diagnosed when the bone mineral

density is less than or equal to 2.5 standard deviations below that of a young adult reference population. This is translated as a T-score

T-score -1.0 or greater is "normal" T-score between -1.0 and -2.5 is "osteopenia"T-score -2.5 or below is “osteoporosis “

OsteoporosisPreventation

Building strong bones in childhood and adolescence is the best defense

A balanced diet rich in calcium and Vitamin D

Weight bearing exerciseA healthy lifestyle with no smoking or

excessive alcohol or coffee intakeBone density testing and medication

when appropriate.

OsteoporosisTreatment Adequate intake of calcium (after fifty years of age 1,200 mg/day)Vitamin D (after fifty years of age 800IU/day)Weight-bearing exercisesDrugs

Bisphosphonates Alendronate Risedronate IbandronateZoledronic acid

CalcitoninSelective estrogen receptor modulator (SERM)

RaloxifeneParathyroid hormone

Teriparatide