Osteoporosis Powerpoint

8/9/2019 Osteoporosis Powerpoint

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Osteoporosis?


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%re&uency

Appro'imately 10 million peoplehave osteoporosis. Another 1(#1)million have osteopenia *low bone

mass+

Appro'imately 1. million !ractures peryear in the nited -tates are attributed to

osteoporosis, and more than 3,000people die !rom subse&uent !racture#

related complications


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/omen vs. Men

• egin bone loss intheir (0s

• apid loss o! bone

mass !or #10 yearsa!ter menopauseonset

• -maller bone cortices

and diameter !romgrowth phase,especially duringpuberty

• egin bone loss intheir (0s

• one loss remainslinear and slow as

se' steroidproductionprogressivelydeclines

• 2arger bonecortices anddiameter !rom

growth phase


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Other is %actors

• hronic glucocorticoid e'cess• 4yperthyroidism

• 5nappropriately high 64

replacement

• Alcoholism

• $rolonged immobili7ation

• 8astrointestinal disorders

• 4ypercalciuria• Malignancies

• igarette smoing


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Medical onditions Associated with5ncreased is o! Osteoporosis

• O$9

• ushing:s syndrome

• ;ating disorders

• 4yperparathyroidism

• 4ypophosphatasia

• 5-

• A, otherautoimmuneconnective tissuedisorders

• 5nsulin dependentdiabetes

• Multiple sclerosis

• Multiple myeloma

• -troe *


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9rugs Associated witheduced one Mass

• Aluminum

• Anticonvulsants

• ytoto'ic drugs

• 8lucocorticosteroids*oral=high doseinhaled+

• 5mmunosuppresants

• 8onadotropin#releasing hormone*e.g. 2upron+

• 2ithium

• 4eparin *chronic use+• -upraphysiologic

thyro'ine doses

• Aromatase inhibitors

• 9epo#$rovera


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Anatomy 6he -eletal-ystem

• %unctions o! the -eletal-ystem – -upport against gravity

– 2everage !or muscle action #movement

– $rotection o! so!t internal

organs – lood cell production

– -torage # calcium,phosphorous, !at


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6he -eletal -ystem

• 6he seletal system includes> – ones

– artilages – ?oints

– 2igaments

– Other connective tissues


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8eneral -hapes O! ones – 2ong bones *e.g., humerus, !emur+

– -hort bones *e.g., carpals, tarsals, patella – %lat bones *e.g., parietal bone, scapula, sternum+

– 5rregular bones *e.g., vertebrae, hip bones+


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-tructure o! 6ypical 2ong one• 9iaphysis # tubular sha!t !orming

the a'is o! long bones. – omposed o! compact bone

– entral medullary cavity

– ontains bone marrow

• ;piphysis @ e'panded end o! long

bones. – omposed mostly o! spongy bone

– ?oint sur!ace is covered with articular(hyaline) cartilage

– ;piphyseal lines separate thediaphysis !rom the epiphyses

• Metaphysis @ where epiphysis anddiaphysis meet


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one Membranes• $eriosteum

– $rovides anchoring points !ortendons and ligaments

– 9ouble#layered protectivemembrane, supplied withnerve fbers, blood, andlymphatic vessels enteringthe bone via nutrient!oramina.

– 5nner osteogenic layer iscomposed o! osteoblasts andosteoclasts

• ;ndosteum

– 9elicate 6 membranecovering internal sur!aces o!bone

– overs trabeculae o! spongybone

– 2ines canals in compact bone

– Also contains bothosteoblasts and osteoclasts


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ells in one

• Osteoprogenitor cells @ precursors toosteoblasts

• Osteocytes # mature bone cells betweenlamellae

• Osteoclasts # bone#destroying cells, breadown bone matri' !or remodeling and releaseo! calcium – -ource o! acid, en7ymes !or osteolysis

– alcium homeostasis• Osteoblasts # bone#!orming cells

– esponsible !or osteogenesis *new bone+

– -ource o! collagen, calcium salts


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one #emodeling=4omeostasis

• ole o! emodeling in -upport – emodelingontinuous breadown and

re!orming o! bone tissue

– -hapes reBect applied loads

– Mineral turnover enables adapting to newstresses

• /hat you don:t use, you lose. 6he

stresses applied to bones duringe'ercise are essential to maintainingbone strength and bone mass


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one emodeling

• one is active tissue @ small changes in bone

architecture occur continuously @ to C o! bonemass is recycled weely @ spongy bone is replacedevery 3#( years and compact bone appro'imatelyevery 10 years

• emodeling nits @ adDacent osteoblasts andosteoclasts deposit and reabsorb bone at periostealand endosteal sur!aces


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one emodeling

• one 9epostition

– Occurs when bone is inDured or e'tra strength is needed – e&uires a healthy diet # protein, vitamins , 9, and A,

and minerals *calcium, phosphorus, magnesium,manganese, etc.+

• one esorption

– Accomplished by Osteoclasts *multinucleate phagocyticcells+

– esorption involves osteoclast secretion o!>

• 2ysosomal en7ymes that digest organic matri'

• 4l that converts calcium salts into soluble !orms

– 9issolved matri' is endocytosed and transcytosed intothe interstitial Buid E the blood


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$athophysiology

• alance between bone resorptionand !ormation *remodeling+ – emodeling is in balance until about age

0• Osteoclasts resorb bone

• Osteoblasts !orm bone

• ;strogen inhibits osteoclastic boneresorption

• $ea bone mass is established by

age F0 !or the hip and during the:


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$athophysiology

• /omen have increased incidence o!osteoporosis compared to men due to>

– 2ower pea bone mass

– 8reater bone loss a!ter menopause *10Cbone loss+

• Men and non#white women have higherpea bone mass than white women

• 8enetic !actors @ 0#)0C o! pea bonemass is genetically determined

• $regnancy and lactation cause transient

bone loss


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$athophysiology

• one &uality – 9isruption o! microarchitectural

elements o! trabecular bone

– ortical thinning

– 9ecrease in degree o! minerali7ation


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one Mineral 9ensity 6esting

So Who Do We Test?

• $ostmenopausal women older than G years

• $ostmenopausal women younger than G years whohave 1 or more ris !actor

• $ostmenopausal women who present with !ragility!ractures

• /omen who are considering therapy in which M9will aHect that decision

• /omen who have been on hormone replacement

therapy *46+ !or prolonged periods• Men who e'perience !ractures a!ter minimal trauma

• $eople with evidence o! osteopenia on radiographs ora disease nown to place them at ris !or osteoporosis


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2ab -tudies

• 2evels o! serum calcium, phosphate,and alaline phosphatase are usuallynormal in persons with primary

osteoporosis, although alalinephosphatase levels may be elevated!or several months a!ter a !racture

• 5t is important to also chec thyroid!unction, and testosterone levels inmen


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M9 5maging

• M9 tests are usually done on bonesthat are liely to brea as a result o!osteoporosis lie the lower spine and

hip• an also be done on the wrist or heel

• 9evices that measure M9 include>

– Iuantitative computed tomography – 9ual#energy '#ray absorptiometry

*9;JA+

– Iuantitative ultrasonography

– adiogrammetry


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Iuantitative omputed 6omography

• Iuantitative computed tomographymeasures M9 as a true volume density ing=cm3, which is not inBuenced by bonesi7e.

• 6his techni&ue can be used !or both adultsand children.

• 9isadvantages in that *1+ it only

determines bone density at the spine, *F+osteophytes can inter!ere withmeasurement, and *3+ it is associated withsignifcant radiation e'posure and highcost


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9;JA

• 9ual#energy '#ray absorptiometry re&uires lessradiation, is less e'pensive, and has betterreproducibility than &uantitative computedtomography

• an also measure bone density at the spine andthe hip. 5t has become the standard method !ordetermining bone density.

• 6his method can be used in both adults andchildren

• on!ounding !actors in 9;JA resultsinterpretation *!alsely high bone density+ includespinal !ractures, osteophytosis, and e'traspinal*eg, vascular+ calcifcation

• $eripheral 9;JA can be used to measure M9 inthe wrist


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Iuantitativeltrasonography

• Iuantitative ultrasonography o! thecalcaneus can be used !or generalscreening

• 4owever, this is not as accurate asother methods and thus is less use!ulin !ollowing response to treatment

• 5ts advantages include low cost,portability, and lac o! ioni7ingradiation


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adiogrammetry

• adiogrammetry, used to measurecortical dimensions, is usuallyper!ormed on the hand, specifcally

the second metacarpal• 5t is use!ul in assessing M9 in

children and is the simplest and leaste'pensive method

• 9isadvantages are that it is not asprecise as 9;JA and, there!ore, isless sensitive !or detecting changes

over time


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/hat Are 6he esultsK

• esults are reported as two values, 6 andL scores

• 6 scores are the number o! standard

deviations above or below what isnormally e'pected in a healthy youngadult o! the same se'

• L score is the number o! standard

deviations above or below what isnormally e'pected !or someone o! thesame age, se', weight, and ethinic origin


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6 -core

• Above #1 indicates the bone densityis normal

• etween #1 and #F. indicates bonedensity is below normal, orosteopenia

• elow #F. indicates osteoporosis


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9;JA 5mages


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M9 -core eport


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L -core

• 6he L score is help !ul because itmay suggest that the patient mayhave a secondary !orm o!

osteoporosis unrelated to normalaging which is causing decreasedM9

• A score less than #1. should maeyou investigate the cause o!decreased M9


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Another eport ard

• %or e'ample, i! the 6#score is #F.0, the M9 islower than average by two standard deviations. 5!the L#score is #0., your bone density is less thanthe norm !or people your age by one#hal! o! a

standard deviation


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I6


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I6

• I6 isolates metabolically activetrabecular bone !or greater anatomicaccuracy than other methods

• A series o! a'ial scans are taen withthe patient lying on a calibrationphantom


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Other 6ests

• As mentioned earlier, ultrasound andradiogrammetry can be used as well

• 6hese are not as accurate indetermining M9 loss but haveadvantages lie less radiation,smaller e&uipment, and they

measure M9 using smaller bones


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6reatment

Universal Recommendations :

• Ade&uate intae o! calcium, vitamin 9

• /eight#bearing and muscle#strengthening e'ercisesto reduce ris o! !alls=!racture

• $rovide strategies !or !all prevention

• Avoidance o! tobacco use=e'cessive alcohol use

• 6al to your provider about bone health

• 4ave a bone density test and tae medication whenappropriate


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Ade&uate 5ntae o! alcium=


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alcium=9 $roduct-election

$roduct *Celemental a+

;lemental

alcium*mg+


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0,000 5 vit9 weely ' G#) wees, thenassess need !or chronic monthly therapy

l / i ht i


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egular /eight#earing;'ercise

• 9efned as those in which bones andmuscles wor against gravity as !eet andlegs bear the body:s weight

• 5nclude waling, Dogging, 6ai#hi, stairclimbing, dancing, tennis, yoga

• 5mprove agility, strength, balance

• May increase bone density modestly,reduce !all ris, enhance muscle strength,improve balance


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Avoidance o! 6obacco and Alcohol

• 6obacco products detrimental toseleton, overall health

• PO% strongly encourages tobaccocessation programs as osteoporosisintervention

• ;'cessive alcohol intae alsodetrimental to bone health andre&uires treatment


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/ho -hould e 6reatedKNOF Recommendations – 2008

• 5nitiate therapy to reduce !ractures inpostmenopausal women=men 0with>

1. M9 6#scores Q #F. at hip or spineF. $rior vertebral or hip !racture

3. 2ow bone mass *6#scores #1.0 to #F. at

hip or spine+ when> – 10#year probability o! hip !racture is 3C – 10#year probability o! maDor osteoporosis#

related !racture is F0C

– ased on -#adapted /4O algorithmwww.nof.org


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%9A#Approved 9rugs !or Osteoporosis

• isphosphonates – Alendronate,

Alendronate plus 9*%osama'R, %osama'$lus 9R+

– isedronate,isedronate withalcium *ActonelR+

– 5bandronate *onivaR+

• -elective ;strogen

eceptor Modulators *-;Ms+ – alo'i!ene *;vistaR+

• alcitonin *MiacalcinR,%orticalR, alcimarR+

• $arathyroid 4ormone

S$64 *1#3(+,teriparatideT – %orteoR

• ;strogen=4ormone

6herapy *;6=46+ – $remarinR, ;straceR,

$remproR


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9a!tar $ustaa

• ==www.webmd.com=osteoporosis=ss=slideshow#osteoporosis#overviewV 9iases ?anuari F01(.

• auer, 9. se o! statins and !racture> results o! (prospective studies and cumulative meta#analysis o!observational studies and controlled trials. Arch 5nternMed. F00( ?an.

• 9empster 9/, et al. J Bone Miner Res. 1W)G>1>1#F1Xeprinted with permission !rom the American -ociety o!one and Mineral esearch.

• AA; 8uidelines !or 9iag and 6reatment o! Osteoporosis #F010
http://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overviewhttp://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overviewhttp://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overviewhttp://www.webmd.com/osteoporosis/ss/slideshow-osteoporosis-overviewhttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnadahttp://www.webmd.com/karriem-norwood-varnada

Osteoporosis Powerpoint

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