Osteoporosis

Definition• Osteoporosis is a condition

characterized by a decrease in the density of bone, decreasing its strength and resulting in fragile bones.

• Osteoporosis literally leads to abnormally porous bone that is compressible, like a sponge.

• This disorder of the skeleton weakens the bone and results in frequent fractures (breaks) in the bones

2Osteoporosis

Definition• Osteoporosis is defined as a

progressive skeletal disorder, characterised by low bone mass & microarchitectural deterioration of bone tissue, leading to a consequent increase in bone fragility, & susceptibility to fracture

3Osteoporosis

Definition

• Fractures of the wrist, spine, and hip are most commonly involved.

• Fractures of the ribs, humerus and pelvis are not uncommon.

4Osteoporosis

DefinitionTwo categories of osteoporosis exist: primary

and secondary osteoporosis.Primary Osteoporosis• The most common form of osteoporosis.• Includes postmenopausal osteoporosis

(type 1) and age-associated osteoporosis (type 2), formerly termed senile osteoporosis.

5Osteoporosis

DefinitionSecondary Osteoporosis• Loss of bone is caused by an identifiable agent or

disease process such as an inflammatory disorder, bone marrow cellularity disorder, and corticosteroid use.

• steroids decrease the amount of calcium absorbed by the intestine

• steroids increase calcium excretion through the kidneys

6Osteoporosis

Risk FactorsNational Osteoporosis Foundation Physician Guidelines for Risk Factors for Osteoporotic Fracture• Current cigarette smoking• Low body weight « 127 pounds)• Alcoholism – depress osteoblast function• Estrogen deficiency• Prolonged amenorrhea (> 1 yr)• Early menopause «45 yr) • Lifelong low calcium intake• Recurrent falls• Poor health/fragility• Inadequate physical activity 7Osteoporosis

Risk Factors

• In men, excessive drinking reduces testrosterone. Since testrosterone is necessary for the work of osteoblasts, it means that less bone is formed.

• In women, excessive drinking can interfere with their menstrual cycle. Irregular periods lead to bone loss

8Osteoporosis

Risk Factors• Long term use of high dose corticosteroid tablets

for conditions such as RA & asthma – interfere with the lifespan of the osteogenic cells

• Close family history of osteoporosis• Medical conditions such thyroid problems• Hyperthyroidism occurs when the thyroid gland

becomes overactive, & the excess of thyroxine –causes the rate of remodelling & loss of BMD to increase

9Osteoporosis

Risk Factors

• Malabsorption problems ( coelic disease, crohn’s disease, intestinal diseases or gastric surgery - affects the persons ability to absorb the essential vitamins & minerals from food

• Eating disorders such as anorexia nervosa, bulimia –malnourished in calcium – lead to decline in body function & production of hormones – estrogen –causing menstruation to cease

10Osteoporosis

Symptoms & Clinical Features

• Osteoporosis can be present without any symptoms for decades because osteoporosis doesn't cause symptoms until bone fractures.

• Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture.

• The symptom associated with osteoporotic fractures usually is pain; the location of the pain depends on the location of the fracture

11Osteoporosis

Symptoms & Clinical Features

• Fractures of the spine (vertebra) can cause severe "band-like" pain that radiates from the back to the sides of the body.

• Over the years, repeated spinal fractures can lead to chronic lower back pain as well as loss of height or curving of the spine due to collapse of the vertebrae.

• The collapse gives individuals a hunched-back appearance of the upper back, often called a "dowager hump" because it commonly is seen in elderly women

12Osteoporosis

Symptoms & Clinical Features

• A fracture that occurs during the course of normal activity is called a minimal trauma or stress fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.

• Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of accidents.

• Hip fractures also may heal slowly or poorly after surgical repair because of poor healing of the bone.

13Osteoporosis

Osteoporosis: The Diagnosis

X-Ray Tests• If you have back pain, your doctor may order an

x ray of your spine to determine whether you have had a fracture.

• An x ray also may be appropriate if you have experienced a loss of height or a change in posture.

• However, because an x ray can detect bone loss only after 30 percent of the skeleton has been depleted, the presence of osteoporosis may be missed

14Osteoporosis

Osteoporosis: The Diagnosis

BMD test is called a dual-energy x-ray absorptiometry, or DXA test.

• BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density.

• When a T-score appears as a negative number (such as –1, –2 or –2.5), it indicates low bone mass. The greater the negative the number, the greater is the risk of fracture.

15Osteoporosis

Osteoporosis: The Diagnosis

Bone Scans• For some people, the doctor may order a bone scan. • A bone scan is different from the BMD test, although

the term "bone scan" often is used incorrectly to describe a bone density test.

• A bone scan involves injecting the patient with a dye that allows a scanner to identify differences in the conditions of various areas of bone tissue. A bone scan can show the doctor changes in bone tissue that may indicate cancer, bone lesions, inflammation, or new fractures

16Osteoporosis

Osteoporosis: The Diagnosis

The most common blood tests evaluate:

• blood calcium levels

• blood vitamin D levels

• thyroid function

• parathyroid hormone levels

• To measure estrogen (in women)

• testosterone levels (in men)

17Osteoporosis

Preventive Measures

• Adequate weight-bearing physical activity for 3-4 hr a wk.

• Avoid low body weight or excessive thinness.

• Avoid excess alcohol intake.

• Lifelong appropriate calcium and vitamin D intake.

18Osteoporosis

Preventive Measures

19Osteoporosis

Adequate calcium intake guidelines

Life stage group Estimated adequate calcium intake

Infants –( 6 month)

(6 – 12 Month)

210

270

Young children (1-3yr) 500

Older Children (4-8yr) 1800

Adolescents & young adults (9-18yr)

1300

Men & women(19-50yr), above 51yr

1000

120020Osteoporosis

Prevention of falls in osteoporotic patients

• Night lights in bathrooms and hallways.

• Nonskid soles for shoes.

• Nonslip mats under rug.

• Equip tub, shower, and toilet areas with grab bars.

• Rise cautiously from a supine position.

• Ensure stairway rails are sturdy.

• Keep a flashlight by the bedside.

21Osteoporosis

Exercise for osteoporosis

Three types of exercise for osteoporosis are:

• Weight-bearing

• Resistance

• Flexibility

22Osteoporosis

Exercise for osteoporosis

• Exercises designed to prevent or treat osteoporosis by strengthening your muscles and bones and improving your posture and balance.

23Osteoporosis