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8/7/2019 Investigations in Osteoporosis
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INVESTIGATIONS
IN OSTEOPOROSIS
ByDr. Deepti Patil
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INTRODUCTION
Most common in women after menopause.
It is estimated that 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
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DEFINATION
Systemic skeletal disease characterizes by
lowered bone mass and micro architectural
deterioration of bone tissue.
Reduction in Bone Mineral Content and Bone
Mineral Density distrust's micro architecture of
the bone
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ETIOLOGY
Remains asymptomatic for considerable period till
bone loss become advanced.
Estrogen deficiency
Inadequate bone formation
Over consumption of dietary protein
Hyperparathyroidism
deficiency of calcium and vitamin D
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RISK FACTORS
Age :
a. Post-menopause
b. Advance age
c. Low testosterone in
men
d. Decreased calcitonin
Nutrition :
a. Low calcium intake
b. Low vitamin D
c. High phosphate intake
d. Inadequate calories
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SIGNS AND SYMPTOMS
Pain
Tenderness
General debility Weakness (muscular and skeletal)
Abdominal distension
Insomnia
Kyphosis and Scoliosis
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INVESTIGATIONS
X ray
DEXA - (Dual Energy X ray Absorptiometry)
Quantitative computed tomography (QCT) and
Quantitative ultrasound (QUS)
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Conti.
Bone biopsy
Bone markers
a. Formation markers (osteoblastic activity).
b. Resorption markers (osteoclastic activity).
Neutron activation analysis
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X RAY
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Dual Energy X-ray Absorptiometry
A scanner used to measure bone
density.
Indirect indicator of osteoporosisand fracture risk.
Painless and non-
invasive andinvolves minimal radiation
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INDICATIONS
All women aged 65 and older regardless of risk
factors
Younger postmenopausal women with one or
more risk factors.
Postmenopausal women who present with
fractures (to confirm the diagnosis and
determine disease severity). Estrogen deficient women at clinical risk for
osteoporosis.
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Individuals with vertebral abnormalities.
Individuals being monitored to assess the
response or efficacy of an approved
osteoporosis drug therapy.
Individuals with a history of eating disorders
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INTERPRETATION
Results are often reported in 3 terms:
Measured density in g cm-3
z-score, the number of standard deviations above or
below the mean for the patient's age, sex and ethnicity
t-
score, the number of standard deviations above or
below the mean for a healthy 30 year old adult of the
same sex and ethnicity as the patient
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LIMITATIONS
Can be affected by the size of the patient, the
thickness of tissue overlying the bone.
Reference standards for some populations (e.g.,
children) are unavailable for many of the
methods used.
Crushed vertebrae can result in falsely high bone
density so must be excluded from analysis.
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QUANTITATIVE COMPUTED
TOMOGRAPHY (QCT)
commonly abbreviated as pQCT.
A type of quantitative computed tomography
(QCT), used for making measurements of the
bone mineral density (BMD) in a peripheral
part of the body. It is useful for measuring bone strength.
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Quantitative Computed Tomography
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Comparison to DXA
A pQCT scan is able to measure volumetric
bone mineral density, plus other measures
such as the stress-strain index (SSI) and the
geometry of the bone.
DXA is only able to provide the areal bone
mineral density
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QUANTITATIVE ULTRASOUND
(QUS)
The modality is small, no ionizing radiation is
involved, measurements can be made quickly
and easily.
The calcaneus is the most common skeletal
site for quantitative ultrasound assessment.
The method can be applied to children,
neonates, and preterm infants, just as well as
to adults.
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BONE BIOPSY
A bone biopsy is the removal of a
piece of bone or bone marrow for
examination
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Bone
Marrow
Aspiration
Needle
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Position of the patient during procedure4/8/2011 24Investigations in Osteoporosis
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PROCEDURE
By applying a numbing medicine (local
anesthetic) to the area, and make a small
(about 1/8 inch) cut in the skin. A special drill
needle is usually used.
The biopsy needle is pushed and twisted into
the bone.
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Conti
Once the sample is obtained, the needle is
twisted out and the sample is sent for
examination.
Pressure is applied to the site.
Once bleeding stops, the site is cleaned andcovered with a bandage.
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BONE MARKERS
a. Formation markers (osteoblastic activity).
b. Resorption markers (osteoclastic activity).
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Conti
Bone markers are blood and urine tests that helpsto determine the rate of bone resorption and/or
formation is abnormally increased or decreased,
Used to determine a persons risk of bone
fracture and to monitor drug therapy for patients
receiving treatment for skeletal disorders,
including osteoporosis.
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Conti
During bone resorption, cells called osteoclasts
dissolve small amounts of bone, while enzymes
dissolve the protein network.
Bone formation is then initiated by cells called
osteoblasts.
They secrete a variety of compounds that help form
a new protein network, which is then mineralized
with calcium and phosphate to produce new bone.
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FORMATION MARKERS
(osteoblastic activity).
Bone formation blood tests include:
Bone-
specific alkaline phosphatase (ALP)
Osteocalcin (bone gla protein)
P1NP (Procollagen Type 1 N-Terminal
Propeptide)
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RESORPTION MARKERS(osteoclastic activity).
Urine or blood tests for bone resorption include:
C-telopeptide (C-terminal telopeptide of type 1
collagen (CTx))
N-telopeptide (N-terminal telopeptide of type 1
collagen (NTx))
Deoxypyridinoline (DPD)
Pyridinium Crosslinks
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NEUTRON ACTIVATION ANALYSIS
Neutron Activation Analysis (NAA) is a
nuclear process used for determining certain
concentrations of elements in a vast amountof materials.
NAA allows discrete sampling of elements as
it disregards the chemical form of a sample,
and focuses solely on its nucleus.
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Conti
Neutron activation analysis is a technique
used to very accurately determine the
concentrations of elements in a sample.
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