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

men4/8/2011 2Investigations in Osteoporosis


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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

exposure4/8/2011 12Investigations in Osteoporosis


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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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Investigations in Osteoporosis