Osteoporosis

Dr. Aisha SheikhFCPS (Pak),

Fellowship Diabetes/Endocrinology (AKUH), PG Dip Diab (UK)

Consultant Endocrinologist

Normal Bone Vs osteoporotic bone

Definition

• Osteoporosis is a skeletal disorder characterized by compromised bone strength, predisposing to an increased risk for the development of fragility fractures

Bone – Living tissue

Bone remodeling and osteoporosis

• Osteoporosis results from an unhealthy imbalance between two normal acitivites of bone i.e.– Bone formation– Bone resorption

Bone remodeling

• The combined processes of bone formation and bone resorption allow the healthy skeleton to be maintained continually by the removal of the old bone and its replacement with new bone

• These combined processes are termed bone remodeling or bone turnover

• During the first 20 to 25 years of life, these processes are balanced

• Following a period of balanced bone formation and resorption, the destruction of bone exceeds the formation of bone; this imbalance leads to a net loss of bone, and the beginning of osteoporosis

• With every 10% decrease in bone mass; the risk of fracture increases from 1.5 to 3 folds

Prevalence of osteoporosis

Osteoporosis - prevalence

Estimated global prevalence

Osteoporosis and fractures

Increased risk of hip fracture

Increased risk of vertebral fractures

Epidemiology

• The risk of osteoporotic fracture increases with age

• Fracture rates in men are approximately one half those seen in women of the same age

• Each year in UK:– 25,000 vertebral fractures– 40,000 wrist fractures– 50,000 hip fractures –

• 1/5 victims die in next 6 months• Only 50% return to their previous level of

independence

• Huge costs

Pathogenesis

• Diminished bone mass can result from:– Failure to reach an optimal peak bone mass in early

adulthood– Increased bone resorption– Decreased bone formation after peak bone mass has

been achieved

• In osteoporosis, the rate of formation is inadequate to offset the rate of resorption and maintain the structural integrity of the skeleton

Risk factors

Diagnosing osteoporosis

• Without a fracture on bone density screening there is no way to diagnose the presence of osteoporosis

• Get information on compounding risk factors

Bone densitometry

• Only method of diagnosing or confirming osteoporosis in the absence of a fracture

• National Osteoporosis Foundation recommends that bone densitometry be performed routinely in all women > 65, particularly in those who have one or more risk factors

• Densitometry can also be used for monitoring the response to therapy

Osteoporosis – prevention and treatment

• Patients should be thoroughly educated to reduce the likelihood of any risk factors associated with bone loss and falling

• Optimal calcium intake

• Supplemental vitamin D

• Exercise in young individuals increases the likelihood that they will attain the maximal genetically determined peak bone mass

Prevention of falls

• Sedatives (sleeping pills) should be minimized or discontinued

• Visual impairment should be corrected• Ambulatory aids (walking aids) should be

used when appropriate• Make the home “fall proof”: adequate

lighting, carpeting, handrails, non-slip surfaces in bathrooms, removal of obstacles to walking

Osteoporosis – treatment

• Management of fracture and treatment of underlying disease

• Medical treatment of osteoporosis:

– Antiresorptive therapy– Anabolic agents

Key points

• Osteoporosis is a common condition resulting in significant morbidity and mortality by predisposing to fragility fractures

• Adequate calcium, vitamin D intake and weight bearing exercises should be utilized for its prevention

• Measures should be taken for prevention of falls in elderly

Key points (Contd.)

• DEXA scan is the most accurate and precise tool for measurement of bone mineral density, with least radiation exposure as well.

• Risk factors should be addressed

• Medical treatment should be offered to patients with osteoporosis

Thank you!!