Osteoporosis Ivan M ü l l e r University Hospital Brno, Orthopaedic Dept Brno-Bohunice.

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Presentation transcript:

Osteoporosis Ivan M ü l l e r University Hospital Brno, Orthopaedic Dept Brno-Bohunice

Orthop. Univ. Dept. FN Brno

Systemic metabolic disease characterized by decreasing of bone mass and disorder of bone microarchitecture with pathological fractures (WHO) University Hospital Brno, Orthopaedic Dept Brno-Bohunice Osteoporosis („silent bone thief“)

University Hospital Brno, Orthopaedic Dept Brno-Bohunice Healthy boneOsteoporotic bone

Every 3rd woman and 6th male (Caucasian, Asian) above 60 yrs Every 3rd woman and 6th male (Caucasian, Asian) above 60 yrs Increasing number of femoral neck fractures during 20 years + 33% Increasing number of femoral neck fractures during 20 years + 33% Czech Republic: these fractures in 1992 Czech Republic: these fractures in 1992 University Hospital Brno, Orthopaedic Dept Brno-Bohunice Occurrence

genetic (60%, Caucasian and Asian, women) genetic (60%, Caucasian and Asian, women) Quality of body, tissues (thinness-low BMI, small figure) Quality of body, tissues (thinness-low BMI, small figure) Life style (hypomobility) Life style (hypomobility) Dysmenorea-disorders of menstruation-emmeniopathy Dysmenorea-disorders of menstruation-emmeniopathy Other disorders (GIT, thyroid gland) Other disorders (GIT, thyroid gland) medication - drugs, tobacco, alcohol medication - drugs, tobacco, alcohol University Hospital Brno, Orthopaedic Dept Brno-Bohunice Risk factors

to 35. yrs prevalence of bone production to 35. yrs prevalence of bone production involution involution menopausa (bone loss of 6% / year) menopausa (bone loss of 6% / year) University Hospital Brno, Orthopaedic Dept Brno-Bohunice Skeletal evolution

Bone mass..increasing.. …Stop bone loss… Elderly … Treat

primary -I. type (post menopausal) primary -I. type (post menopausal) II. type (elderly) juvenile secondary - hormonal secondary - hormonal drugs - corticosteroids nutritional disorders other disorders University Hospital Brno, Orthopaedic Dept Brno-Bohunice Osteoporosis

Stress (load) pain of spine and extremities Stress (load) pain of spine and extremities Trunk shortening and round back Trunk shortening and round back Reflex skin, fasciae, muscles changes Reflex skin, fasciae, muscles changes Pathological fractures Pathological fractures University Hospital Brno, Orthopaedic Dept Brno-Bohunice Osteoporosis symptoms

1. medical (anamnesis, physical exam.) 2. Laboratory (blood, urine) 3. Bone density 4. Radiological methods 5. Bone biopsy University Hospital Brno, Orthopaedic Dept Brno-Bohunice Examination

1. Calcium mg per day 2. Vitamin D 400 IU per day 3. Estrogens 4. SERM remedies (Raloxifen) 5. Bisphosphonates (Alendronate, Risendronate – T-score: -2,5 and less T-score: -2,5 and less 6. Calcitonin 7. Anabolic hormons (elderly) University Hospital Brno, Orthopaedic Dept Brno-Bohunice Treatment

Fractures treatment – hip, wrist, proximal humerus, spine, pelvis, ankle, knee (3R) Fractures treatment – hip, wrist, proximal humerus, spine, pelvis, ankle, knee (3R) Treatment of posttraumatic deformities Treatment of posttraumatic deformities Vertebral kyfoplasty (bone cement) Vertebral kyfoplasty (bone cement) University Hospital Brno, Orthopaedic Dept Brno-Bohunice Surgical management

University Hospital Brno, Orthopaedic Dept Brno-Bohunice

Physiotherapy and orthotic management management

wrong good

1. Primary (good skeletal evolution) 2. Secondary (osteoporosis treatment) 3. Terciary (technical arrangements against falls, fall prevention, physiotherapy, regeneration, “well-ness“ programme - spas) University Hospital Brno, Orthopaedic Dept Brno-Bohunice Prevention

diet diet motion regime (gait, dance) motion regime (gait, dance) struggle against risks struggle against risks ergonomic arrangements ergonomic arrangements University Hospital Brno, Orthopaedic Dept Brno-Bohunice General arrangements against osteoporosis

Conclusion University Hospital Brno, Orthopaedic Dept Brno-Bohunice Osteoporosis is consequential disease with predominant women occurrence, including fragility fractures. Everybody should adhere to regime approach, healthy life style. Early diagnosis and treatment are conditions for successful management of osteoporosis.