Post Menopausal Osteoporosis Prof G S Patnaik Prof and Head, Dept Of Orthopedics NMCH Bihar

Osteoporosis: The Silent Killer A well planned program of treatment for osteoporosis depends on correction of all underlying nutritional and physiologic abnormalities there needs to have a strategic balance between bone resorption and bone formation

Postmenopausal Osteoporosis Systemic skeletal disease characterized by: low bone mass Micro architectural deterioration of bone tissue increased bone fragility and susceptibility to fracture

Pathophysiology of PMO: Overview Bone remodeling occurs throughout an individual’s lifetime In normal adults, the activity of osteoclasts (bone resorption) is balanced by that of osteoblasts (bone formation) With the onset of menopause (mid-forties or fifties), diminishing estrogen levels lead to excessive bone resorption that is not fully compensated by an increase in bone formation

Osteoporotic Fractures Aging Menopause Increased bone loss Propensity to fall High bone turnover FRACTURES Low peak bone mass

Biochemical Assessment: Excluding Secondary Causes of Osteoporosis First Level (Routine Tests) Complete blood cell count Serum chemistries: calcium phosphorus creatinine alkaline phosphatase albumin liver enzymes thyroid-stimulating hormone (TSH)

WHO Criteria for Diagnosis of Bone Status Diagnostic criteria* Classification T is above or equal to -1 Normal T is between -1 and -2.5 Osteopenia (low bon mass) T is -2.5 or lower Osteoporosis T is -2.5 or lower + fragility fracture(s) Severe or established osteoporosis *Measured in "T scores." T score indicates the number of standard deviations below or above the average peak bone mass in young adults.

Diagnosis of PMO: Bone Density Assessment Technique Sites measured Advantages Disadvantages Dual-energy X-ray absorptiometry (DXA) Lumbar spine Proximal femur Total body Forearm Calcaneus Phalanges Diagnostic test of choice High accuracy, precision, resolution Measures all areas Short scan time, low radiation dose AP spine measurement influenced by degenerative sclerosis, other artifacts Combined trabecular and cortical measure- ment 2-dimensional

Biochemical Assessment: Excluding Secondary Causes of Osteoporosis (cont’d) Second Level (Nonroutine Tests) Urinary calcium excretion Markers of bone remodeling Urinary free cortisol Erythrocyte sedimentation rate (ESR) Parathyroid hormone (PTH) 25-hydroxyvitamin D Protein electrophoresis Bone biopsy

Diagnosis of PMO: Clinical Evaluation Medical history Risk factor assessment Signs and symptoms Bone mineral density (BMD) testing Physical examination Laboratory tests, as appropriate Height assessment

Management of PMO: Goals of Therapy Prevent first fragility fracture or future fractures if one has already occurred Stabilize/increase bone mass Relieve symptoms of fractures and/or skeletal deformities Improve mobility and functional status Initiate lifestyle changes to enhance prevention of fractures

Management of PMO: Goals of Therapy Prevent first fragility fracture or future fractures if one has already occurred Stabilize/increase bone mass Relieve symptoms of fractures and/or skeletal deformities Improve mobility and functional status Initiate lifestyle changes to enhance prevention of fractures

Thank you