Osteoporosis Dr. Aisha Sheikh FCPS (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

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