A progressive bone disease characterized by decrease bone mass decreased bone density increased fracture risk Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

“Osteoporosis is different from osteomalacia” Osteomalacia is a deficiency of Vitamin D which is characterized by abnormal bone mineralization softening of bones bone pain Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Osteoporosis & Osteomalacia Very commonly coexist Similar treatment (though not entirely) Markers of poor health Significant health implications Preventable!! Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

What causes OSTEOPOROSIS? Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Partly an ageing response Partly lifestyle Partly genetic (it runs in families) Poor Nutrition Bad lifestyle Smoking Heavy alcohol intake Lack of exercise Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Non - Modifiable Risks Advancing Age Female Sex European or Asian race Heredity Early Menopause Modifiable Risks Poor nutrition Poor habits (smoking etc.) Poorly controlled diabetes and other endocrine disorders Sedentary lifestyle Certain medicines Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Vitamin D An essential substance in our bodies for good bone health The deficiency of Vitamin D is very common, especially in Asians and women Related to other important diseases like heart conditions, cancers, infections etc. however the link to these is still being ascertained. Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Have you got osteomalacia? Deep bone pain Muscle weakness Bending of bones Easy fractures Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

You may not know! You may not feel it! Usually totally asymptomatic!! Presents with symptoms when it is relatively advanced Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

How does osteoporosis present? Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Common fractures in osteoporosis – also called “fragility fractures” Wrists Spine (Vertebra) Hips Around the joints Pelvis Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Hip Fractures & Osteoporosis Most worrying outcome of osteoporosis Serious fracture Invariably requires surgery High mortality!! Nearly 30% in the first year of the fracture due to cascading effects on health! Mortality lowered with surgery for such fractures Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Reduced mobility Gradually reduces independence High risk of falls and fractures Slow decline Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

When does osteoporosis start? At any age! Women – commonly after menopause Men – usually in 70s Should be looked for earlier! The earlier its diagnosed, the better it’s treated! Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Diagnosis Clinical – Family history – History of typical fractures (hip, wrist, back) – Fractures after trivial injuries Bone density assessment Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Diagnosis Bone density assessment X-rays Not very reliable DEXA Scan Easy Non Invasive Reliable May need to be done for several bones to get a clearer picture Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Two types of scores on BMD T score (relative to normal young people) Z Score (BMD relative to similar aged people) FRAX Score A WHO score to assess the fracture risk Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Treatment Risk Reduction (modifiable risk factors) Nutrition Lifestyle Exercise Medicines Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho

Exercise For Strength For Endurance For Flexibility Major health benefits of exercising in elderly! Dr Gaurav Rathore MS Ortho, MCh Ortho, FRCS Trauma & Ortho