Osteoporosis Dr. Faik Altıntaş Yeditepe Üniversitesi Tıp Fakültesi Ortopedi ve Travmatoloji AD

Osteoporosis S.E. 84 y o female Right hip pain after minor trauma in household Could not walk after the fall and had agony 6 hours after fall, administrated to the hospital

Osteoporosis

Osteoporosis

Osteoporosis Osteoporosis is a disease of bone that leads to an increased risk of fracture In osteoporosis The bone mineral density (BMD) is reduced Bone microarchitecture is disrupted The amount and variety of non-collagenous proteins in bone is altered

Osteoporosis Primary Osteoporosis More than 95% of osteoporosis in women Most cases occur in postmenopausal women Postmenopausal, involutional, senile, and age-related osteoporosis are synonims Cause of osteoporosis is a lack of estrogen Estrogen deficiency increases bone breakdown and results in rapid bone loss Bone loss is even greater if calcium intake or vitamin D levels are low. Low vitamin D levels result in calcium deficiency and increased activity of the parathyroid glands (secreting parathyroid hormone), which can also stimulate bone breakdown Bone production also decreases

Osteoporosis Secondary Osteoporosis Chronic kidney failure Hormonal disorders (especially Cushing's disease, hyperparathyroidism, hyperthyroidism, hypogonadism, and diabetes mellitus) Drugs (corticosteroids, barbiturates, and anticonvulsants)

Osteoporosis Breaks usually occur in the hip, spine and wrist Hip and spine fractures are a major concern Hip fractures almost always require surgery and hospitalization Spine fractures have serious consequences such as loss of height, severe back pain, and deformity

Osteoporosis When you are young your body makes new bone faster than it breaks down old bones As you get older, this process slows down and you start losing bone density The risk for osteoporosis depends on how much bone mass you attained to age 30 and how fast you lose it As part of the aging process, bones begin to break down faster than they are formed. Accelerates after menopause. Estrogen is the hormone that protects against bone loss

Osteoporosis Certain people are more likely to develop this disease than others Female Thin and/or small frame Advanced age Family history of osteoporosis Post menopause

Osteoporosis Anorexia nervosa or bulimia Diet low in calcium Use of certain medications Low testosterone levels in men An inactive lifestyle Cigarette smoking Excessive use of alcohol, coffee Being Asian or Caucasian

Osteoporosis Symptoms At first, osteoporosis causes no symptoms because bone density loss occurs very gradually Some people never develop symptoms. Eventually bone density may decrease enough for bones to collapse or fracture Severe sudden pain or gradually developing aching bone pain and deformities Vertebral crush fractures ,the weakened vertebrae may collapse spontaneously or after a slight injury Chronic back pain , an abnormal curvature of the spine (a “dowager‘s hump”)

Osteoporosis Diagnosis Suspect osteoporosis in the following people All women age 65 or older Women aged 50 to 65 who have risk factors for osteoporosis All men and women who have had a previous osteoporotic fracture (a fracture caused by little or no force), even if the fracture occurred at a young age Adults age 65 or older who have unexplained back pain People whose bones appear thin on x-rays Bone density testing , the dual-energy x-ray absorptiometry (DEXA), which measures bone density at the sites at which major fractures are likely to occur: the spine and hip. Blood tests may be performed to measure calcium and vitamin D levels Further testing may be needed to rule out treatable conditions for secondary osteoporosis

Osteoporosis Dual energy X-ray absorptiometry (DXA, formerly DEXA) Gold standard for the diagnosis of osteoporosis Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young adult reference population. This is translated as a T-score T-score -1.0 or greater is "normal" T-score between -1.0 and -2.5 is "osteopenia" T-score -2.5 or below is “osteoporosis “

Osteoporosis Preventation Building strong bones in childhood and adolescence is the best defense A balanced diet rich in calcium and Vitamin D Weight bearing exercise A healthy lifestyle with no smoking or excessive alcohol or coffee intake Bone density testing and medication when appropriate.

Osteoporosis Treatment Adequate intake of calcium (after fifty years of age 1,200 mg/day) Vitamin D (after fifty years of age 800IU/day) Weight-bearing exercises Drugs Bisphosphonates Alendronate Risedronate Ibandronate Zoledronic acid Calcitonin Selective estrogen receptor modulator (SERM) Raloxifene Parathyroid hormone Teriparatide

17