1. Osteoporosis Jiří Slíva, M.D.

2. Osteoporosis §a bone disease that is characterized by progressive loss of bone density and thinning of bone tissue §higher risk of fractures

4. §25 yr – balance between bone resorption & formation - PBM (peak bone mass) §duration approx. 5 yr §exaggerated resorption (0,5% /year) §climacterium Sceletal status by age

9. Risk factors for osteoporosis I §genetic factors §elderly §females §early climacterium (before 45. yr)

10. §time after climacterium §late menarche §race differences – Caucasians, etc. §drugs – antiepileptics, etc. §diseases – malabsorption, Cushing sy Risk factors for osteoporosis II

11. Concomitant factors §unhealthy lifestyle §low of calcium intake §lack of vitamin D §excessive alcohol intake §stress, smoking

12. Primary prevention §Increase of body performance – stimulation of osteoblasts §Sufficient intake of calcium – at least 1 g/d, people in higher risk up to 2 g/d §vitamin D - food, sun

13. Regulatory mechanisms of bone metabolism §parathormone §calcitonine §sexual hormones - estrogens & gestagens

14. Epidemiology §7-8% population in CZ §1/3 women after climacterium

15. Diagnosis §Anamnesis, clinical examination §Densitometry §Markers of resorption – pyridinoline in urine

16. §nonspecific…according to risk factors §specific Treatment

17. Calcium §stimulation of calcitonine x inhibition of parathormone §1 000 mg/d

18. Vitamin D §at least 400 IU, in elderly up to 800 IU §formulations containing ergocalciferole, cholecalciferole §risk of overdosage

19. Antiresorptive treatment - HRT §Estrogens support bone synthesis & inhibit resorption §Proliferaratory effects are inhibited by gestagens §Referral from EMEA

20. SERM §selective modulators of estrogen receptors §non-steroidal structure §protection of endometrium §raloxifen, tamoxifen, droloxifen

21. Calcitonine §inhibition of osteoclasts, increase of tubular reabsorption of calcium, analgesic eff., stimulatuon of bone formation §calcitoninum salmonis or humanum (200 IU)

22. Bisphosphonates §Influence on calcium metabolism §Inhibition of resorption (via cytotoxicity on osteoclasts?) §Accumulation in bones §Elimination via kidneys

23. §1st generation - etidronate, clodronate §2nd generation - pamidronate, alendronate §3rd generation - risedronate, ibandronate §CI – disease of oesophagus, stomach or kidneys, pregnancy, lactation Bisphosphonates

24. Thiazide diuretics §diminished renal excretion of calcium; ??? increase of BMD ??? §good for patients with hypertension

25. Drugs stimulating bone formation §fluoride -? MÚ, 14ti měsíční cykly (12+2) §vitamin K §magnesium §STH – increased activity of osteoblasts §Parathormone ??? §promethazine