Hinduja hospital conducts regular webinars and tweetinars for online users where they can seek advice from expert doctors of hinduja hospital for free. Above is the webinar conducted by hinduja hospital on Osteoporosis where issues like osteoporosis symptoms, osteoporosis prevention, osteoporosis treatment were discussed successfully by Spine Consultant, Dr. Uday Pawar.
To know more about such upcoming webinars and tweetinars from hinduja hospital, visit http://www.hindujahospital.com/communityportal/
5. What is osteoporosis
• A condition rather than a disease
• Silent until complications arise
• Spine, hip & wrist fractures
6. WHO criteria for diagnosis of
Osteoporosis
Kanis et al. J Bone Miner Res 1994; 9:1137-41
T-score
Normal - 1.0 and above
Osteopaenia - 1.0 to - 2.5
Osteoporosis - 2.5 and below
Severe (established)
osteoporosis
- 2.5 and below, plus one
or more osteoporotic
fracture(s)
11. 3. Treating osteoporosis
• Prevention is the only treatment of
osteoporosis
• Hence early diagnosis is the most important
step in treating osteoporosis !
12. Size of the Problem in India
• 26 million (2003) 36 million by 2013
• 1 out of 8 males and 1 out of 3 females suffers from osteoporosis
• The high incidence among men and the lower age of peak incidence
compared to Western countries
• Peak incidence of osteoporosis
– Western countries-70-80 years of age
– India –50-60 years
International Osteoporosis Foundation
13. The Magnitude Of The Problem
In women > 50 years, the lifetime risk of:
• Vertebral fracture is 1/3
• Hip fracture is 1/5
NICE guidance 160 October 2008
14. Osteoporotic Fractures in Women:
Comparison with Other Diseases
1 500 000*
0
500
1000
1500
2000
Osteoporotic
Fractures
*
annual incidence all ages
†
annual estimate women 29+
‡
annual estimate women 30+
§
1996 new cases, all ages
513 000†
228 000‡
184 300§
750 000
vertebral
250 000
other sites
250 000
forearm
250 000
hip
Heart
Attack
Stroke Breast
Cancer
Annualincidencex1000
Riggs BL, Melton LJ. Bone 1995
Heart and Stroke Facts, 1996, American Heart Association
Cancer Facts & Figures, 1996, American Cancer Society
15. Osteoporosis affects entire skeleton
• Osteoporosis is responsible for >1.5 million vertebral and
non-vertebral fractures per year
• Spine, hip, and wrist fractures are most common
19. How is osteoporosis diagnosed
Diagnosis is made on the basis of-
• Detailed medical history
• Examination
• Blood and other tests
20. Early diagnosis of Osteoporosis
• Clinical parameters
– ‘at risk’ subject
– Bone pains
– Generalized tiredness
– Progressive kyphosis
• Investigations
– Radiographs
– DEXA
– QCT, MRI, Bone scan
– Blood markers
21. Clinical Risk Fractures (CRF)
Predictors of low bone mass-
• Female
• Advanced age
• Low bone mineral density
• Gonadal hormone deficiency ( estrogen or testosterone )
• White race
• Low body weight & BMI
• Family history of osteoporosis
• Low calcium intake
• Smoking / excessive alcohol intake
• Low level of physical activity
• Chronic glucocorticoid use
• Prior fragility fracture
National Osteoporosis Foundation (NOF)
22. Clinical Presentation
• Severe backache after minor injury
• Pain worse on sneezing, coughing , standing
erect, changing positions.
• Limited to wheelchair
• Stooped Posture
• Weakness in legs
25. • Osteogenesis imperfecta
• Hepatic insufficiency
• Diabetes mellitus
• Multiple myeloma
• Metastatic disease
• Drug induced
Osteoporosis other causesOsteoporosis other causes
26. Assessment of bone mineral density by DXA
Current gold standard for diagnosis of osteoporosis
BMD (g/cm2
) = Bone mineral content (g) / area (cm2
)
Diagnosis based on comparing patient’s
BMD to that of young, healthy individuals
of same sex
27.
28.
29. • Blood count , CRP
• Calcium, Phosphate, Alkaline
Phosphatase (AP)
• Kidney function studies
• Basal Thyroid and parathyroid.
• Protein-immunoelectrophoresis.
• Vit D (25 and 1.25)
Laboratory tests*
NOTES:
- * These are in addition
to routine labs tests.
- These are screening
labs, more may be
indicated based on these
results
32. Non-modifiable Risk Factors
• Older age
• Female gender
• Ethnic background
• Small bone structure
• Family history of osteoporosis or osteoporosis-related fracture in a parent
or siblings
• Previous fracture
• Menopause/hysterectomy
• Some medicines like steroids, anti-epileptics
• Rheumatoid arthritis
• Reduced levels of Gonadal hormones in men
34. How much and which Calcium??
• 1000-1500mg “elemental calcium”
Type of calcium Elemental Calcium
Calcium carbonate 40%
Calcium gluconate 9%
Calcium lactate 13%
Calcium citrate 20-30%
Calcium acetate 30%
Micro cryst HA complex 100%
◦ May be difficult to attain those levels.
◦ To try a combination of diet and medicines
◦ Can’t give more than 500mg elemental calcium as tabs at a single dose
42. Treatment with PTH
(woman 69 years)
Dempster DW et al, J Bone Miner Res, 2001;16:1846-1853
Before CtTh: 0.32 mm
CD: 2.9 mm3
After CtTh: 0.42 mm
CD: 4.6 mm3
1 5 10
1520
25 30
Ser Val Ser Glu Ile Gln Leu Met His Asn
Leu
Gly
LysHisLeuAsnSerMetGluArgValGlu
Trp
Leu
Arg Lys Lys Leu Gln Asp Val His Asn Phe
43. Take home points…
• No longer a problem of the WEST
• Awareness essential amongst general public
• Prevention is the best treatment
• Moms and grandmoms vulnerable group
44. OPD Schedule: Tue- 1500 to 1600 hours, Thu- 0900 to 1100
hours, Sat- 1100 to 1300 hours
Appointment Helpline: 022-39818181/67668181/24451515
For any Queries, please write us on: info@hindujahospital.com
Thank You
Notas del editor
Treatment and prevention (7) One of the most important preventive strategies is to encourage the achievement of optimal peak bone mass in the young, since this has a major impact on bone mass and the risk of osteoporosis after the menopause. Although peak bone mass is largely determined by genetics and diet (calcium and vitamin D intake), it can also be influenced by physical activity, smoking and alcohol consumption. It is, therefore, important to encourage both children and adolescents to adopt a healthy lifestyle.
Treatment and prevention (8) For those patients at particularly high risk of osteoporosis, or who have developed osteoporosis, there are a number of pharmacological interventions available for the prevention and management of osteoporosis. The aim of these interventions should be to reduce the frequency of fractures, which are responsible for the high levels of morbidity associated with the disease.