4. Lifetime Changes In Bone Mass 50% of cancellous &35% of cortical bone mass are lost over a lifetime www.freelivedoctor.com
5. Bone Remolding Osteoblasts deposit new lamellar bone. Osteocytes are osteoblasts trapped in the matrix Osteoclasts resorb matrix www.freelivedoctor.com
6. Determinants Of Peak Bone Mass Peak Bone Mass Physical activity Gonadal status Nutritional status Genetic factors www.freelivedoctor.com
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9. Normal bone Osteoporosis Microarchitectural deterioration Low bone density www.freelivedoctor.com
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15. DEXA It employs two x-ray beams of different energy levels www.freelivedoctor.com
46. Spine Hip 50% 50% 50% 40% 30% 30% HRT/Tibolone >35% >30% > 30% Raloxifene: Evista 60 mg /d 34% 21% Parathyroid Hormone Fort é o 20micg/d for 2y 65% 45% National Osteoporosis Foundation.; 2003 & The Medical Journal of Australia 2004 Drugs used for prevention & treatment of osteoporosis Alendronate :Fosomax 5mg/d or35mg/w Calcitonin (Miacalcic 100IU/d IM .sc or 200IU/d nasal Other non spine Strontium Ranelate (Protelos, 2g) 30% 30% 30% Risedronate: Actonel 5mg/d or 35mg/w www.freelivedoctor.com
48. A 53-year-old G6P4 woman complains of Amenorrhea 11 months with 10-15 hot flushes/day. She is afraid as her mother has died 9 months after fracture neck femur at the age of 67 years BP 120/75, weight 74 kg , height 171cm (BMI 25kg/m2) Breast, abdominal &pelvic examinations revealed no abnormal findings. www.freelivedoctor.com
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50. As the patient has significant hot flushes and has no contraindication : HRT may be the option of choice What Is The Treatment Option Of Choice? www.freelivedoctor.com
51. As the patient has significant hot flushes and has no contraindication : HRT may be the option of choice What Is The Treatment Of Choice? www.freelivedoctor.com
52. So far there are false perceptions regarding the use of HRT -even in big authorities - due to: 1- Old data 2-Incomplete analysis of the data (subgroup) Discussion www.freelivedoctor.com
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59. HRT is not recommended for cases with cured cancer breast even after 5 years except in some exceptional condition for a very short time under strict follow up There are other 2 lines of therapy What is The Treatment of Choice? www.freelivedoctor.com
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66. For hot flushes 1-Venlafaxine = (Effexor) 2-Tibolone very short time under strict follow up for hot flushes For prevention of osteoporosis : 1- Bisphosphonates Or 2-Strontium Ranelate What is The Treatment of Choice? www.freelivedoctor.com
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68. Lower Higher -2.5 BMD (T-score) Bisphosphonates Or Strontium Ranelate Osteoporosis Therapy Algorithm Postmenopausal Women 50 55 60 65 70 75 80 85 90 www.freelivedoctor.com Raloxifene PTH Calcitonin HRT HRT During Hot Flushes Post Vasomotor Symptoms Pre fracture Post Fracture Risk of Fracture AGE At Risk/Osteopenia Osteoporosis Severe Osteoporosis STAGE
69. Lower Higher -2.5 BMD (T-score) Bisphosphonates Or Strontium Ranelate Osteoporosis Therapy Algorithm Postmenopausal Women 50 55 60 65 70 75 80 85 90 Tibolone www.freelivedoctor.com Raloxifene PTH Calcitonin HRT HRT During Hot Flushes Post Vasomotor Symptoms Pre fracture Post Fracture Risk of Fracture AGE At Risk/Osteopenia Osteoporosis Severe Osteoporosis STAGE
Editor's Notes
147
Children need calcium/vitamin D because their bones are growing fast ( growing in both length and strength ). Teens need calcium/vitamin D because bones are still growing fast and this is the time to maximize bone mass. About 90% of adult bone mass is laid down by age 18 in most people. Young adults need calcium/vitamin D to make sure they maximize bone mass while they can. Adults need to continue to consume enough calcium/vitamin D to keep their maximum bone mass and to slow bone loss that starts when older ( during menopause for women; usually in 60s or older in men ).
Children need calcium/vitamin D because their bones are growing fast ( growing in both length and strength ). Teens need calcium/vitamin D because bones are still growing fast and this is the time to maximize bone mass. About 90% of adult bone mass is laid down by age 18 in most people. Young adults need calcium/vitamin D to make sure they maximize bone mass while they can. Adults need to continue to consume enough calcium/vitamin D to keep their maximum bone mass and to slow bone loss that starts when older ( during menopause for women; usually in 60s or older in men ).
Children need calcium/vitamin D because their bones are growing fast ( growing in both length and strength ). Teens need calcium/vitamin D because bones are still growing fast and this is the time to maximize bone mass. About 90% of adult bone mass is laid down by age 18 in most people. Young adults need calcium/vitamin D to make sure they maximize bone mass while they can. Adults need to continue to consume enough calcium/vitamin D to keep their maximum bone mass and to slow bone loss that starts when older ( during menopause for women; usually in 60s or older in men ).
