Osteoporosis presentation by Dr. Cho Mar Lwin

1. Osteoporosis
Dr. Cho Mar Lwin
Rheumatology Unit, YGH
15th Medical Specialties Conference, 2011
MMA

2. Definition
“Systemic skeletal disease
characterized by low bone mass
and micro architectural
deterioration with a consequent
increase in bone fragility and
susceptibility to fractures”.
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Normal bone
Osteoporotic Bone
Consensus Development Conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.

3. Definition
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In 1994, an expert panel convened by The World Health
Organization has published criteria for osteoporosis
based on bone density

4. Definition
• Osteopenia (low bone mass) - bone
density measurement between 1 and 2.5
SD below the young-adult mean (T-score
between -1 and -2.5).
• Osteoporosis - bone density
measurement less than 2.5 SD below
young, healthy controls (T-score <2.5).
• Established osteoporosis is defined as a
T-score <2.5 and the presence of a
fracture.
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- 1
- 2.5
Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-
Force for Osteoporosis. Osteoporos Int 1999;10: 259-64.

5. Incidence and Prevalence
Worldwide
estimated to affect 200 million women .
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Kanis JA (2007) WHO Technical Report, University of Sheffield, UK: 66.
10% of > 60 yr 20% of > 70 yr 40% of > 80 yr 65% of > 90 yr
Non Osteoporotic women Osteoporotic women

6. • An osteoporotic fracture is estimated to occur
every 3 seconds world wide
• Osteoporotic fractures after 50 year of age
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1/3 1/5
Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with
osteoporotic fractures. Osteoporos Int 17:1726.
Incidence and Prevalence

7. 80% of osteoporotic people are women
By 2050, the worldwide incidence of hip
fracture in men is projected to increase by
310% and 240% in women
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Incidence and Prevalence
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407.
Lindsay R et al., 2001, JAMA 285:320

8. The annual incidence rate of osteoporotic fractures in
women is greater than the combined incidence rates of
heart attack, stroke and breast cancer
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Incidence and Prevalence
Riggs BL and Melton LJ, 1995, Bone 17(s5); 505S; American Heart Association, Heart & Stroke Facts 1996; American Cancer Society,
Cancer Facts and Figures, 1996

9. Burden of the Disease
The combined lifetime risk
for hip, forearm and
vertebral fractures coming
to clinical attention is
around 40%, equivalent to
the risk for cardiovascular
disease
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Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929.

10. The disability due to osteoporosis is greater than that
caused by cancers (with the exception of lung
cancer) and is comparable or greater than that lost to
a variety of chronic non communicable diseases,
such as rheumatoid arthritis, asthma and high blood
pressure related heart disease
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Burden of Disease
Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and
disability associated with osteoporotic fractures. Osteoporos Int 17:1726.

11. The worldwide cost
burden of osteoporosis
(for all ages) is forecast to
increase to USD131.5
billion by 2050
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Burden of the Disease
Lindsay R et al., 2001, JAMA 285:320

12. Updates on some Asian Countries
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300%  last 30 yr
22.5% - men > 50
50.1% - women > 50
Women 30 – 60 yr
52% - osteopenia
29% - osteoporosis
Women 50 – 79 yr
35% - spine
9.5% - hip
Hip fractures  4
times over 10 yrs
Hip fractures  x 5 in
women , x 1.5 in
men over 3 decades
Osteoporosis in
51.8% urban
menopausal women
Osteoporosis -
> 50 % in > 70 yr old
women
Osteoporosis –
61.5% in women >
50 yr old

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Prevalence of 5 main musculoskeletal
diseases in Myanmar (C Soe, 2006)

14. Prevalence in Myanmar
• A study on risk factors of bony fractures in post-
menopausal Myanmar women, by Thida Win-1998
conducted in Trauma unit YGH
Postmenopausal osteoporosis fracture - 53.8%
• Osteoporosis, Prevalence and Risk by
Chit Soe, Aye Aye Khaing and Pandora Aung Gyi
( Myanmar Health Research Congress, 2004)
Osteopenia in 31%of teachers and 31.5%of
nurses; no patient with osteoporosis
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15. • YGH osteoporosis study (Chit Soe, 2010) conducted in
67 Rheumatology patients
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Prevalence in Myanmar
Female osteopenia
(19.3%), osteoporosis
(15.8%)
Male osteopenia
(20%), osteoporosis
(10%)

16. 1. Primary
Previous fracture at <50 yr, parent or sibling with previous
fractures, cigarette smoking, weight <127 lb or height >5 ft
7 in
2. Secondary
Non modifiable
• White race, advanced age, frailty or poor health,
dementia
Modifiable
• Low calcium intake, eating disorder, low testosterone
levels (men), premenopausal estrogen deficiency
(amenorrhea >1 yr or menopause at age <45 yr),
• excessive alcohol intake, physical inactivity, impaired
vision, neurologic disorders, lack of sunlight exposure
Risk Factors for Osteoporosis
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17. Indications for Bone Densitometry
• All postmenopausal women <65 yr who have one or more
additional risk factors for osteoporosis, besides menopause
• All women >65 yr regardless of additional risk factors
• Documenting reduced bone density in a patient with a
vertebral abnormality or osteopenia on a radiograph
• Estrogen-deficient women at risk for low bone density,
considering use of estrogen or an alternative therapy, if bone
density would facilitate the decision
• Women who have been on estrogen replacement therapy for
prolonged periods or to monitor the efficacy of a therapeutic
intervention or interventions for osteoporosis
• Diagnosing low bone mass in glucocorticoid-treated
individuals
• Documenting low bone density in patients with asymptomatic
primary or secondary hyperparathyroidism7/10/2011 15th Medical Specialties Conference, 2011 17