Management of osteoporosis

2. Management of Osteoporosis
Presented By,
Dr. Sajid Hasan
MBBS
Army Medical College Chattogram

3. What is Osteoporosis?
 Osteoporosis is a systemic skeletal disease characterized by
low bone density and micro architectural deterioration of bone
tissue with a consequent increase in bone fragility.

4. Causes
 Low calcium diet
 Lack of physical activity
 Positive family history
 Gender: More in female
 Ethnicity: Asian & White people are more likely to be affected by
osteoporosis.
 Gastrointestinal surgery
 Estrogen deficiency in post menopausal women
 Hyperthyroidism
 Smoking

5. Risk Factors
 Nonmodifiable:
a) Advance age
b) Female gender
c) White/Asian race
d) Low peak body mass
e) Family history of osteoporosis
f) Personal history of fracture
g) Low body mass index
 Modifiable:
a) Smoking
b) Inadequate Calcium intake
c) Inadequate Vitamin D intake
d) Low body weight (BMI <21)
e) Estrogen deficiency
f) Hypogonadism
g) Chronic Glucocorticoid therapy

6. Symptoms of Osteoporosis
Usually, there are no symptoms of osteoporosis. That is why it is
sometimes called a silent disease. However, some patient may have
following symptoms:
 Loss of height (getting shorter by an inch or more).
 Change in posture (stooping or bending forward).
 Shortness of breath (smaller lung capacity due to compressed disks).
 Bone fractures.
 Pain in the lower back.

7. Diagnosis
Diagnosis can be done by:
 Physical examination
 Bone Mineral Density (BMD)
 Duel-energy X ray Absorptiometry (DEXA)
 Ultrasonic measurement of bone
 MRI
 Radiograph

8. Management of Osteoporosis
Goals of treatment
 Control pain from the disease
 Slow down or Stop bone loss
 Prevent bone fractures with medicines that strengthen bone
 Minimize the risk of falls that might cause fractures.

9. Management of Osteoporosis
Cont..
Osteoporosis management involves both pharmacological & Non
pharmacological measures-
 Non Pharmacological Approach:
 Smoking cessation
 Moderation of alcohol intake
 Adequate dietary calcium intake
 Exercise
 Vitamin D
 Fall Prevention
 Good nutrition
 Minimization of Glucocorticoids

10. Management of Osteoporosis
Cont..
Pharmacological Approach:
 Hormone replacement therapy.
 Selective estrogen receptor modulators.
 Calcitonin
 Bisphosphonate
 Denosumab: It is a human monoclonal antibody that inhibits the formation
and activity of osteoclasts by blocking receptor activator of nuclear factor
kappa B ligand
 Anabolic agents: Teriparatide. It is a recombinant human parathyroid
hormone with bone anabolic activity
 Sclerostin inhibitors: Romosozumab, Blosozumab

11. Management of Osteoporosis
Cont..
There are also some exercises for prevention of osteoporosis
a) Weight bearing exercise – Walking, Jogging, Playing tennis
b) Resistance exercise – Stretch bands, Free Wt lifting, Wt machine
c) Balance exercises – Yoga
d) Riding a stationary bicycle
e) Using rowing machine
f) Postural retraining – Improves core muscle strength at back

12. Prevention of Osteoporosis
From a young age, both men and women can take steps to prevent
osteoporosis by making sure that they –
 Have a healthy and varied diet with plenty of fresh fruit, vegetables and
whole grains.
 Eat calcium-rich foods.
 Absorb enough vitamin D.
 Avoid smoking.
 Limit alcohol consumption.
 Limit caffeine.

13. Take Home Messages
 Osteoporosis is a progressive metabolic bone disease that decreases
bone density with deterioration of bone density.
 Osteoporosis has a major impact on a individual’s quality of life.
 Physical exercise & movements with appropriate sunlight exposure is an
important preventive tools specially in childhood.
 The treatment of osteoporosis consists of life style measures &
pharmacologic therapy.

14. References:
1) https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-
causes/syc-20351968
2) https://www.nhs.uk/conditions/osteoporosis/#:~:text=Osteoporosis%20is%2
0a%20health%20condition,broken%20wrist
3) https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
4) https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html