Lecture By:Dr.Ehab Abusinnah Ortho-surgeon Meeqat hospital,Madina.KSA

1. By Ehab Abusinna
OSTEOMALACIA
OSTEOPOROSIS
RICKETS

3. OSTEOPOROSIS - WHO
Systemic skeletal disease characterized by low bone
mass and micro architectural deterioration of bone
tissue with a consequent increase in bone fragility
and susceptibility to fracture which usually involves
the wrist ,spine, hip, pelvis, ribs or humerus.

4.  Most common of all metabolic bone disorders
 Significant morbidity(50% for hip fractures)
and mortality(20% for hip fractures in 1 year)
 Lifetime Osteoporotic Fracture Risk(Caucasian)
Woman- 40%
Men - 20%
 Preventive therapies available.
Osteoporosis

5.  Low bone density
 Micro architectural deterioration
 Fractures
Osteoporosis

6. Target Sites for Osteomalacia

8. TYPES OF OSTEOPOROSIS
 Primary Osteoporosis
 Postmenopausal Osteoporosis
 Senile Osteoporosis
 Secondary Osteoporosis
 Diet
 Drug
Endocrine disease
Other Systemic Disorders.

9. Senile or post-menopausal – 95%
Indiopathic
Primary Osteoporosis

10. SECONDARY OSTEOPOROSIS
Endocrine:
cushing + exog steroids
Hyperthyroidism
Hypogonadism
Hyperparathyroidism
Dm
Proclatinoma
Acromegaly
Preg & lactation

11. RENAL
C R F

12. Malabsorption, Celiac
Gastrectomy
T P N
Hepatobiliary disease
Chronic hypophosphatemia
NUTRITION AND GIT

13. DRUGS
Heparin
Steroids
Anti-convulsants

14.  Diet
 Low calcium intake
 Low vitamin D intake
 Excessive intake of
protein, sodium and caffeine
 Inactive lifestyle
 Smoking , Alcohol abuse
Risk factors…

15. RISK INCREASED BY:
F – sex
Menopause
Decreased Ca
Smoking
Alcohol
Inactivity
White Race (↓ black)

16. • Osteoporosis, the "silent
disease," has bone loss
without symptoms.
• Onset only occurs with
sudden strains, bumps,
or fall causes a fracture
or a vertebra to collapse.
• Collapsed vertebrae may
initially be felt or seen in the form of severe back
pain, loss of height, or spinal deformities such as
kyphosis or stooped posture.
SYMPTOMS

17. RICKETS

18. RICKETS

19. RICKETS

20. RICKETS

21. OSTEOMALACIA – LOOSER ZONE

22. OSTEOMALACIA – LOOSER ZONE

23. CHEMISTRY: NORMAL
WHY ↑ALK, BUT NOT PERSISTENT

24. PREVENTION:
Exercise
Good Ca intake
Non-smoking

25. LIFESTYLE ISSUES
 Tobacco- eliminate it
Food – eat it
 Exercise – do it
 Fall Prevention – work on it

26. Avoid smoking, alcohol and excess soft drink and coffee

27. Eat a health diet
lean meat, fish, green leafy vegetables, and oranges and
Off course Plenty Milk

28. Healthy bone balance

29. • Prevent further bone loss
• Increase or at least stabilize bone density.
• Relieve pain and prevent fracture.
• Increase level of physical functioning
• Increase quality of life
Goals of management

30. TREATMENT
Ca 1200 mg/day
Vitamin D:- 400-2000 IU / day
HRT
Biphosphonates
Calcintonin
S E R M S
Parathyroid hormone

31. Vertebral Fracture Cascade

32. COMPLICATIONS
FRACTURE ,
The most serious complication of
Osteoporosis that leads to
 Increased morbidity
 Increased mortality
 Decreased quality of life

33. THE TIP OF THE ICEBERG
ASSESSMENT MANAGEMENT

34. Each year, one in three Ontarians over
the age
of 65 will take a serious tumble that
may land
them in hospital with a broken hip.
One in three
of those who do break their hip will
die within
a year. Two thirds will experience
dementia-like
symptoms. Most will never see home
again.

35. Osteoporosis, is it only for women??

36. OSTEOPOROSIS IN
MEN
HAS ITS TIME COME?

37. Osteoporosis, only for older
people ??