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As General Practioners

As General Practioners. We diagnose and treat Hypertension. We diagnose and manage Diabetes. We suspect thyroid hypo or hyper function and evaluate and treat uncomplicated cases. We do suspect, diagnose and refer cases of acute appendicitis for surgery.

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As General Practioners

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  1. As General Practioners We diagnose and treat Hypertension We diagnose and manage Diabetes We suspect thyroid hypo or hyper function and evaluate and treat uncomplicated cases We do suspect, diagnose and refer cases of acute appendicitis for surgery Much the same way, is Osteoporosis. We need to know when to suspect, to diagnose and treat. The ONUS is on US

  2. I can read your mind….. Pick a card, any card, remember it, think of it but do not tell me what it is….. Dr.Sarma@works

  3. DO NOT FORGET YOUR CARD YOU WILL NOW BE AMAZED THE COMPUTER IS RESPONDING TO YOUR THOUGHT-WAVES PRESS THE ENTER KEY CONCENTRATE Dr.Sarma@works

  4. I have now taken your card away Dr.Sarma@works

  5. The Look a likes…. Dr.Sarma@works

  6. Let us start Dr.Sarma@works

  7. OSTEOPOROSIS A Hidden Hazard A comprehensive review by Dr. R.V. S. N. Sarma, M.D., M.Sc., Consultant Physician, Thiruvallur 602 001 Dr.Sarma@works

  8. www.nih.us.gov www.who.bonedisease.org www.paworld.net www.thewellproject.org www.primarycarewales.org.uk www.lancster.unl.edu www.foodandhealth.com www.radiography.derby.ac.uk Web resources consulted Dr.Sarma@works

  9. Introduction Osteoporosis Dr.Sarma@works

  10. A systemic disease - results in bone loss Both qualitative and quantitative loss Resultant easy predisposition to fractures with little or minor trauma Up to 20% of bone loss occurs immediately after menopause Resultant Morbidity, Mortality, QUALY, Socio-economic burden on the society Osteoporosis Dr.Sarma@works

  11. Burden of illness Osteoporosis Dr.Sarma@works

  12. Osteoporosis is a major health hazard 44 million Americans currently have or at risk of Osteoporosis (OS) Asian and European women more prone 80% of OS cases are undiagnosed (hidden) In men all races are equally prone 55% of women and men above the age of 50 years have significant bone loss 7.8 m ♀ and ♂ 2.3 m in USA have OS Half of them suffer from # in lifetime Osteoporosis Dr.Sarma@works

  13. World wide 323 million fractures in 1990 1.66 million are hip # alone due to OS 1.55 billion # by 2050 6.2 million hip # alone due to OS - 2050 Five times this number will have OS 20% of hip # pts die within 1 year 35 to 50% of them lose functionality OS – Global Burden Dr.Sarma@works

  14. OS – related fractures Dr.Sarma@works

  15. OS fractures – relative burden Dr.Sarma@works

  16. More than the combined life time risk of breast, uterine and ovarian cancers put together OS related Hip fractures Dr.Sarma@works

  17. OS – Fracture patterns Dr.Sarma@works

  18. 750,000 spine fractures each year 2/3 are clinically silent Acute or chronic back pain ↓ in height of 2.5 to 6 cm Respiratory / GI difficulties ↓ Daily life activities Depression, loss of self esteem ↑ in all cause mortality OS – Spine fractures Dr.Sarma@works

  19. 250,000 Hip fractures each year 25% excess mortality each year 65,000 American ♀ die/year -hip # 50% permanently disabled 20% require LTC Tremendous burden on the society OS – Hip fractures Dr.Sarma@works

  20. OS – Hip # Bed days Dr.Sarma@works

  21. Vertebral # Physiological changes Dr.Sarma@works

  22. Vertebral # with kyphosis 50 years 75 years Dr.Sarma@works

  23. Vertebral # Physiological changes Dr.Sarma@works

  24. Mortality after Vertebral, Hip # Dr.Sarma@works

  25. Pathophysiology Osteoporosis Dr.Sarma@works

  26. What is bone ? It is a living tissue It is both strong and flexible It is made up of collagen, Ca and Phos. Bone strength is determined by Bone density and The quality of the bone In osteoporosis both are affected. Osteoporosis Dr.Sarma@works

  27. Support the flabby soft tissues Protect the vital organs Provide mobility by muscle attachments. Factory of blood formation Reservoir of minerals Functions of Skeleton Dr.Sarma@works

  28. In the bone we have 3 types of cell lines The Osteoblasts – The depositing checks The Osteoclausts – The withdrawal Chqs. The Osteocytes – The Mechano-sensors The first two types conduct remodelling Trabecular and cortical bone Bone Metabolism Dr.Sarma@works

  29. Bone Metabolism Dr.Sarma@works

  30. B.R.U Dr.Sarma@works

  31. Osteoporosis Dr.Sarma@works

  32. Dr.Sarma@works

  33. Bone micro-damage Dr.Sarma@works

  34. Bone Structure in Dr.Sarma@works

  35. Bone Structure in OS Frail and Thin bony trabeculae, Larger pores Dr.Sarma@works

  36. Severe Osteoporotic Bonewith Osteonecrosis Dr.Sarma@works

  37. Peak bone mass by age 30-35 years 85% bone mass by age 20 years This is possible only with adequate calcium intake throughout childhood Bone mass declines from 40 years Yearly loss up to 1% in men above 50 yr Yearly bone loss up to 5% in women after menopause Bone Mass Development Dr.Sarma@works

  38. Changes in Bone Mass Dr.Sarma@works

  39. Wall Occiput Distance – marker of # Validated with Thoracic, Lum X-rays Standing straight – heels touch wall WOD > 3cm PPV 69%, NPV79% WOD > 7cm PPV 92%, NPV 76% Consider OS in # above 50 years Think of OS in ♀ > 50 and ♂ > 65 yrs. Ask for old CXRs to Dx vertebral # Physical Exam Dr.Sarma@works

  40. Clinical features Dr.Sarma@works

  41. Post Menopausal OS – PMO (Type I) Senile Osteoporosis – SOS (Type II) Glucocorticoid induced OS – GIO Primary Osteoporosis Secondary Osteoporosis Osteoporosis with fracture(s) Osteopenia OS related # with re-fracture risk Osteoporosis - Types Dr.Sarma@works

  42. Hip Vertebral Compression (T and L) Colles / Distal Radius Proximal Humerus Proximal Tibia Pelvic bone Malleolar ankle # Osteoporotic Fractures Dr.Sarma@works

  43. PMO Dr.Sarma@works

  44. PMO (type I) Estrogen Deficiency Neg Ca ++ balance - PMO Osteoblast receptors↓ Stimu. of Osteoclasts ↓ Intestinal Ca ++ absor ↓ 1, 25 DHC in Kidney Bone Ca ++ Leaks ↑inSerum Ca ++c ↓ PTH Secretion Dr.Sarma@works

  45. SOS (type II) ↓ 1, 25 DHC in Kidney Neg Ca ++ balance - SOS ↓ Intestinal Ca ++ absorption ↑ Bone resorption ↓ PTH Secretion Bone Ca ++ Leaks Dr.Sarma@works

  46. Life style Low calcium and Vit. D intake Low BMI < 18, High BMI > 30, DM Limited exercise from childhood (AWNP) Smoking, Alcohol, Caffeine Genetic Female Gender, Asian or European Vit D receptor gene, Procollagen, Chr. 11 gene Drugs Glucocorticoids, Phenytoin, Thyroid hormone OS – Risk factors Dr.Sarma@works

  47. Osteoporosis - Secondary Dr.Sarma@works

  48. Common iatrogenic OS 3-6 months cont. use is adequate Not a feature of inhaled steroids Steroid use for chronic asthma, Skin COPD, RA, Inf. BD – common causes 50% pts. suffer OS related # G I O Dr.Sarma@works

  49. Glucocorticoids ↓GI Ca Absorption ↓Adrenal androgens ↑ Osteocytic Apoptosis ↑Urinary Ca ex ↓Testosterones ↓Serum Ca ↓Estrogens ↑ PTH ↓ Osteoblastic Bone formation ↑ Osteoclastic Bone resorption Osteoporosis G I O - Pathophysiology Dr.Sarma@works

  50. Diagnostic Tests Osteoporosis Dr.Sarma@works

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