1 / 14

Osteoporosis

Osteoporosis. Definition : Reduced bone mass May be primary (age-related) Or Secondary (another condition or drugs) T Score ≤ - 2.5 Prevalence: > 50 yrs ♀18%♂6% Women lose trabeculae with age but men do not – hence less lifetime fracture risk. Pathogenesis

cid
Télécharger la présentation

Osteoporosis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Osteoporosis

  2. Definition: Reduced bone mass • May be primary (age-related) • Or Secondary (another condition or drugs) • T Score ≤ - 2.5 Prevalence: • > 50 yrs ♀18%♂6% • Women lose trabeculae with age but men do not – hence less lifetime fracture risk

  3. Pathogenesis • OP results from ↑ bone breakdown by osteoclasts & ↓ bone formation by osteoblasts • BM ↓ with age but will depend on peak mass obtained during life • Genetic factors are single most significant influence

  4. BMD dependent Risk Factors: • Female sex • Caucasian/Asian • GI disease • Immobilization • CLD/CRD • Low dietary calcium intake • Vit D insufficiency • COPD • Endocrine Disease (thyroid, Cushings) • Other disease (DM, myeloma) • Drugs *

  5. Drugs* • Main ones we need to know; • Heparin • Calcineurin inhibitors • Ciclosporin • PPI’s • SSRI’s • Glucocorticoids

  6. BMD-independent Risk Factors; • Age • Previous fragility fracture • Family H(x) • Low BMI • Smoking • Alcohol • Glucocorticoid therapy • RA

  7. Risk Factors: • SHATTERED • Steroid use > 5mg/day of prednisalone • Hyperthyroidism • Alcohol & Tobacco use • Thin (BMI ≤ 22) • Testosterone ↓ • Early menopause • Renal or liver failure • Erosive bone disease (RA or myeloma) • Dietary Ca2+ ↓(malabsorption T1DM)

  8. Clinical Presentation; • Fractures are the only cause of symptoms • Sudden onset of severe pain in spine, radiating to front – VCF • Pain from mechanical derangement • Increasing kyphosis • Height loss • Colles fractures • Fractures of proximal femur etc

  9. Investigations • X-ray • DEXA scan • Bloods – CA, PO4, & alk phos • Consider specific investigations for secondary causes • Biopsy is unreliable and not often used

  10. Management • Treat known risk factors if possible (drugs etc) Lifestyle measures; Smoking & alcohol cessation WB exercise & balance training Calcium and vit D dietary intake Home based fall prevention program

  11. Pharmacological T(x) • Bisphosphonates 1st line • Calicum and Vit D • Strontium ranelate (2nd line after BisP) • Hormone replacement therapy (prevention) • Raloxifene • Teriparatide • Calcitonin • Testosterone ( in men)

  12. Quiz • What is the most common presentation of OP? • What does SHATTERED stand for in terms of OP risk factors? • What investigations would you do on a patient with suspected OP?

  13. Quiz • Mrs X has a T score of -2.3. Is she osteoporotic? • List 5 lifestyle modifications for treatment of OP: • List 5 pharmacological mangements for OP; • What is the 1st line treatment?

More Related