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Osteoporosis is a skeletal disorder characterized by compromised bone strength, leading to an increased risk of fractures. It can be categorized into postmenopausal, age-related, and secondary osteoporosis. Pathophysiology involves an imbalance between bone resorption and formation, often exacerbated by factors such as estrogen deficiency and aging. Patients are often unaware of their condition until fractures occur. Management focuses on prevention, optimizing bone mass, and stabilizing bone strength through lifestyle changes and pharmacological treatments.
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Osteoprosis Haya M. Al-Malaq, Msc Lecturer Clinical Pharmacy Department Haya_malak@yahoo halmalaq@ksu.edu.sa
Defenition • Osteoporosis is a skeletal disorder characterized by compromised bone strength predisposing individuals to an increased fracture risk.
Categories • postmenopausal osteoporosis, • age related steoporosis • secondary osteoporosis.
Pathophysiology • Bone loss occurs when bone resorption exceeds bone formation, usually from high bone turnover when the number and/or depth of bone resorption sites greatly exceed the rate and ability of osteoblasts to form new bone. • In addition to reduced bone mineral density (BMD), bone quality and structural integrity are impaired because of the increased quantity of immature bone that is not yet adequately mineralized. • Men and women begin to lose a small amount of bone mass starting in the third or fourth decade as a consequence of reduced bone formation. • Estrogen deficiency during menopause increases proliferation, differentiation, and activation of new osteoclasts and prolongs survival of mature osteoclasts; this increases bone resorption more than formation. • Men do not undergo a period of accelerated bone resorption similar to menopause. • The etiology of male osteoporosis is multifactorial; secondary causes and aging are the most common contributing factors. • Age-related osteoporosis occurs mainly because of hormone, calcium, and vitamin D deficiencies leading to accelerated bone turnover and reduced osteoblast formation. • Drug-induced osteoporosis may result from systemic corticosteroids (prednisone doses greater than 7.5 mg/day), thyroid hormone replacement, some antiepileptic drugs (e.g., phenytoin, phenobarbital), depot medroxyprogesterone acetate, and other agents.
Clinical presentation • Many patients are unaware that they have osteoporosis and only present after fracture. Fractures can occur after bending, lifting, or falling, or independent of any activity. • The most common osteoporosis-related fractures involve the vertebrae, proximal femur, & wrist. 2/3 of patients with vertebral fractures are asymptomatic; the remainder present with moderate to severe back pain that radiates down a leg after a new vertebral fracture. The pain usually subsides significantly after 2 to 4 wks, but chronic, low-back pain may persist. • Multiple vertebral fractures decrease height & sometimes curve the spine with or without significant back pain.
Clinical presentation • Patients with a non vertebral fracture frequently present with severe pain, swelling, & reduced function & mobility at the fracture site.
Diagnosis • History • Major risk factor (<127 lb in postmenopausal women), history of osteoporotic fracture in a first-degree relative, and personal history of low-trauma fracture as an adult. age, high bone turnover, low BMI index (<19 kg/m2), RA, & glucocorticoid use. • Complete physical examination • BMD of central hip & spine • T score: Normal bone mass is a T-score greater than –1, osteopenia is –1 to –2.4, & osteoporosis is at or below –2.5. • low trauma fracture
Desired outcome • The primary goal of osteoporosis management is prevention. • Optimizing skeletal development & peak bone mass accrual in childhood, adolescence, and early adulthood will reduce the future incidence of osteoporosis. • Once osteopenia or osteoporosis develops, the objective is to stabilize or improve bone mass and strength and prevent fractures. • Goals in patients who have already suffered osteoporotic fractures include reducing future falls and fractures, improving functional capacity, reducing pain and deformity, and improving quality of life.
Non-Pharmacologicla • balanced diet with adequate intake of calcium & vitamin D or , calcium supplements. • caffeine increases calcium excretion, caffeine intake should be limited to two servings per day. • Smoking cessation • Weight-bearing aerobic and strengthening exercises improving muscle strength, coordination, balance, & mobility.
Glucocorteciods-induced osteoprosis • Guidelines for managing corticosteroid-induced osteoporosis recommend measuring BMD at the beginning of chronic therapy (prednisone 5 mg or more daily or equivalent for at least 6 months) and follow up monitoring with DXA in 6 to 12 months. BMD should be measured in patients taking chronic therapy whose baseline values were not obtained. • All patients starting or receiving long-term systemic glucocorticoid therapy should receive at least 1,500 mg elemental calcium and 800 to 1,200 units of vitamin D daily and practice a bone-healthy lifestyle.
