Scribd
Upload
215 views27 pages

Osteoporosis Overview by Shoban Raj

Osteoporosis is a disease where bone mineral density is lower than normal, leading to weakened bones that are more prone to fractures. It can be primary, related to aging, or secondary due to other conditions. Key factors for developing osteoporosis include family history, smoking, menopause, and chronic illnesses. Diagnosis involves physical exams, imaging like x-rays and DEXA scans, and lab tests. Prevention focuses on adequate calcium and vitamin D intake, exercise, and avoiding risk factors. Treatment includes managing fractures, physical therapy, treating underlying causes, supplements, bisphosphonates, and hormone replacement therapy.

Uploaded by

Shoban Raj
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
215 views27 pages

Osteoporosis Overview by Shoban Raj

Osteoporosis is a disease where bone mineral density is lower than normal, leading to weakened bones that are more prone to fractures. It can be primary, related to aging, or secondary due to other conditions. Key factors for developing osteoporosis include family history, smoking, menopause, and chronic illnesses. Diagnosis involves physical exams, imaging like x-rays and DEXA scans, and lab tests. Prevention focuses on adequate calcium and vitamin D intake, exercise, and avoiding risk factors. Treatment includes managing fractures, physical therapy, treating underlying causes, supplements, bisphosphonates, and hormone replacement therapy.

Uploaded by

Shoban Raj
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

Osteoporosis

Shoban Raj a/l Vasudayan


Osteoporosis
• Bone is qualitatively normal • Localized ( disuse /
but there is less of it than inflammation)
would be expected in a • Generalize
person of that age and sex
 Primary
 Secondary
• WHO: Bone mineral density
that is 2.5 SD below the
mean peak value in young
adults of the same age and
sex
Age related Osteoporosis
• Age related changes in • Risk factor
the bone  Family history
 Smoking
 Osteoblastic and  Oophorectomy
osteoclastic activities  Race ( Whites, Asian
 Estrogen withdrawal >Negroid)
 Oophorectomy  Chronic illness
 MEN – 15 yrs later  Dietary
Post menopausal Osteoporosis
Clinical features
• Women age of > 55
• Acute back pain
• Progressive kyphosis
• Fractures
Involutional osteoporosis
• > 70 years old
• Involve male: female
equally
• # of femoral neck
• # of proximal end of
humerus
• Systemic disease
Diagnosis
Physical
examination ! Investigations
! Height loss Radiography
Body weight USD mesurement
Kyphosis DEXA
Humped back CT scan

Tooth loss
Wall occiput
distance
Rib – pelvis distance • Usually obvious
• Exclude other pathology if <
45 ( full inx)
• Suspect osteomalacia if:
a. Multiple #
b. Increased ALP
c. Looser zone on X-ray
Prevention
• Maintain adequate level of dietary calcium
and vit.D
• Physical activity
• Avoid smoking and alcohol
• Hormonal replacement therapy (HRT)
• Biphosphonates
Treatment
• Manage # - internal fixation ( early mobilization)

• Mobilization + rehab

• Treat associated factors


a. Illnesses
b. Dietary deficiencies
c. Sunlight exposure
d. Supplements
e. Biphosphonate / HRT
Secondary osteoporosis

Nutritional

Endocrine
idiopathic disorders

Non
Drug
Malignant
disease induced

Malignant
disease
RICKETS & OSTEOMALACIA
Rickets & Osteomalacia
• Different expression of the same disease
• Rickets – specifically to children ( + defective
bone growth)
• Osteomalacia – Bone + softening

Incomplete mineralization of the bone !!!

Vitamin D Calcium deficiency


Hypophosphatemia
Comparison
Osteomalacia Rickets
• Characterized by: • Characteristic changes arise from:

a. Appearance of thin trabeculae a. Inability to calcify intercellular matrix


surrounded by unusually wide
uncalcified osteoid.
b. Cellular part of physis is thicker than
normal
b. Mild cases: bone looks normal

c. Newly formed bone in metaphysis is


c. Severe cases: bone cortices are weak  indented and cup shaped
thinner, signs of old/ new stress #

d. Further away from physis


d. Vertebral compression # are common osteomalacia changes seen
Rickets
Vitamin D deficiency Hypophosphataemic
• Dietary lack • Impaired renal tubular
reabsorption
• Underexposure to sunlight
• Calcium levels are normal but
bone mineralization is defective
• Infant – present with
tetany /convulsion, Failure • Vitamin D resistant rickets
to thrive, muscular flacidity (Familial hypophosphataemic
rickets)
• Seldom seen nowadays • Commonest form today
Radiography
• Bowing of long bone –
femur
• Flaring of physes
• Distorted metaphyseal
margin
• Cupping of metaphysis
• Hazy epiphyseal margin
Looser zone
• Lucent band of
decreased cortical
density
• Perpendicular to bone
surface
Biconcave Vertebra
• Inward protrusion of
intervertebral discs
Trefoil Pelvis
• Impression of sacrum
and femora into pelvis
• Also known as triradiate
pelvis
Investigations
• Serum Ca and phosphate are diminished
• Alkaline phosphatase is increased
• Urinary calcium excretion is diminished
Treatment
VIT. D Deficiency Rickets Hypophosphataemic Rickets
• Corrective osteotomy • Large dose of vitamin D (>
50,000 IU)
• Vitamin D supplement
(calciferol 400 -1000 IU per • Up to 4g of inorganic phosphate a
day) day

• Bony deformity – require bracing or


osteotomy

• If the child need to be immobilized


 Vit. D need to be stopped
temporarily
Osteomalacia
• Causes ??
• Lack of vitamin D
• Underexposure to
sunlight
• Intestinal malabsorption
• Defective conversion to
active metabolites in liver
or kidney Stress #

• Why no bony changes


Vertebral
compression #

as in rickets ????
Radiography
• Generalized rarification of bone
• Si of previous # in vertebrae, ribs, pubic rami,
long bones
• Looser zone
Investigations
• Serum calcium and phosphate diminished
• Alkaline phosphatase is raised
• Diminished 25-HCC, 1,25-DHCC
• Biopsy maybe needed
• Ix for underlying cause
Treatment
• Vit D + Ca supplements
• Higher dose of vit D for elderly
(2000 IU/day)
• Treat underlying disorder
THANK YOU ……….. 

You might also like