Osteoporosis
Supervised by: Dr Yosra Moria
Presented by: Forat Obid Alshhada
ID: 161353
Objectives
Background
Saudi Arabia Literature Review
Clinical Features
Physical Examination
Diagnostic Tests
Management
Prognosis
Summary & Take Home Massage
MCQs
Background – Definition Why is it important?
2.5
Background – Classifications
Osteoporosis
Secondary
Primary osteoporosis
osteoporosis
Where there is no underlying(
caused by systemic disease(
)systemic cause
)or medication
Type I Type II (Age related)
(Postmenopausal) Due to aging skeleton and
Due to estrogen deficiency calcium deficiency
Background – Causes of Osteoporosis
Background – Causes of Osteoporosis
Background – Causes of Osteoporosis
Background – Causes of Osteoporosis
Saudi Arabia Literature Review
Saudi Arabia Literature Review
Clinical Features
Most common asymptomatic.
Pathological fractures: A pathologic fracture is a fracture that’s
caused by a pathology in the bone, rather than an injury.
Location of the fractures:
- Vertebral (most common), Vertebral compression.
- Hip fracture.
- Colle’s fracture.
- Fractures of the long bones (e.g., humerus).
Long-term consequences of vertebral compression:
Decreased height (loss of 2–3 cm with each fracture).
Thoracic hyperkyphosis → “dowager's hump”.
Clinical Features
Most common asymptomatic.
Pathological fractures: A pathologic fracture is a
fracture that’s caused by a pathology in the bone, rather
than an injury.
Location of the fractures:
- Vertebral (most common), Vertebral compression.
- Hip fracture.
- Colle’s fracture.
- Fractures of the long bones (e.g., humerus).
Long-term consequences of vertebral compression:
Decreased height (loss of 2–3 cm with each fracture).
Thoracic hyper-kyphosis → “dowager's hump”.
Dowager's hump and decreased height
due to vertebral compression
Physical Examination
Inspection
- Measure height and weight, looking for
decreased height.
- Spine abnormalities (dorsal kyphosis).
- Dowager’s hum and cervical lordosis.
Specific examination:
- Localized pain.
- Neurologic examination (for any deficit
from spinal cord compression).
- Range of motion.
- Wall-Occiput test.
- Rib-pelvis distance test.
Diagnostic Tests
DEXA Scan (GOLD STANDARD)
- Dual-energy x-ray absorptiometry.
- Low dose X-ray to measure bone density.
2.5
Diagnostic Tests
Other tests for secondary causes:
• Complete blood count.
• Blood calcium levels.
• 24-hour urine calcium measurement.
• Thyroid function tests.
• Parathyroid hormone levels.
• Testosterone levels in men.
• 25-hydroxyvitamin D test.
Management
Management of fractures:
Hip fracture Surgical Management.
Pain management.
Physiotherapy.
Management of underlying cause
Controlling risk factors (FRAX tool)
Management
Lifestyle modifications:
Prevent falls in elderly
Nutritional intake of Ca
Weight-bearing exercise
Cut the risk factors:
Smoking cessation.
Stopping alcohol drinking.
Minimize steroids intake as much as possible.
Management – Medications
Selective
estrogen
receptor
modulators
RANKL: Receptor activator of nuclear factor kappa B ligand
Management – Medications
Estrogen:
For women with intolerance to 1st- or 2nd-line
treatment options or with persistent menopausal
symptoms.
Contraindicated in : breast cancer, venous
thromboembolism.
Testosterone:
Men with hypogonadism.
Prognosis
If detected early and proper intervention is done Good prognosis.
If fractures happen:
Vertebral fractures: Increased mortality with poor life quality.
Hip fracture Poor quality of life and the need for surgical
intervention.
Take Home Massage
Little MCQs
Which of the following is the most common site for fractures
in osteoprosis:
A. Femur
B. Colle’s fracture
C. Vertebral fracture
Little MCQs
All of the following represent a risk factor for osteoporosis
except:
A. Smoking
B. Alcohol
C. Low BMI
D. High BMI
Little MCQs
What is the cut of point in diagnosing osteoporosis via DEXA
scan?
A. 1.5 standard deviation from the mean.
B. 2 standard deviation from the mean.
C. 2.5 standard deviation from the mean for the same age and
sex
References:
• Harrison Principles for Internal Medicine.
• Myoclinic
• NCBI
• National Osteoporosis Foundation
[Link]
• Wolter’s Kluwer
[Link]
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