Some facts……..

Osteoporosis is a global public health problem currently

affecting more than 200 million people worldwide

Eighty percent of people who suffer osteoporosis are women.

Statistics suggests that the disorder is responsible for more than 1.5
million fractures worldwide annually, including
• over 3,00,000 hip fractures
• approximately 7,00,000 vertebral fractures
• 2,50,000 wrist fractures and
• 3,00,000 fractures at other sites.

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Number of Osteoporosis patients
are approximately
26 million (2003 figures) ,
the numbers projected to
increase to 36 million by 2013
1 out of 8 males and 1 out of 3 females
in India suffers from osteoporosis,
making India one of the largest affected
countries in the world.

Two points worth noting about Osteoporosis in India –

• the high incidence among men and
• the lower age of peak incidence compared to Western countries.

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h Osteoporosis is a condition characterized by a decrease in the density of
bone, decreasing its strength and resulting in fragile or weak bones.
h Osteoporosis literally leads to abnormally porous bone that is
compressible, like a sponge.

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Contd…

• Bones that are affected by

osteoporosis can break with
relatively minor injury that
normally would not cause a bone to
fracture.

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h Bone fractures from Osteoporosis can occur in almost any bone.

h Fractures of :-

spine, hips,

ribs, and wrists are common

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 The bone is a living structure

It is constantly being built and removed

(resorbed).

This process is an essential part for

• maintaining Calcium levels in the blood,
• serves to repair tiny cracks
(which occur with normal daily activity) and
• to remodel bone

Osteoporosis results when the rate of bone resorption (calcium uptake from
bones) exceeds the rate of bone rebuilding.

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 Calcium leaches from the bone mass

small holes form in the bones

bone weakening

process continues

pores and empty spaces within the bone

grow larger

Osteoporosis

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i Female gender

i Low estrogen levels in women (such as occur in menopause or with early

surgical removal of both ovaries)

i Caucasian or Asian race

i Family history of Osteoporosis

i Cigarette smoking & Alcohol consumption

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i Lack of exercise

i Poor nutrition, diet low in calcium and poor general health

i Amenorrhea (loss of the menstrual period)

i Low testosterone levels in men

i Immobility, such as after a stroke

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i Hyperthyroidism – excessive Thyroid hormone

i Hyperparathyroidism - excessive Parathyroid Hormone (PTH)

PTH --- > removes Calcium from the bone ----> maintains Blood Calcium levels
In untreated hyperparathyroidism --- > excessive PTH --- > too much Calcium
removed from the bone ---- > Osteoporosis

i Vitamin D deficiency ---- > the body cannot absorb adequate amounts of
calcium from diet + lack of intestinal absorption of the vitamin or reduced intake

Osteoporosis

i Medications - esp. Anti-epileptic Medicines & Steroids

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i Osteoporosis can be present without any symptoms

i Bone fractures

Æ Recurrent Vertebral fractures -- Loss of height, presenting as hunched back

Æ Hip fractures -- occur as a result of a fall

i Cramps in the legs at night

i Neck pain, persistent pain in the lower back

i Fatigue, Brittle nails

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i X-ray
Not an accurate indicator of Bone Mineral Density (BMD).

i Dual-energy X-ray absorptiometry scan (DXA, formerly known as DEXA)

DXA measures BMD in the hip and the spine.

i Quantitative Computed Tomography

- Measures BMD
- The radiation dose with QCT is about ten times that of DXA
- More expensive than DXA.

i Peripheral Bone Density Testing

- Used for osteoporosis screening
- Lower cost portable devices
- Determine BMD at peripheral sites (radius, phalanges, or calcaneus)
- low bone density in the hip or spine may be missed

i Blood Calcium levels have no role whatsoever in diagnosis of Osteoporosis

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Goal of treatment is the prevention of bone fractures by
- reducing bone loss and
- increasing bone density and strength.

Early Detection and timely Treatment of Osteoporosis can substantially decrease

the risk of future fractures

Osteoporosis treatment and prevention measures are :

i Lifestyle changes

i Medications that stop bone loss and increase bone strength

Biphosphonates (alendronate, risedronate, zoledronate), Calcium, Vitamin D3,
Calcitonin etc

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Lifestyle Changes
i Quitting Cigarette smoking

i Curtailing excessive Alcohol intake

i Exercising regularly

i Consuming a balanced diet with adequate Calcium and vitamin D –

- Adequate calcium intake throughout life
- especially early in life, during pregnancy, during lactation, and
- in old age when calcium absorption is erratic.

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 Medications

Anti Resorptive Agents Anabolic Agents

Slow the process of bone loss Stimulate bone formation

i Hormone Replacement Therapy

(Estrogen alone / combined with Progestin) i Teriparatide
i Selective Estrogen Receptor Modulators (portion of PTH – injectable)
(Raloxifene)
i Biphosphonates
(Alendronate, Risedronate, Etidronate – Oral
Zoledronate – Intravenous preparation)

Increase Bone Mineral Density

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 Calcium & Vitamin D3
Supplements are given to ensure
i Adequate levels in the body
i Maximum effectiveness of Drug Therapy

Calcitonin
i Hormonal Preparation
i Injectable / Nasal Spray
i Decreases rate of vertebral fractures by 33%

Denosumab
i Human Monoclonal Antibodies
i Inhibits bone resorption
i Decreases risk of Vertebral fractures by 70%

The drugs should be used in accordance with Official guidance.

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 Ages Required Calcium per day

25 – 50 (Women & Men) 1000 mg

51 – 64 (Women on ERT & Men) 1000 mg

51 + (Women not on ERT) 1500 mg

65 or older 1500 mg

ERT – Estrogen Replacement Therapy

National Institute of Health

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Chicken
Crab
Cauliflower

Fenugreek

Almonds
Ragi

Beetroot
Milk
Prawn, Mutton
Pistachio Raisins
Curds, Milk powder

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Thank you