Professional Documents
Culture Documents
Blondina Marpaung
Rheumatology Division
Internal Department
Medical Faculty USU - Medan
EPIDEMIOLOGY
Osteoporosis is a major public health problem, and
postmenopausal osteoporosis constitutes as a major part
of the problem.
Claus Christiansen, Am J Med 1993
Introduction
Osteoporosis is a disease characterized
by low bone mass and microarchitectural
deterioration of bone tissue, leading to
enhance bone fragility and a consequent
increase in fracture risk
(WHO)
Senile Osteoporosis
Occurs
Etiology :
General factor predictive of osteoporosis :
1. Peak bone mass at maturity :
General / familial
Nutritional
Physical (activity status, exercise, etc)
Life style (alcohol, cigarettes, caffeine)
Medical (chronic disease, hypogonadal states, etc
Iatrogenic (corticosteroid, anticonvulsant, etc)
Orthopaedics Study Guide, Metabolic Bone Disease, 1999, p.885-889
Bone Mass
Development
Bone Mass
Bone Loss
male
Menopause
female
20
40
age
Age (year)
60
80
4. Risk factors
Genetic, life style, Medical, Iatrogenic
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
- Female sex
- Caucasian / Asian ethnicity
- Family history of osteoporosis
2. Life Style
3. Medical :
- Early menopause
- Gonadal hormone deficiency
states
- Eating disorders
- Chronic liver / kidney disease
- Malabsorption syndrome
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
4. Iatrogenic
- Corticosteroids
- Excessive thyroid hormone
- Chronic heparin therapy
- Radiotherapy to skeleton
- Long-term anticonvulsants
- Loop diuretics
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
DIAGNOSIS
History :
o ras, sex and age
o health status
o life style (alcohol, smoking)
o physical activity (sports)
o history of previous disease including administration of
drugs, previous fracture.
Physical Examination :
Body weight and height (BMI)
Extremities and spine including :
deformity, MMT and ROM
Laboratory findings :
o blood serum
o hormone
o Urine
LABORATORY FINDINGS :
Routine:
- Serum :
- Complete blood counts
- Electrolytes, creatinine, blood urea, nitrogen calcium
- Phosphorus, protein, albumin, alkaline phosphatase,
liver enzyme
- Protein electrophoresis
- Thyroid function tests
- Testoterone (men only)
- 24 hours urine :
- calcium
- Pyridinium cross-links
LABORATORY FINDINGS :
Spesial :
- Serum:
- 25 hydroxyvitamin D3
- 1,25 hydroxyvitamin D3
- intact parathyroid hormone
- osteocalcium (bone Gla protein)
- Urine :
- Immunoelectrophoresis
- Bence-Jones protein
IMAGING :
Radiology : plain X-ray
(especially the spine, hip and wirst)
The spine
The Hip
- Singh Index
The Wirst
Fracture risk
Teatment
> +1
very low
no treatment
densitometry with indication
-1 s/d 0
low
no treatment
densitometry after 5 years
- 1 s/d +1
low
no treatment
densitometry after 2 years
-1s/d -2,5
midle
prevention
densitometry after 1 years
< - 2,5
no fracture
high
osteoporosis treatment
continue prevention
densitometry after 1 years
< - 2,5
With fracture
very high
osteoporosis treatment
continue prevention
surgery with indication
densitometry after within
Prevention
Aging process is a natural process of a person
getting old
3 steps of osteoporosis prevention :
I. Up to the end of 3rd decade
where Peak Bone Mass should be
achieved
II. After the 3rd decade up to menopause /
Andropause
III. Senile, prevent from minor injury /
accident
1st Prevention :
Good nutrition
2nd Prevention
3rd Prevention
Prevent from accident
(minor injury could cause fracture)
Care giver especially after fracture
Operative intervention and bracing
Treatment
Nowadays there is a lot of medication
For osteoporosis such as :
- calcium and vitamin D
- calcitriol
- calcitonin
- bisphosphonate : generation : I III
such as (clorodronate, alendronate, and
risedronate (actonel))
- hormone : - anabolic
- sex hormone
- SEMs (Selective Modulator)
- SERM (Selective Estrogen Reseptor
Modulator : Raloxifene
(analogue of tamosifene)
SURGERY
Calcium
: 1500 mg / day
HRT
Dr. C. Deeply
400 700
1000 1500
750 1000
1500
2000
800 1000
1000 1200
1200 1500
mg
mg
mg
mg
mg
mg
mg
mg
/
/
/
/
/
/
/
/
day
day
day
day
day
day
day
day
100 g
40 g
100 g
Emping
1 gelas
20 gr
Food ingredient
Teri nasi
Kepiting
2. Calcium Lactate
3. Calcium Phosphate
Note :
Brand name
Ca-C 100 Sandoz
Calsan
Caxon-F
Calsium Sandoz
Epocaldi
Ca-C 1000 Sandoz
Calcidin
Calsium Sandoz
Calcidin
Calcalcin
Calsium(mg)
327
1250
250
300
400
1000
100
2940
200
800