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Transcript of 1 Tuesday 28 Oct 2008 Hall I Session I: 8:00- 10:00 Symposium... 1 Tuesday 28 Oct 2008 Hall I...
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• 1 Tuesday 28 Oct 2008 Hall I Session I: 8:00-10:00 Symposium ...
• www.iranoa.org/congress/16_complete.pdf• File Format: PDF/Adobe Acrobat - Quick View
A.Shahla, MD (Iran). 9:14-9:22. Treatment of femoral shaft fractures a comparative study between open intramedullary nail and plate & screw (paper) ...
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Evaluation of osteoporosis in patients with a hip fracture
A,SHAHLA.MDUrmia university of medical sciences
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“…a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.”
Definition of osteoporosis
World Health Organization (WHO), 1994
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normal osteoporotic
Trabecular bone
Bone quality is not the only factor …
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Osteoporosis major public healt treat55% people 50yr and older
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Bone loss starts slow decline 3rd decade 0.5-1% pr/yr
6rd decade 2-3% pr/yr
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The life risk of sustaining an osteoporotic fracture has been estimated at50%,compared with9% for
breast cancer and 31% for coronary artery disease
Arch intern med1989;149:2445-8.
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Osteoporosis evaluation
Bone mineral density (BMD)
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World Health Organization (WHO)guidelines for osteoporosis
Osteoporosis Osteopenia
Normal
Peak Bone Mass
-2.5 -2 1 0T-Score
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Definitions: BMD Results
Status T-scoreT-score= # of SDs below or above mean value of BMD for young (20-29yo) adults
Normal +2.5 to −1.0, inclusiveOsteopenia Between −1.0 and −2.5Osteoporosis −2.5Severe osteoporosis −2.5 + fragility fracture
Z-score= # of SDs below the mean value for people ofthe same age
Kanis JA. J Bone Miner Res 1994;9:1137-1141.
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Osteoporotic fractures
• 1.5 million in USA• 250.000 fx/yr• 300.000 hip• 250.000 wrist• 700.000 spine• 300.000 other sites
• National osteoporosis foundaton.2005
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Hip fracture is serious consequence of hip fractureeven small increase in lifespan will lead to large
increase in the rate of hip fractures
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Hip fractures worldwidewas1.7million in1990 and projected to 6.3 million in2050
Curr osteoporos.2003;1:66-70
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Consequences of hip fracture
• 20%mortality within 6months• 50%loss ability to walk• 20%sever impaired mobility after 12 months
requiring nursing care• Increased risk of furher fracture5.2%first yr-
10.3% 3 yr
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Optimal fracture treatment – a prerequisite for maintaining quality of life
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Care gap
Few patients are offered investigation or treatment for osteoporosis
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Interventions to improve osteoporosis treatment following hip fracture
Gardner MJ. JBJS(American).2005;87:3-7
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Barriers and solution to osteoporosis care in patients with a hip fracture
Kaufman JD. JBJS(American).2003;85:1837-43
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Orthopedic surgeon should identify and initiate the assessment of osteoporosis in patients with fragility fractures
Intrnational osteoporosis foundation(IOF)
osteoporosis int.2005;16 suppl:44-53
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BMD,T score is suggested for evaluation of osteoporotic fractures
USA National osteoporosis risk assessment(NORA)
Osteoporos int.2006;17:565-74
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Evaluation of osteoporosis in patients with a hip fracture in Urmia
Shahid motahhari hospitalSeptember2004-january2006
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Contra lateral hip BMD were detected
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Excluding criteria
• Previous hip fracture• Precedent osteoporosis treatment• Acute medical complications requiring intense
care• Long term steroid therapy• Paralytic patients• bedridden
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76 hip fracture patients
• 50yr and older• Low energy trauma(fall)
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Men 44(57.9%) Women 32(42.1%0)Age 50-90 mean 66yrTrochantric 55(77.4%)Femoral neck 21(27.6%)
.
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Fixation 58(76.3%)Hemiathroplasty 12(15.8%)Traction 3(3.95)Conservative 3(3.9%)
.
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55(72%) osteoprosis17(23%) osteopenia4(5%) normal
.
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There were not significance
men and womenNeck and trochantric fractures
age
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Urmia • 76 patients• Female 42%• Male 58%• Mean age 66yr• Femural neck 27.6%• Intertrochantric 77.4%• Subtrochantric –• Osteporosis 72%
Florida Kamel H. Clin Rheumatol 2005;11:68-71. • 95 patients• Female 71%• Male29%• Mean age 81yr• Femural neck 51%• Intertrochantric 46%• Subtrochantric 3%• Osteoporosis 17%
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Definition vs Treatment
• Defination• T score > _1.0 normal• T score = _1 to_2.5
osteopenia• T score <_2.5
osteoporosis
• Treat for osteoporosis• WHO T score<_2.0• NOF T score<_1.5
with additional risk factors
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Alendronate 10mg /day_70mg /week
Vit D 800-1000 iu/dayCalcium 500-1000 mg/day
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bisphosphonates
• Mechanism: blind to hydroxappetite at site of active bone resorption inhibiting osteoclast function
• Alendronate 10mg /day_70mg /week
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Advantages of bisphosphonates
• Increased BMD 1-4%• Decrease fracture risk 41-44%• No increased risk of breast,uterine
thromboembolic events• Weekly dosing