:Definition
The word osteoporosis literally means " المثقب porous bonesالعظم
".it is clincle disorder charichters by abnormely low bone mass,quanititive defect in bone stracture.
-Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily .
Fully minerlize
The three main mechanisms by which osteoporosis
develops are:
Decrease bone formation
Increased bone resorbton
mixedImbalance between them lead to decrease
Bone mass and loss of bone strengh
:Types of Osteoporosis
*Primary osteoporosis :
There are two different types of primary osteoporosisType 1 - Post-menopausal osteoporosisType 1 usually occurs between the ages of 50 to 70, largely because of estrogen loss at menopause
•Exaggerated form of physiological bone depltion that normely
accompined aging and loss of gonadel activity
•Two overlapping phases ,, 1-high turn over osteoporsis duto
increase osteoclast function•2-low turn over duto decrase
osteoblastic activity
* Secondary osteoporosis :
-
:
Secondary osteoporosis can have many causes, including; -Diseases that affect the endocrine systemsuch as hyperthyroidism or hyperparathyroidism -Liver disease and Alcoholism
•-A vitamin D deficiency.
•-Premature menopause•-Sometimes the drug used to
treat other health problems causes osteoporosis. For example: corticosteroids (e.g. Prednisone, inhaled steroids for asthma) •
Risk Factors:
•-Female gender: Because women have lighter, thinner bones than men
•-Advancing age: especially the onset of menopause.
•-Family history• - :Build :Women with thin or
small frames have a higher risk for bone fractures
•-Alcohol consumption;• :Studies show that consuming two
or more alcoholic drinks daily decreases a woman’s rate of calcium absorption, which may lead to bone loss. Alcohol also interferes with vitamin D synthesis-a process that helps bones absorb calcium .
•-Certain diseases: Women who have anorexia (an eating disorder) diabetes, chronic diarrhea, or kidney or liver diseases are at an increased risk for osteoporosis
•-Smoking :smoking interferes with the body’s processing of calcium. smokers experience vertebral fractures more frequently than
nonsmokers .
Sign and symptom:
• Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. *Typical fragility fractures occur in the vertebral column, rib, hip and wrist.
Diagnosis:
•*an initial physical exam•*various x rays that detect skeletal
problems*laboratory tests that reveal important
information about the metabolic process of bone breakdown and formation
•*a bone density test to detect low bone density
*X-Ray Tests:•x ray can detect bone loss only after
30 percent of the skeleton has been depleted
•*Bone Mineral Density Tests: The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. The BMD test is painless, a bit like having an x ray, but with much less exposure to radiation. It measures bone density at the hip and spine .
•During a BMD test, an extremely low energy source is passed over part or all of the body. A computer program evaluates the information and allows the doctor to see how much bone mass you have .
•BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density. When a T-score appears as a negative number (such as –1, –2 or –2.5), it indicates low bone mass. The greater the negative the number, the greater is the risk of fracture.
•RESULTS:•T-score- 1.0 or greater is "normal "
•T-score between -1.0 and -2.5 is "low bone mass" (or osteopenia
•T-score -2.5 or below is osteoporosis
Bone Scans:•A bone scan involves injecting
the patient with a dye that allows a scanner to identify differences in the conditions of various areas of bone tissue. A bone scan can show the doctor changes in bone tissue that may indicate cancer, bone lesions, inflammation, or new fractures.
Lab Tests:•*The most common blood tests
evaluate:•blood vitamin D levels
•thyroid function•parathyroid hormone levels
•estradiol levels to measure estrogen (in women)
•follicle stimulating hormone (FSH) test to establish menopause status
•testosterone levels (in men)•osteocalcin levels to measure bone
formation
Treatment:
Drugshormone replacement therapy( HRT ,)also called
estrogen replacement therapy However, the WHI also revealed several risks with taking combined HRT )estrogen and progesterone(. In fact, the trial was stopped early because the incidence of invasive breast cancer in women on HRT passed a threshold that was considered too risky for the benefits they were receiving. The study also found that the women on combined hormone therapy were at increased risk for coronary heart disease
and stroke
bisphosphonate
Supression osteoclastic bone resorbtion . Alendronate. Used one dose per week for month ,have git side effect if pt cant tolerate pamidronate hase given iv every 3
month
Denosumab
•New approch of antiresorptive therpy
•It is human monoclonal antibody which inhibits the receptor activitor
need to activate osteoclast differentiation
•Adminstreted subcutaneous injection every 6 month and must
supplimented with ca and vit d
Osteomalacia vs osteoporosis
Osteomalacia Osteoporosis Ageing fem, #, decreased bone dens
Ill Not illGeneral ache Asympt till#
Weak musclesnormalLoosersnil
Alk ph incr normalPO4 decrnormal
Ca x PO4 <2.4Ca x PO4 >2.4
Alternative treatment:
•Alternative treatments for osteoporosis focus on maintaining or building strong bones. A healthy diet low in fats and animal products and containing whole grains, fresh fruits and vegetables, and calcium-rich foods (such as dairy products, dark-green leafy vegetables, salmon), along with nutritional supplements (such as calcium, magnesium, and vitamin D), and weight-bearing exercises are important components of both conventional prevention
Prognosis:•Although osteoporosis patients
have an increased mortality rate due to the complications of fracture, it is rarely lethal
•-Hip fractures; can lead to decreased mobility and an additional risk of numerous complications(such as deep venous thrombosis and/or pulmonary embolism pneumonia)
•-Vertebral fractures:can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare,
multiple vertebral fractures can lead to such severe hunch back (kyphosis) that the resulting pressure on internal organs can impair one's ability to breathe .
Prevention:
•Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways to prevent osteoporosis. Getting calcium from foods Getting vitamin d Avoiding smoking and alcohol
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