Osteoporosis rough final.pptx by Final year MBBS

Clinical features of osteoporosis , introduction

1. Osteoporosis NAME: NANDINI SAHA REG NUMBER: 122016101082

2. introduction Osteoporosis is characterised by a decrease in the amount of bone, but the ratio of bone mineral to bone matrix is normal. In osteomalacia, the ratio of bone mineral to bone matrix is low. Osteoporosis means “porous bone”. The rate of bone formation is often normal, whereas rate of bone resorption is often increased. Osteoporosis is associated with increase in risk of fractures especially the spine and hip. It is a leading cause of morbidity and mortality in elder people. It is the most common bone disease. One-third of all women and one-fifth of men aged 50 and above suffer from fractures at some point in life. Common sites of fractures are the forearm (Colle’s fracture), spine ( vertebral fracture), humerus and rib. Fractures increase with age. Hip fractures are more common complications. Immediate morbidity is 12% Continued morbidity is 20%

3. Defining Osteoporosis "Progressive systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk" True Definition: bone with lower density and higher fracture risk WHO: utilizes Bone Mineral Density as definition (T score < -2.5); surrogate marker Changes in bone mass with age: Changes in men(blue line), changes in women(red line)

4. Pathophysiology Result of prolonged imbalance of Bone Remodeling: - Bone remodeling occurs throughout an individual's lifetime. - In normal adults, the activity of osteoclasts (bone resorption) is balanced by that of osteoblasts (bone formation). - Normal bone remodeling in the adult result in gradually increase bone mass until the early 30s. with ageing the peak bone mass is gradually decrease and 1. Calcitonin which inhibit bone resorption and promote bone formation. (decrease) 2. Estrogen which inhibit bone breakdown. (decrease) 3. PTH increase bone turnover and resorption. (increase)

5. PATHOPHYSIOLOGY Bone remodeling has two primary functions ✓ To repair micro damage within the skeleton to maintain skeletal strength and relative youth of the skeleton ✓ To supply calcium from the skeleton to maintain serum calcium After 30-45 years of age, bone resorption exceeds formation Remodeling may be activated by micro damage to bone as a result of excessive or accumulated stress

6. pathogenesis Rate of Resorption > formation Bone becomes weak and brittle & loss of bone mass Bone mineral density is decreased due to deficiency of Ca and Vitamin D. Since there is Ca deficiency it stimulates parathyroid gland. PTH desorbs Ca from bones to meet bodily requirement of Ca.

7. Risk factors for osteoporosis Genetics :- Single – Gene disorder: LRP5 mutations Oestrogen Receptor Mutations Polygenic Inheritance Polygenic Inheritance: Common variants in many pathways Endocrine Disease :- Hypogonadism Hyperthyroidism Hyperparathyroidism Cushing’s Syndrome

8. Inflammatory Disease :- Ankylosing Spondylitis Inflammatory Bowel Disease Rheumatoid arthritis Drugs :- Glucocorticoids Gonadotrophin – releasing hormone (GnRH) agonists Levothyroxine Over replacement Aromatase inhibitors Thiazolidinediones Anticonvulsants Alcohol intake > 3 u per day Heparin

9. Gastrointestinal Disease :- Malabsorption Chronic liver disease Lung Disease :- Chronic Obstructive Pulmonary Disease Cystic Fibrosis Miscellaneous :- Myeloma Homocystinuria Anorexia Nervosa Highly trained athletes HIV Infection Gaucher’s Disease Systemic mastocystosis

10. Miscellaneous :- Immobilisation Low Body Mass Index Heavy Smoking Auto antibodies to osteoprotegenin

11. AETIOLOGY OF OSTEOPOROSIS PRIMARY OSTEOPOROSIS :- TYPE 1 - mainly affects women, hormone related and due to overactive osteoclasts. Bone loss is most rapid in 10 years after menopause. TYPE 2: affecting both sexes, age related and due to underactive osteoblasts IDIOPATHIC: less common, affects young. SECONDARY OSTEOPOROSIS :- T his is associated with factors which predispose individual to reduced bone density e.g.. Nutrition, hormones, drugs, disease, rheumatologic conditions.

12. CAUSES OF OSTEOPOROSIS Confined to the bed. Vitamin D deficiency, lack of calcium, chronic arthritis, kidney disease. Excess consumption of alcohol and cigarettes. Family history. Idiopathic age related osteoporosis (most common)

13. Clinical features RISK OF FRACTURES :- Osteoporosis can be clinically silent and does not have specific symptoms. However, it increases the risk of bone fractures and the fracture is the only cause of symptoms which increases the morbidity and mortality in elderly. FRAGILITY FRACTURE :- It is a low-trauma fracture, that is mechanical forces (situations) that would not ordinarily result in fracture in healthy people. They typically occur in trabecular bone. The most common sites are : Spine (Vertebrae) : Sudden severe backpain (in the spine) that radiates around to the front suggests vertebral crush fracture (compression fracture) Hip (Proximal femur) :Fractures of the proximal femur usually occurs in elderly persons falling on their side or back. Wrist (Distal Radius) :Colle’s fractures follow a fall on an outstretched arm Other sites include arm (humerus), pelvis, ribs, and other bones.