Transcript
Osteoporosis
Dr. Cho Mar Lwin
Rheumatology Unit, YGH
15th Medical Specialties Conference, 2011
MMA
Definition
“Systemic skeletal disease
characterized by low bone mass
and micro architectural
deterioration with a consequent
increase in bone fragility and
susceptibility to fractures”.
7/10/2011 15th Medical Specialties Conference, 2011 2
Normal bone
Osteoporotic Bone
Consensus Development Conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.
Definition
7/10/2011 15th Medical Specialties Conference, 2011 3
In 1994, an expert panel convened by The World Health Organization has published criteria for osteoporosis based on bone density
Definition• Osteopenia (low bone mass) - bone
density measurement between 1 and 2.5 SD below the young-adult mean (T-score between -1 and -2.5).
• Osteoporosis - bone density measurement less than 2.5 SD below young, healthy controls (T-score <2.5).
• Established osteoporosis is defined as a T-score <2.5 and the presence of a fracture.
7/10/2011 15th Medical Specialties Conference, 2011 4
- 1
- 2.5
Genant HK, Cooper C, Poor G, et al. Interim report and recommendations of the World Health Organization Task-
Force for Osteoporosis. Osteoporos Int 1999;10: 259-64.
Incidence and Prevalence
Worldwide
estimated to affect 200 million women .
7/10/2011 15th Medical Specialties Conference, 2011 5
Kanis JA (2007) WHO Technical Report, University of Sheffield, UK: 66.
10% of > 60 yr 20% of > 70 yr 40% of > 80 yr 65% of > 90 yr
Non Osteoporotic women Osteoporotic women
• An osteoporotic fracture is estimated to occur every 3 seconds world wide
• Osteoporotic fractures after 50 year of age
7/10/2011 15th Medical Specialties Conference, 2011 6
1/3 1/5
Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and disability associated with
osteoporotic fractures. Osteoporos Int 17:1726.
Incidence and Prevalence
80% of osteoporotic people are women
By 2050, the worldwide incidence of hip
fracture in men is projected to increase by
310% and 240% in women
7/10/2011 15th Medical Specialties Conference, 2011 7
Incidence and Prevalence
Gullberg B, Johnell O, Kanis JA (1997) World-wide projections for hip fracture. Osteoporos Int 7:407.
Lindsay R et al., 2001, JAMA 285:320
The annual incidence rate of osteoporotic fractures in
women is greater than the combined incidence rates of
heart attack, stroke and breast cancer
7/10/2011 15th Medical Specialties Conference, 2011 8
Incidence and Prevalence
Riggs BL and Melton LJ, 1995, Bone 17(s5); 505S; American Heart Association, Heart & Stroke Facts 1996; American Cancer Society,
Cancer Facts and Figures, 1996
Burden of the Disease
The combined lifetime risk for hip, forearm and vertebral fractures coming to clinical attention is around 40%, equivalent to the risk for cardiovascular disease
7/10/2011 15th Medical Specialties Conference, 2011 9
Kanis JA (2002) Diagnosis of osteoporosis and assessment of fracture risk. Lancet 359:1929.
The disability due to osteoporosis is greater than that
caused by cancers (with the exception of lung
cancer) and is comparable or greater than that lost to
a variety of chronic non communicable diseases,
such as rheumatoid arthritis, asthma and high blood
pressure related heart disease
7/10/2011 15th Medical Specialties Conference, 2011 10
Burden of Disease
Johnell O and Kanis JA (2006) An estimate of the worldwide prevalence and
disability associated with osteoporotic fractures. Osteoporos Int 17:1726.
The worldwide cost
burden of osteoporosis
(for all ages) is forecast to
increase to USD131.5
billion by 2050
7/10/2011 15th Medical Specialties Conference, 2011 11
Burden of the Disease
Lindsay R et al., 2001, JAMA 285:320
Updates on some Asian Countries
7/10/2011 15th Medical Specialties Conference, 2011 12
300% last 30 yr22.5% - men > 50 50.1% - women > 50
Women 30 – 60 yr52% - osteopenia29% - osteoporosis
Women 50 – 79 yr35% - spine9.5% - hip
Hip fractures 4 times over 10 yrs
Hip fractures x 5 in women , x 1.5 in men over 3 decades
Osteoporosis in 51.8% urban menopausal women
Osteoporosis -> 50 % in > 70 yr old women
Osteoporosis –61.5% in women > 50 yr old
7/10/2011 15th Medical Specialties Conference, 2011 13
Prevalence of 5 main musculoskeletal diseases in Myanmar (C Soe, 2006)
Prevalence in Myanmar
• A study on risk factors of bony fractures in post-menopausal Myanmar women, by Thida Win-1998 conducted in Trauma unit YGH
Postmenopausal osteoporosis fracture - 53.8%
• Osteoporosis, Prevalence and Risk by Chit Soe, Aye Aye Khaing and Pandora Aung Gyi( Myanmar Health Research Congress, 2004)
Osteopenia in 31%of teachers and 31.5%of nurses; no patient with osteoporosis
7/10/2011 15th Medical Specialties Conference, 2011 14
• YGH osteoporosis study (Chit Soe, 2010) conducted in 67 Rheumatology patients
24.1.06 BJD 15
Prevalence in Myanmar
Female osteopenia (19.3%), osteoporosis (15.8%)
Male osteopenia (20%), osteoporosis (10%)
1. PrimaryPrevious fracture at <50 yr, parent or sibling with previous
fractures, cigarette smoking, weight <127 lb or height >5 ft 7 in
2. SecondaryNon modifiable
• White race, advanced age, frailty or poor health, dementia
Modifiable• Low calcium intake, eating disorder, low testosterone
levels (men), premenopausal estrogen deficiency (amenorrhea >1 yr or menopause at age <45 yr),
• excessive alcohol intake, physical inactivity, impaired vision, neurologic disorders, lack of sunlight exposure
Risk Factors for Osteoporosis
7/10/2011 15th Medical Specialties Conference, 2011 16
Indications for Bone Densitometry• All postmenopausal women <65 yr who have one or more
additional risk factors for osteoporosis, besides menopause
• All women >65 yr regardless of additional risk factors
• Documenting reduced bone density in a patient with a vertebral abnormality or osteopenia on a radiograph
• Estrogen-deficient women at risk for low bone density, considering use of estrogen or an alternative therapy, if bone density would facilitate the decision
• Women who have been on estrogen replacement therapy for prolonged periods or to monitor the efficacy of a therapeutic intervention or interventions for osteoporosis
• Diagnosing low bone mass in glucocorticoid-treated individuals
• Documenting low bone density in patients with asymptomatic primary or secondary hyperparathyroidism7/10/2011 15th Medical Specialties Conference, 2011 17
top related