Osteoporosis

Dr.Suneet TandonDr.Suneet Tandon

Assistant Prof. OrthopaedicsAssistant Prof. OrthopaedicsGandhi Medical College, BhopalGandhi Medical College, Bhopal

OSTEOPOROSISOSTEOPOROSISWhat is it?What is it?

Osteoporosis, or porous bone, is a disease Osteoporosis, or porous bone, is a disease characterized by low bone mass and structural characterized by low bone mass and structural deterioration of bone tissue, leading to bone deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fragility and an increased susceptibility to fractures, especially of the spine, hip and wrist, fractures, especially of the spine, hip and wrist, although any bone can be affected . although any bone can be affected .

Bones…Bones…

Real bone is not what Real bone is not what one sees in one sees in dissection hall or dissection hall or graveyardgraveyard

Real bone is the Real bone is the living tissue of the living tissue of the body, it is very body, it is very dynamic structure dynamic structure with high metabolic with high metabolic activity.activity.

Bones…Bones…

Human skeleton consists of two Human skeleton consists of two

types of bone types of bone

– Cortical or Compact boneCortical or Compact bone ::

makes up 80% of bone mass. It is makes up 80% of bone mass. It is

found primarily in skull and shaft of found primarily in skull and shaft of

long bones. long bones.

– Cancellous bone:Cancellous bone: makes up 20% makes up 20%

of total bone mass. It is found of total bone mass. It is found

primarily in vertebrae, distal ends of primarily in vertebrae, distal ends of

long bones. long bones.

Bones…Bones…

No available material in the No available material in the world can withstand all the world can withstand all the mechanical stresses put on it for mechanical stresses put on it for a long time without breaking. a long time without breaking.

Our bones may last for as long Our bones may last for as long

as 100 years without breaking. as 100 years without breaking.

That’s why the term : That’s why the term :

““AS HARD AS BONE , AS HARD AS BONE ,

AS STRONG AS BONE.”AS STRONG AS BONE.”

Bone Turnover…Bone Turnover… Throughout your lifetime, old bone is removed Throughout your lifetime, old bone is removed

(resorption) and new bone is added to the skeleton (resorption) and new bone is added to the skeleton (formation). (formation).

• During childhood and teenage years, new bone is During childhood and teenage years, new bone is added faster than old bone is removed. As a result, added faster than old bone is removed. As a result, bones become larger, heavier, and denser. bones become larger, heavier, and denser. • Bone formation continues at a pace faster than Bone formation continues at a pace faster than resorption until resorption until peak bone mass (maximum bone (maximum bone density and strength) is reached around age 30.density and strength) is reached around age 30.

Bone Turnover…Bone Turnover… After age 30, bone resorption slowly begins After age 30, bone resorption slowly begins

to exceed bone formation. Calcium starts to exceed bone formation. Calcium starts going out of the bone at the rate of 2-3% going out of the bone at the rate of 2-3% during the first few years and thereafter at during the first few years and thereafter at the rate of 0.5-1%. Bone loss is most rapid in the rate of 0.5-1%. Bone loss is most rapid in the first few years after menopause but the first few years after menopause but persists into the postmenopausal years. persists into the postmenopausal years.

Osteoporosis develops when bone resorption Osteoporosis develops when bone resorption occurs too quickly or if replacement occurs occurs too quickly or if replacement occurs too slowly. Osteoporosis is more likely to too slowly. Osteoporosis is more likely to develop if you did not reach optimal bone develop if you did not reach optimal bone mass during your bone building years.  mass during your bone building years. 

RISK FACTORSRISK FACTORSRisk factors you cannot change: Risk factors you cannot change:  GenderGender -- Your chances of developing osteoporosis Your chances of developing osteoporosis

are greater if you are a woman. Women have less are greater if you are a woman. Women have less bone tissue and lose bone more rapidly than men bone tissue and lose bone more rapidly than men because of the changes involved in menopause.  because of the changes involved in menopause. 

Age Age - - the older you are, the greater your risk of the older you are, the greater your risk of osteoporosis. Your bones become less dense and osteoporosis. Your bones become less dense and weaker as you age.  weaker as you age. 

Body sizeBody size - - Small, thin-boned women are at greater Small, thin-boned women are at greater risk.  risk. 

Ethnicity Ethnicity -- Caucasian and Caucasian and AsianAsian women are at women are at highest risk. African-American and Latino women have highest risk. African-American and Latino women have a lower but significant risk.  a lower but significant risk. 

Family historyFamily history -- Susceptibility to fracture may be, in Susceptibility to fracture may be, in part, hereditary. People whose parents have a history part, hereditary. People whose parents have a history of fractures also seem to have reduced bone mass of fractures also seem to have reduced bone mass and may be at risk for fractures. and may be at risk for fractures. 

RISK FACTORSRISK FACTORS

Risk factors you can change: Risk factors you can change:  Sex hormones: abnormal absence of Sex hormones: abnormal absence of

menstrual periods (amenorrhea), low menstrual periods (amenorrhea), low estrogen level (menopause), and low estrogen level (menopause), and low testosterone level in men.  testosterone level in men. 

Anorexia.  A lifetime diet low in calcium Anorexia.  A lifetime diet low in calcium and vitamin D.  Use of certain and vitamin D.  Use of certain medications, such as glucocorticoids or medications, such as glucocorticoids or some anticonvulsants.  An inactive some anticonvulsants.  An inactive lifestyle or extended lifestyle or extended bed rest. bed rest. 

Cigarette smoking.  Cigarette smoking.  Excessive use of alcoholExcessive use of alcohol

CLINICAL FEATURES…CLINICAL FEATURES…

Osteoporosis : Silent Osteoporosis : Silent epidemic because as such epidemic because as such it does not cause any it does not cause any symptom. symptom.

Only signs and symptoms Only signs and symptoms are of Fracture.are of Fracture.Like -Like -

Pain Pain Deformity Deformity DisabilityDisability

FACTS AND FIGURES…FACTS AND FIGURES… As per WHO report over 65Yrs world population will As per WHO report over 65Yrs world population will

almost double from 380 million in year 1996 to 690 almost double from 380 million in year 1996 to 690 million in year 2020. A growth of about 84% and million in year 2020. A growth of about 84% and along with it grows the no. of patients having along with it grows the no. of patients having osteoporosis. osteoporosis.

With the advances in the field of medicine a woman With the advances in the field of medicine a woman is expected to spend more than one third of her is expected to spend more than one third of her lifetime in the post menopausal dayslifetime in the post menopausal days

Osteoporosis affects 200 million people around the Osteoporosis affects 200 million people around the worldworld

In India In India 61 million people61 million people suffer from osteoporosis. suffer from osteoporosis. 80%80% of them are females. of them are females.

FACTS AND FIGURES…FACTS AND FIGURES… Every 20 seconds osteoporosis causes a fracture. Every 20 seconds osteoporosis causes a fracture.

Osteoporosis is supposed to cause 1.5 million fractures Osteoporosis is supposed to cause 1.5 million fractures annually.annually.

20% of women who experience a vertebral fracture will 20% of women who experience a vertebral fracture will

have another fracture within a year. have another fracture within a year. 24% of hip fracture patients die within a year of getting 24% of hip fracture patients die within a year of getting

the fracture. the fracture. 50% of hip fracture patients require support for 50% of hip fracture patients require support for

walking. walking.

FACTS AND FIGURES… FACTS AND FIGURES… Out of 50million Americans with Out of 50million Americans with

hypertension two out of three are diagnosed hypertension two out of three are diagnosed and about one half are under treatment. In and about one half are under treatment. In contrast 9 out of 10 individuals with contrast 9 out of 10 individuals with significant bone loss receive no treatment.significant bone loss receive no treatment.

In India it is estimated that 99 percent of In India it is estimated that 99 percent of osteoporosis goes undiagnosed. osteoporosis goes undiagnosed.

One in Two women and One in Four men One in Two women and One in Four men over age 50 will have an osteoporosis-related over age 50 will have an osteoporosis-related fracture in her/his remaining lifetime fracture in her/his remaining lifetime

Don’t worry it is not that gloomy…Don’t worry it is not that gloomy…

Osteoporosis is a disease Osteoporosis is a disease

which can be treated. which can be treated.

Osteoporosis is a disease Osteoporosis is a disease

which can be prevented which can be prevented

from occurring.from occurring.

What is required is What is required is

awareness.awareness.

Don’t worry it is not that gloomy…Don’t worry it is not that gloomy…

Reaching optimal peak bone mass during Reaching optimal peak bone mass during adulthood is most effective weapon to adulthood is most effective weapon to combat osteoporosis. For this purpose combat osteoporosis. For this purpose factors worth taking into consideration factors worth taking into consideration areare

CalciumCalcium Vitamin D Vitamin D Regular exercisesRegular exercises Avoiding smoking and excessive Avoiding smoking and excessive

alcoholism.alcoholism. Avoiding long term medications of Avoiding long term medications of

drugs which causes decreased bone drugs which causes decreased bone mass.mass.

Bone density testing and taking Bone density testing and taking medications when appropriate.medications when appropriate.

Detection …Detection … Bone mineral density (BMD) testsBone mineral density (BMD) tests measure bone measure bone

density in the spine, wrist, and/or hip (the most density in the spine, wrist, and/or hip (the most common sites of fractures due to osteoporosis), while common sites of fractures due to osteoporosis), while others measure bone in the heel or hand. These tests others measure bone in the heel or hand. These tests are painless, noninvasive, and safe.are painless, noninvasive, and safe.

Bone density tests can:Bone density tests can:    # Detect low bone density before a fracture # Detect low bone density before a fracture

occurs.  occurs.  #Confirm a diagnosis of osteoporosis if you have #Confirm a diagnosis of osteoporosis if you have

already fractured.  already fractured.  #Predict your chances of fracturing in the #Predict your chances of fracturing in the

future.  future.  #Determine your rate of bone loss and/or #Determine your rate of bone loss and/or

monitor the effects of treatment if the test is monitor the effects of treatment if the test is conducted at intervals of a year or more. conducted at intervals of a year or more. 

Prevention of fallsPrevention of falls

Protect other problems of old age by Protect other problems of old age by proper medical management. proper medical management.

Vision testing. Vision testing. Hearing testing. Hearing testing. Home visits. Home visits. Proper lighting. Proper lighting. Hip protectors.Hip protectors.

Prevention of fallsPrevention of falls

AVOID: AVOID:

– Use of sedatives and alcohol. Use of sedatives and alcohol.

– Wearing inappropriate foot wear & Wearing inappropriate foot wear &

spectacles. spectacles.

– Hazardous home arrangement. Hazardous home arrangement.

– Traveling in poor weather condition. Traveling in poor weather condition.

Remember…Remember…

Osteoporosis is by no means a price Osteoporosis is by no means a price

that must be paid for growing old.that must be paid for growing old.

THANKSTHANKS