Osteoporosis

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”.

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Normal bone

Osteoporotic Bone

Consensus Development Conference: prophylaxis and treatment of osteoporosis. Am J Med 1991;90:107-10.

Definition

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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.

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- 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 .

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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

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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

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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

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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

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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

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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

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Burden of the Disease

Lindsay R et al., 2001, JAMA 285:320

Updates on some Asian Countries

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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

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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

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• YGH osteoporosis study (Chit Soe, 2010) conducted in 67 Rheumatology patients

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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

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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