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


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.


- 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 .


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


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.


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



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



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


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


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


Burden of the Disease

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

Updates on some Asian Countries


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


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


• 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


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

Osteoporosis

Health & Medicine

Osteoporosis