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ortopedi
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OSTEOPOROSISDAVIN PANNAAUSTEN
WHAT IS OSTEOPOROSIS?
Osteoporosis which means porous bone is a generalized disease of bone characterized by a combination of decreased osteoblastic formation of matrix and increased osteoclastic resorption of bone, with a resultant decrease in the total amount of bone in the skeleton
ETIOLOGY• Endocrine diseases• Hypogonadism• Hypercortisonism• hyperthyroidism
• Disuse• Post-menopausal state• Senility• Alcohol abuse
RISK FACTORS• Gender (female>male) 25% vs 12.5%• Amenorrhea • Insufficient calcium in diet• Eating disorders such as anorexia nervosa• Smoking• Excessive consumption of caffeine or alcohol• Inadequate physical exercise• Race (black Africans somehow less prone to age related
fracture, whites and Asians more at risk)
PATHOLOGY• Involves increased bone resorption• Also involves a decrease in bone formation• Both are surface phenomena• Affects trabecular bone more than cortical bone due to the
larger surface area• Thus, osteoporosis is most severe in vertebral bodies and
metaphyses of long bones• Cortical bone eventually becomes thin and porous as well
PATHOLOGY• This reduction in bone mass causes the bones to become
fragile, instead of becoming “soft” as in osteomalacia • As such, even modest stress or low energy trauma can cause
fractures: pathological fractures
X-RAY IMAGING• Generalized rarefaction of all bones, but most marked in
cancellous bone• Thin cortices• Evidence of deformity particularly in vertebral bodies• In severe cases a fracture or collapse of the spinal bones may
be seen
RAREFACTION OF BONE
BONE MINERAL DENSITOMETRY (BMD)
• An imaging technique used to measure bone density • Expressed in gram per unit area• Method of choice is the dual energy x-ray absorptionetry
(DXA)
INDICATIONS FOR BMD• All women > 65 years• All postmenopausal women< 65 years with other risk factors• Men with testosterone deficiency• Post-oophorectomy• X-ray features of osteopenia• Patients with hyperparathyroidism, hyperthyroidism, renal
insufficiency, or rheumatoid arthritis• Patients on long term glucocorticoids, thyroid hormone
replacement, thiazide diuretics• Dietary deficiencies• Checking treatment results
LAB TESTS• Serum calcium and phosphate• Serum bone alkaline phoisphatase• Osteocalcin• Parathyroid hormone activity• Vitamin D activity• Urinary calcium and phosphate• Glucocorticoid levels• Thyroid hormone levels• Estrogen / testosterone levels
PRINCIPLES OF MANAGEMENT• Osteoporosis cannot be reversed• Therefore treatment is given to slow down or stop the
progression• Any fracture must be managed properly as and when they
happen• Increase mobility to prevent disuse osteoporosis• Avoid prolonged immobilization
MEDICATION• Vitamin D• Calcium• Anti-resorptive medication (biphosphonates, calcitonin)• Hormone replacement therapy