Upload
others
View
3
Download
0
Embed Size (px)
Citation preview
Osteoporosis Osteoporosis
Geneva,Geneva, February February 27 200827 2008
Prof René Rizzoli M.D.Prof René Rizzoli M.D.
Division of Division of bone diseasesbone diseasesWHOWHO collaborating center collaborating center for for osteoporosis preventionosteoporosis prevention
Department Department of of rehabilitation and geriatricsrehabilitation and geriatricsGeneva university hospitals and Faculty Geneva university hospitals and Faculty of of medicinemedicine
Geneva, SwitzerlandGeneva, Switzerland
A A systemic skeletal diseasesystemic skeletal disease characterized characterized
by by low bone masslow bone mass and and
microarchitectural microarchitectural deteriorationdeterioration, with a, with a
consequent consequent increase in bone fragilityincrease in bone fragility with with
susceptibility to fracture.susceptibility to fracture.
Osteoporosis DefinitionOsteoporosis Definition
Consensus Development Conference: Consensus Development Conference: Am J MedAm J Med 1991;90:107-110 1991;90:107-110
OsteoporosisOsteoporosis::a 2-Stage a 2-Stage DiseaseDisease
••WithWith••Without Without FractureFracture
OsteoporosisOsteoporosis::Lecture ContentLecture Content
••Disease DefinitionDisease Definition••EpidemiologyEpidemiology••BurdenBurden••DiagnosisDiagnosis••PathophysiologyPathophysiology••ManagementManagement
00
55
1010
1515
2020
2525
3030
WomenWomen MenMen WomenWomen MenMen WomenWomen MenMen
Age Group (Years)Age Group (Years)
Minor FracturesMinor FracturesOther Major FracturesOther Major FracturesVertebral FracturesVertebral FracturesProximal Femur FracturesProximal Femur Fractures
60 60––69 7069 70––79 79 >> 80 80
Center J et al. Center J et al. Lancet.Lancet. 1999;353:878 1999;353:878––882.882.
Fractures by Age and GenderFractures by Age and GenderDubboDubbo Osteoporosis Osteoporosis EpidemiologyEpidemiology Study, Study,
19891989––19941994
Perc
ent
Perc
ent o
f of to
tal p
opul
atio
nto
tal p
opul
atio
n
Lifetime risk Lifetime risk ofof fragility fragility fracture in fracture in thetheSwedish Swedish population population at the at the age of 50 age of 50 years years (%)(%)
WomenWomen MenMen
•• Proximal Proximal femurfemur 2323 1111
•• Distal Distal forearm forearm 2121 5 5
••Vertebral Vertebral ((clinicalclinical)) 1515 8 8
••Proximal Proximal HumerusHumerus 1313 5 5
•• AnyAny 46 %46 % 22 %22 %From Kanis From Kanis et al 2000et al 2000
1 500 000 *1 500 000 *
00
500500
10001000
15001500
20002000
Osteoporotic Osteoporotic FracturesFractures
Riggs BL, Melton LJ. Bone. 1995.Heart and Stroke Facts. 1996. American Heart Association.
Cancer Facts & Figures. 1996. American Cancer Society.
**annual incidence all agesannual incidence all ages †† annual estimate women 29+annual estimate women 29+ ‡‡annual estimate women 30+annual estimate women 30+
§§1996 new cases,all ages1996 new cases,all ages
513 000 513 000 ††
228 000 228 000 ‡‡ 184 300 184 300 §§750 000750 000vertebralvertebral
250 000250 000other sitesother sites
250 000250 000forearmforearm
250 000250 000hiphip
Ann
ual i
ncid
ence
x 1
000
Ann
ual i
ncid
ence
x 1
000
HeartHeartAttackAttack
StrokeStroke BreastBreastCancerCancer
OsteoporoticOsteoporotic Fractures in Women: Fractures in Women:Comparison With Other DiseasesComparison With Other Diseases
Projected burden Projected burden of of osteoporoticosteoporotic hip fractures hip fractures worldwideworldwide
0
200
400
600
800
NorthAmerica
Europe LatinAmerica
Asia
19502050
3250
Estimated n°of hipFractures (1000s)
Number Number of hip fractures: of hip fractures: 1990: 1.66 million1990: 1.66 million; ; 2050: 6.26 million2050: 6.26 millionAdapted from Adapted from Cooper C., Cooper C., Melton Melton U, U, Osteoporosis Osteoporosis IntInt 2:285-289, 1992 2:285-289, 1992
If If the prevalence the prevalence of hip fractureof hip fracturecontinues to continues to rise at current rise at current rates, rates, it mayit may
well be that well be that in in the next the next few few decadesdecades,,orthopaedists will orthopaedists will do do little else little else but but treattreat
this problemthis problem..
W. C. HayesW. C. Hayes, In: , In: Bone Bone Formation Formation and Repairand Repair((American Academy American Academy of of Orthopaedic Orthopaedic Surgeons) 1994Surgeons) 1994
BurdenBurden
Degree Degree of of dependencedependence
5050 7070 8080 90906060
normal normal agingaging
ForearmForearmfracturefracture
VertebralVertebralfracturefracture
Hip fractureHip fracture
Age (Age (yearsyears))
Morbidity After Vertebral FracturesMorbidity After Vertebral Fractures
•• Back painBack pain•• Loss of heightLoss of height•• Deformity (Deformity (kyphosiskyphosis, protuberant abdomen), protuberant abdomen)•• Reduced pulmonary functionReduced pulmonary function•• Diminished quality of life: loss of self-esteem,Diminished quality of life: loss of self-esteem,
distorted body image, dependence on narcoticdistorted body image, dependence on narcoticanalgesics, sleep disorder, depression, loss ofanalgesics, sleep disorder, depression, loss ofindependenceindependence
A A Fragility Fragility Fracture -> FractureFracture -> Fracture