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OSTEOPOROSIS

OSTEOPOROSIS. Mohit Chhabra 47. Objectives. To define osteoporosis To understand the pathophysiology Basics of Bone Mass Density Tests Approach to a patient Management. Definition.

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OSTEOPOROSIS

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  1. OSTEOPOROSIS MohitChhabra 47

  2. Objectives • To define osteoporosis • To understand the pathophysiology • Basics of Bone Mass Density Tests • Approach to a patient • Management

  3. Definition • Reduction in strength of bone due to loss of bone tissue associated with deterioration in skeletal microarchitecture • Operationally defined as bone density that falls 2.5 standard deviations below the mean (T score)

  4. Factors Leading to Osteoporotic Fractures

  5. Pathophysiology • Bone Remodeling • Calcium Nutrition • Vitamin D • Estrogen Status • Physical Activity • Chronic Disease • Medications • Smoking

  6. Bone Remodeling • Principal metabolic skeletal process in adults • Primary functions • Repair skeletal micro-damage • Maintain serum calcium • More the remodeling, more the loss of bone tissue • Different from bone modeling • Activated by acute or chronic calcium demands

  7. Calcium Homeostasis

  8. Vitamin D • Compensatory Secondary Hyperparathyroidism • Treatment with Vitamin D prevents bone loss

  9. Estrogen Status • Estrogen deficiency leads to • Activation of remodeling sites • Imbalance between formation and resorption • Trabecular bone affected morethan cortical bone • Hence vertebral fractures are an early consequence

  10. Chronic Disease Harrison’s 18/e: Vol 2: Page 3124 • Hypogonadal states • Endocrine disorders • Nutrition disorders • Rheumatologic disorders • Hematologic • Inherited

  11. Medications • Glucocorticoids • Cyclosporine • Thyroxine • Alcohol • Aromatase inhibitors • Heparin • Cytotoxic drugs

  12. Bone Mass Density (BMD) • Techniques • DXA • SXA • CT • USG • Indications • Estrogen deficiency • Vertebral osteopenia and fractures • Glucocorticoid treatment • Primary hyperparathyroidism

  13. Approach to a Patient • No established algorithm • CBC, Calcium analysis, LFT, KFT, PTH analysis • X Rays • Chronic diseases to be ruled out/treated • LOOK OUT FOR MYELOMA!! • BMD tests • Bone biopsy (little clinical relevance) • Biochemical markers • Bone formation • Bone resorption

  14. Radiological Features • Vertebral collapse • Cod fish appearance • Ground glass appearance • Singh’s Index: 6 grades based on trabecular pattern • Metacarpal index • Vertebral index

  15. Managing Osteoporotic Fractures • Management depends on • Location • Whether acute or chronic • Severity • Neighboring joints • General status • Usually three modalities used are • ORIF with nails/pins (Denim) • Hemiarthroplasty • Total arthroplasty • Prophylactic weight bearing exercises and bracing

  16. Managing the Underlying Disease • Risk factor Reduction (FRAX Calculation tool) • Nutritional Recommendations • Medications • Bisphosphonates : alendronate, risedronate • Teriparatide • Estrogens and Progestins • SERM : raloxifene and tamoxifene • Calcitonin • PTH • Non pharmacologic – hip protectors, kyphoplasty, vertebroplasty • Monitoring tool - BMD

  17. THANK YOU

  18. Presentation Available At • www.chhabramohit.yolasite.com • Google Image Search • Harrison’s Principles of Internal Medicine 18/e • Essential Orthopedics by Maheshwari Sources

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