King Abdul Aziz University Faculty Of Pharmacy Department Of Clinical Pharmacy

1. King Abdul Aziz University Faculty Of Pharmacy Department Of Clinical Pharmacy Prepared by:Ahmed Fahad Basilim Supervised by:Dr. Abdurrahman Al Ahdal

2. OSTEOPOROSIS

3. MAIN POINT I- Definition and types. II- Pathogenesis. III- Diagnosis of osteoporosis. IV- Prevention & Treatment.

4. I- Definition: A systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue lead to bone fragility and susceptibility to fracture.

5. Common Fracture Sites Vertebral Fracture Forearm Fracture Hip Fracture

6. Cont. • There are two types: A- Primary osteoporosis. B- Secondary osteoporosis.

7. A- Primary osteoporosis: -Primary osteoporosis classified as : 1. Type I (menopausal): - Occurs mainly in persons aged 51 to 75. - Six times more common in women. - Associated with vertebral and Colles' (distal radius) fractures.

9. Cont. 2. Type II (senescent): - Occurs in persons > 60. - Two times more common in women. - Associated with vertebral and hip fractures. • Overlap between types I and II is substantial, so this classification is of limited clinical use.

11. B- Secondary osteoporosis: Endocrine Nutritional Drug-Induced Immobilization Other Rheumatoid A. Diabetes Tumors (Myeloma, etc.) Hyperthyroidism Hypogonadism Cushing Syndrome Glucocorticoids Immunosuppressly Anticonvulsants

12. II- Pathogenesis: • Diminished bone mass can result from: A- Failure to reach an optimal peak bone mass in early adulthood. B- Increased bone resorption. C- Decreased bone formation after peak bone mass has been achieved. • All three of these factors probably play a role in most elderly persons. Low bone mass, rapid bone loss, and increased fracture risk correlate with high rates of bone turnover (i.e., resorption and formation).

13. Cont. • In osteoporosis, the rate of formation is inadequate to offset the rate of resorption and maintain the structural integrity of the skeleton.

14. III- Diagnosis of Osteoporosis: A- Physical examination. B- Measurement of bone mineral content: 1. Dual X-ray absorptiometry (DXA). 2. Ultrasonic measurement of bone. 3. CT scan. 4. Plain radiography .

15. Osteoporosis: Height loss Body weight Kyphosis Humped back Tooth loss A- Physical examination: No single maneuver is sufficient to rule in or rule out osteoporosis without further testing.

16. 1. Dual X-ray absorptiometry -The test is non-invasive and involves no special preparation. -Accuracy at hip > 90%. -Low radiation exposure and the procedure is rapid. -Error in Osteomalacia Osteoarthritis Previous fracture

18. 2. Ultrasonic measurement -Can assess the density and structure of the skeleton. -No radiation exposure, Inexpensive and portable. -Preferred use in assessment of fracture risk.

19. 3. CT scan -True volumetric study. -Most useful in cancellous bone assessment. -Drawback: High cost High radiation exposure Difficult quality control

20. 4. Plain radiography -Low sensitivity. -High availability.

21. IV- Prevention and treatment: • Optimal calcium intake reduces bone loss. • Routine to recommend supplemental vitamin D. • Exercise in young individuals increase the likelihood that they will attain the maximal genetically determined peak bone mass.

22. Cont. • Person with low bone mass and multiple risk factors, particularly those who have already had an osteoporotic fracture should be consider for antiresorptive therapy.

23. Antiresoptive drugs: • Include: 1- Estrogens. 2- Bisphosphonate. 3- Selective estrogen receptor modulators (SERMs). 4- Calcitonin.

24. 1- Estrogens:” Activella” • Can prevent menopausal bone loss in most women. • The treatment of choice for postmenopausal women, particularly those who had an early menopause, and for women who have had a hysterectomy. • Decreases the risk of osteoporotic fractures by 30 to 50%.

25. 2- Bisphosphonates: • Bisphosphonates drugs like alendronate “Fosamax “ and pamidronate. • Use for women cannot tolerate estrogen or have contraindications (e.g., preexisting breast cancer, risk factors of breast cancer). • These drugs increased bone mass and decrease the risk of fractures, particularly in patient taking glucocrticoids.

26. Cont. 3- Selective estrogen receptor modulators: -These drugs are antiestrogenic and have antiresorptive effects on bone. 4- Calcitonin: -Used for many years in prevention and treatment of osteoporosis.

27. Other therapies: 1- Anabolic therapy. 2- Parathyroid hormone and fluoride: • Stimulate bone formation and inhibit bone resorption. • Their efficacy and safety remain to be established. 3- Thiazides: • Decrease urinary calcium excretion and slow bone loss.

28. Conclusion: • Osteoporosis is chronic silent disease no symptoms at the early stage of bone loss. • Osteoporosis requires early intervention before the dramatic 1st fracture followed by a cascade of others fractures.

29. Cont. • Patient should be educated to reduce the likelihood of any risk factors associated with bone loss and falling. • Osteoporosis does not directly cause death. However, an excess mortality of 10 to 20% occurs in patient with established osteoporosis, particularly those with hip fractures.

30. sources: 1- www.osteoporosis. 2- www.osteo.org. 3- www.webmd.com /osteoporosis/default. 4-www.nof.org. 5- www.endocrineweb.com/osteoporosis.

31. Thank you