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Metabolic bone disease

Metabolic bone disease. Dr santosh kumar Assistant professor Medical unit 2. Definition . The term “metabolic bone disease” denotes those Conditions producing diffusely decreased bone density And diminished bone strength. . O steoporosis . Essential of diagnosis.

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Metabolic bone disease

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  1. Metabolic bone disease Dr santoshkumar Assistant professor Medical unit 2

  2. Definition The term “metabolic bone disease” denotes those Conditions producing diffusely decreased bone density And diminished bone strength.

  3. Osteoporosis

  4. Essential of diagnosis • Asymptomatic to severe backache from vertebral • fractures. • Spontaneous fractures often discovered incidentally • on radiography; loss of height. • Serum PTH, calcium, phosphorus, and alkaline phos- • phatase usually normal. • Serum 25-hydroxyvitamin D levels often low as a • comorbid condition. • Demineralization, especially of spine, hip, pelvis, • and wrist

  5. Definition It is defined as low bone mass and micro-architectural destructions of Bone tissue leading fragility and fracture of bone. Bone is normally mineralized but decrease in quantity ,quality and Structural Integrity.

  6. Peak bone mass and bone loss are regulated by genetic(80%) and environmental factor (20%),genetic like (ESR1)oestrogen receptor gene,(LRP5)lipoprotein related receptor gene In normal individual 20-40years bone formation is increased but fall after that. After menopause is an accelerated phase of bone loss. pathophysiology

  7. Post menopausal osteoporosis Osteoporosis in men Steroid induced osteoporosis Pregnancy associated osteoporosis Other causes variety

  8. Hypogonadism Hyperthyroidism Hyperparathyroidism Cushings syndrome Etc Endocrine disease

  9. Inflammatory bowel disease Ankylosing spondylitis RA Etc Inflammatory disease

  10. Malabsorption syndrome Chronic liver disease Others causes Gasterointestinal disease

  11. Corticosteroids Thyroxine over –replacement Gonadotrophin-releasing hormone agonist Sedative Anticonvulsant drugs Alcohal excess Heparin others drugs

  12. Myeloma Homocystinuria Anorexia nervousa High trained athletes HIV infection Immobilisation Poor diet /low birth weight miscellaneous

  13. Asymtomatic until fracture occurs. Osteoporotic spinal fracture present back pain or gradual onset of height loss and kyphosis with chronic pain. in hip fracture affected leg shortened and externally rotated. Some time on bony pain in old age or menupause Incidental osteopenia in xrays performed foe other reasons. Sign and symptoms

  14. Investigations X rays of bone related limb Routine profile of blood Serum calcium level Alkaline phosphatase level Bone density like radiographs, DXA sccaning

  15. Management of osteoporosis • Assess risk factors • If present, proceed to DXA (may not be necessary • In all patients with fragility fractures). • Exclude secondary causes in patients with osteoporosis

  16. In patients with previous fragility fracture And those aged over 65 years with BMD T Score < -2.5 measured by DXA • Offer lifestyle advice (e.g. exercise, diet, smoking • cessation) • Offer treatment: • First-line option alendronate or risedronate • Also-raloxifene in woman with vertebral osteoporosis • -Teriparatide in woman with very severe osteoporosis, • or if intolerant to other therapies • Give calcium and vitamin D supplements where • appropriate

  17. In younger patients with BMD T score < -2.5 (measured by DXA, hip + spine) • Assess need for treatment based on age and other • independent risk factors • Offer lifestyle advice • Offer treatment as above, if appropriate

  18. In frail older individuals • Offer lifestyle advice • Fall risk assessment and advice where appropriate • Give calcium and vitamin D supplements • Hip protectors for individuals in nursing homes

  19. Thanks

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