osteoporosis

Asma

:Definition

The word osteoporosis literally means " المثقب porous bonesالعظم

".it is clincle disorder charichters by abnormely low bone mass,quanititive defect in bone stracture.

-Over time, bone mass, and therefore bone strength, is decreased. As a result, bones become fragile and break easily .

Fully minerlize

The three main mechanisms by which osteoporosis

develops are:

Decrease bone formation

Increased bone resorbton

mixedImbalance between them lead to decrease

Bone mass and loss of bone strengh

:Types of Osteoporosis

*Primary osteoporosis :

There are two different types of primary osteoporosisType 1 - Post-menopausal osteoporosisType 1 usually occurs between the ages of 50 to 70, largely because of estrogen loss at menopause

•Exaggerated form of physiological bone depltion that normely

accompined aging and loss of gonadel activity

•Two overlapping phases ,, 1-high turn over osteoporsis duto

increase osteoclast function•2-low turn over duto decrase

osteoblastic activity

Type 2 – age realted osteoporsisaftr 70 years mostely pt come with fracture

* Secondary osteoporosis :

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Secondary osteoporosis can have many causes, including; -Diseases that affect the endocrine systemsuch as hyperthyroidism or hyperparathyroidism -Liver disease and Alcoholism

•-A vitamin D deficiency.

•-Premature menopause•-Sometimes the drug used to

treat other health problems causes osteoporosis. For example: corticosteroids (e.g. Prednisone, inhaled steroids for asthma) •

Risk Factors:

•-Female gender: Because women have lighter, thinner bones than men

•-Advancing age: especially the onset of menopause.

•-Family history• - :Build :Women with thin or

small frames have a higher risk for bone fractures

•-Alcohol consumption;• :Studies show that consuming two

or more alcoholic drinks daily decreases a woman’s rate of calcium absorption, which may lead to bone loss. Alcohol also interferes with vitamin D synthesis-a process that helps bones absorb calcium .

•-Certain diseases: Women who have anorexia (an eating disorder) diabetes, chronic diarrhea, or kidney or liver diseases are at an increased risk for osteoporosis

•-Smoking :smoking interferes with the body’s processing of calcium. smokers experience vertebral fractures more frequently than

nonsmokers .

Sign and symptom:

• Osteoporosis itself has no specific symptoms; its main consequence is the increased risk of bone fractures. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as fragility fractures. *Typical fragility fractures occur in the vertebral column, rib, hip and wrist.

Diagnosis:

•*an initial physical exam•*various x rays that detect skeletal

problems*laboratory tests that reveal important

information about the metabolic process of bone breakdown and formation

•*a bone density test to detect low bone density

*X-Ray Tests:•x ray can detect bone loss only after

30 percent of the skeleton has been depleted

•*Bone Mineral Density Tests: The most widely recognized BMD test is called a dual-energy x-ray absorptiometry, or DXA test. The BMD test is painless, a bit like having an x ray, but with much less exposure to radiation. It measures bone density at the hip and spine .

•During a BMD test, an extremely low energy source is passed over part or all of the body. A computer program evaluates the information and allows the doctor to see how much bone mass you have .

•BMD tests provide doctors with a measurement called a T-score, a number value that results from comparing your bone density to optimal bone density. When a T-score appears as a negative number (such as –1, –2 or –2.5), it indicates low bone mass. The greater the negative the number, the greater is the risk of fracture.

•RESULTS:•T-score- 1.0 or greater is "normal "

•T-score between -1.0 and -2.5 is "low bone mass" (or osteopenia

•T-score -2.5 or below is osteoporosis

Bone Scans:•A bone scan involves injecting

the patient with a dye that allows a scanner to identify differences in the conditions of various areas of bone tissue. A bone scan can show the doctor changes in bone tissue that may indicate cancer, bone lesions, inflammation, or new fractures.

Lab Tests:•*The most common blood tests

evaluate:•blood vitamin D levels

•thyroid function•parathyroid hormone levels

•estradiol levels to measure estrogen (in women)

•follicle stimulating hormone (FSH) test to establish menopause status

•testosterone levels (in men)•osteocalcin levels to measure bone

formation

•*The most common urine tests are:•-24-hour urine collection to measure

calcium metabolism

Treatment:

Drugshormone replacement therapy( HRT ,)also called

estrogen replacement therapy However, the WHI also revealed several risks with taking combined HRT )estrogen and progesterone(. In fact, the trial was stopped early because the incidence of invasive breast cancer in women on HRT passed a threshold that was considered too risky for the benefits they were receiving. The study also found that the women on combined hormone therapy were at increased risk for coronary heart disease

and stroke

bisphosphonate

Supression osteoclastic bone resorbtion . Alendronate. Used one dose per week for month ,have git side effect if pt cant tolerate pamidronate hase given iv every 3

month

Denosumab

•New approch of antiresorptive therpy

•It is human monoclonal antibody which inhibits the receptor activitor

need to activate osteoclast differentiation

•Adminstreted subcutaneous injection every 6 month and must

supplimented with ca and vit d

Osteomalacia vs osteoporosis

Osteomalacia Osteoporosis Ageing fem, #, decreased bone dens

Ill Not illGeneral ache Asympt till#

Weak musclesnormalLoosersnil

Alk ph incr normalPO4 decrnormal

Ca x PO4 <2.4Ca x PO4 >2.4

Alternative treatment:

•Alternative treatments for osteoporosis focus on maintaining or building strong bones. A healthy diet low in fats and animal products and containing whole grains, fresh fruits and vegetables, and calcium-rich foods (such as dairy products, dark-green leafy vegetables, salmon), along with nutritional supplements (such as calcium, magnesium, and vitamin D), and weight-bearing exercises are important components of both conventional prevention

Prognosis:•Although osteoporosis patients

have an increased mortality rate due to the complications of fracture, it is rarely lethal

•-Hip fractures; can lead to decreased mobility and an additional risk of numerous complications(such as deep venous thrombosis and/or pulmonary embolism pneumonia)

•-Vertebral fractures:can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare,

multiple vertebral fractures can lead to such severe hunch back (kyphosis) that the resulting pressure on internal organs can impair one's ability to breathe .

Prevention:

•Building strong bones, especially before the age of 35, and maintaining a healthy lifestyle are the best ways to prevent osteoporosis. Getting calcium from foods Getting vitamin d Avoiding smoking and alcohol