OSTEOPOROSIS,DIAGNOSIS

&MANAGEMENT.

BY SCT.NWUDELE

CHIBUEZE

OUTLINE.•INTRODUCTION•FUNCTONS OF BONE•CAUSES AND CONSEQUENCES•ROLES OF VITAMIN D, CALCIUM AND EXERCISE •RISK FACTORS OF OSTEOPOROSIS•OSTEOPOROSIS DIAGNOSIS•MANAGEMENT OF OSTEOPOROSIS•CONCLUSION•RECOMMENDATION•REFERENCES

Vertebral Fracture Cascade

LEARNING OBJECTIVES• To understand how osteoporosis is caused.• To understand why calcium, vitamin D and

Exercise are important in preventing osteoporosis.

• To understand the risk factors that associate osteoporosis and how to handle some of the risk factors.

• To outline the consequences of osteoporosis.• To learn different approaches used in

diagnosing osteoporosis.• To understand the basis of osteoporosis drug

treatment.

INTRODUCTION• Osteoporosis is a condition in which bones lose their strength and are

more likely to break, usually following a minor bump or fall (NOS, 2015). Broken bones are also referred to as ‘fractures’.

• Fractures that occur because of reduced bone strength are described as ‘fragility fractures’ and many of these will be caused by osteoporosis.

• One in two women and one in five men over the age of 50 experience fractures, mostly as a result of low bone strength (NOS, 2015)

• Although fragility fractures caused by osteoporosis can happen in various parts of the body, the wrists, hips and spine are the most commonly affected sites.

• Osteoporosis is also a term used to describe low bone density as measured on a bone density (DXA) scan. This means your bones may have lost strength. 

FUNCTIONS OF BONE• Support • Protection for internal organs• Storage of calcium and other

minerals.• Protect bone marrow centre, for blood

cell formation.• Allow movement.

BONE AND OSTEOPOROSIS • Bone contains fibres and minerals

(calcium mainly).• Bone production occurs more

often than resorption from birth to age 35.

• This means the bones loss strength and density.

• If small amount is lost continually, it results in osteoporosis but if bone loss large osteoporosis results.

WHO CAN SUFFER OSTEOPOROSIS

• Women,• Men,• Younger men and women.

HOW OSTEOPOROSIS AFFECT YOU (consequences of

osteoporosis)• Broken wrists.• Broken hips• Spinal fractures • Loss of height and spinal curvature

(Dowager’s hump).

SYMPTOMS Back pain, which can be severe if fractured or

collapsed vertebra

Loss of height over time, with an accompanying stooped posture

Fracture of the vertebrae, wrists, hips or other bones

Wrist fracture.

Hip fracture in osteoporosis

Height loss in osteoporosis

TYPES OF COMPRESSION FRACTURE

HEALTH BENEFITS OF CALCIUM, VITAMIN D AND EXERCISE

CALCIUM• Gives strength and rigidity to bones.• 99% of the body content (1kg) and in the bones.

• Healthy balance diet with adequate calcium and protein as well as vitamin D are essential for baby to develop a healthy skeleton (NOS, 2014).

• Higher intakes of calcium and protein are required during adolescence

Vitamin D• Vitamin D helps in the absorption of

calcium.• The major source of vitamin D is

sunlight

• Ultraviolet part of sunlight convert the inactive form of vitamin D to active form.

• Building healthy bones actually starts in the womb.

SOURCES OF CALCIUM• Cheese and egg (quiche).• Yoghurt .• Porridge (made with semi-skinned milk).• Sardines.• Green beans.• Tinned tomatoes.• Fried onions.• Water cress etc.

(NOS, 2014)

EXERCISE• Exercise is important for everyone at all stages of lives,

but is especially important for people with osteoporosis and risk of fracture.

• Helps to build strong bones in childhood.

• Prevents bone loss and maintains muscle strength in adults.

• Increase balance and posture, prevent weak bones and fracture in elderly.

• Aids rehabilitation (rebuilding of the bone, relief from pain).

Adults Are Also Involved In Exercise

Exercise

What keeps bones healthy• Regular exercise • Adequate amounts of calcium • Adequate amounts of vitamin D, which is very

essential for absorbing calcium

RISK FACTORS OF OSTEOPOROSIS

• Fixed risk factors,• Modifiable risk factors

Fixed risk factors of osteoporosis

• Age • Gender • Ethnicity • Fractures (previous fracture)• Genes • Menopause• Hysterectomy

Modifiable Risk Factors Of Osteoporosis

• Alcohol• Tobacco/smoking.• Low BMI• Poor nutrition• Eating disorder• Frequent falls and injuries• Steroid use.

Cigarette As A Risk Of Osteoporosis

DIAGNOSIS OF OSTEOPOROSIS • Dual energy X-ray absorptiometry

(DXA).• Urine and blood tests (bone markers). Markers of bone resorption include:• Telopeptide• N-telopeptide (NTX) – ELISA method.• C-telopeptide (CTX) – ELISA method.Markers of bone formation• bone Alp • Osteocalcin

• Measurements of Calcium and Vitamin D

• Computerized tomography (CT) scanning.

• Magnetic resonance imaging (MRI).• X-rays.• Bone (Radioisotope) scanning.

Dual energy X-ray absorptiometry (DXA) (NOS, 2014)

Computerized tomography scanning

MANAGEMENT• What do drug treatments for

osteoporosis do and how do they work?

• Drug treatments for osteoporosis help to strengthen your bones and reduce your risk of having fractures.

• Most drug treatments work by slowing down the activity of the cells that break down old bone (osteoclast) and they are called antiresorptive drugs.

MANAGEMENT CONTD• Others work to stimulate the cells that

build new bone (osteoblast) and they are called anabolic drugs.

• The main aim of these drugs is to decrease the risk of breaking bones .

• Often treatment will show an increase in bone density as well.

WHICH DRUGS ARE AVAILABLE?

• Bisphosphonate 70mg/week (tablet).

• Alendronate 70mg/week (tablet).

• Risedronate • Selective oestrogen receptor• Parathyroid hormone treatment.

• CONCLUSION• Osteoporosis is a common form of bone

disease, and it is characterized by low bone mass and deterioration of the bone structure. While many osteoporosis prevention studies have focused on calcium, the emphasis for some of these studies has now shifted toward the importance of vitamin D and regular exercise in the management of this disease. In order to maintain healthy bone strength and integrity, 700mg of calcium is recommended daily for adults, regular exercise and those modifiable risk factors discussed in this work are encouraged to be modified.

REFERENCES• David B. E, Robert K. R (2012).Disorders of Bone.

In: C. A Burtis, E. R Ashwood, D. E Brun. Tietz Foundermentals of Clinical Chemistry, 6th edn. Saunders, Elsevier pp 711-734.

 • National Osteoporosis Society, 2015. An

Introduction to Osteoporosis; A short Guide to Bone Health, Fragile Bones and Fractures. www.nos.org.uk pp 1-26.

 • National Osteoporosis Society, 2014. Scans and

Tests and Osteoporosis. www.nos.org.uk. pp 1-28

THANK YOU IMMENSELY

FOR YOUR TIME