stikes akbid osteoporosis
TRANSCRIPT
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Usia harapan hidup: 58th, 62th,72th (2025)
Kenaikan lansia : 414 % (2025)
Lansia meningkat peny.Degeneratif meningkatOsteoporosis/ Age Related Diseases meningkat
Osteoporosis Masalah besar Usia lanjut
angka kesakitan dan kematian , pendanaan
Menopause : 24 juta (2015) Osteoporosis sekitar352.000
Osteoporosis fraktur immobilisasiosteoporosis
Rontgen kurang sensitif untuk Diagnosis.Penurunan
massa tulang 30 % baru terdeteksi
Latar belakang/ masalah
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Bone & Teeth Ca ++
98%
Extracellular Intracellular* Excitation Contraction coupling
in heart & others* Nerve system synaptic transmission* Platelet aggregation, coagulation* Hormones secretion
* Cell division* Muscle contractility* Cell motility* Membrane trafficking &
secretion
2%
-Mekanik-Protektif
-Metabolik
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Homeostasis calcium dan pembentukan Tulang
Bone formation : osteoblast.
-Estrogen-Calcitriol
-Calcitonin
-Insulin,growth hormon
Bone Resorption : Osteoclast-Paratiroid hormon
-Estrogen-Steroid-I G F I-Tiroid Hormon
Catatan :Bone Remodelling Adalah bone formation dan bone Absorption.Bone Turn Over Adalah kecepatan Bone formation dan Bone Absorption
Calcium
Calcitriol
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C a l c I t r I o lCALCITRIOL
I
III PTH
II
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Bone
QualityBone
Strength +
Architecture
Turnover rate
Damage AccumulationDegree of Mineralization
Properties of the collagen/
mineral matrix
Shifting the Osteoporosis Paradig Bone Strength
NIH Consensus Statement 2000
Adapted from NIH Consensus Development Panel on Osteoporosis. JAMA 285:785-95; 2001
Bone
Quantity
Bone size
Bone density
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180 kg
20 kg
Micro architecture and Bone Strength
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Umur 0 sampai 34 thn :
Bone Formation >>>>
Umur 34 th --- 44 thn :
B.Formation:B.Resorption
Umur > 44 tahun :
Bone resorption >>>>
Peak bone mass and density changes overLifetime in men and women
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Osteoporosis
Definisi/ Batasan : Penyakit sistemik tulang
yang disifati oleh berkurangnya MASSA
TULANG dan kelainan MIKROARSITEKTUR
jaringan tulang yang mineralisasinya
NORMAL, sehingga tulang menjadi rapuh
dengan akibat mudahPATAHdengan trauma
MINIMAL.1Consensus Development Conference.Am J Med. 1991.
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Criteria for Osteoporosis
- 2.5 SD - 1.0 SD
Osteoporosis Osteopenia Normal
Quantitatively /density : WHO consensus
Dengan D E X A
Normal : T Score is +/- 1 SD
Osteopenia : T Score is 1 SD to 2.5 SD
Osteoporosis :T Score is 2.5 SD or more
Severe Osteoporosis:
T Score is 2.5 SD or more plus one or more osteoporosis fracture.
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Normal Bone Osteoporotic Bone
Reproduced from J Bone Miner Res. 1986;1:15-21
with permission of the American Society for Bone and Mineral Research
Osteoporotic Bone Loss
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Normal and osteoporotic bone
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Osteoporosis- Risk Factors
Factors which can be influenced Sex hormones
Eating disorders Diet
Activity level
Medication Smoking
Alcohol use
Obat, Faktor mobilisasi
Factors which cannotbe influenced
Gender
Age
Body size
Ethnic heritage
Family history
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KLASIFIKASI & ETIOLOGIOSTEOPOROSIS
OSTEOPOROSIS PRIMER :
-Post menopause/ Tipe cepat/ tipe I- Senilis/ tipe lambat/ Tipe II
OSTEOPOROSIS SEKUNDER :-Gagal ginjal kronik- Cushing sindrome/ tx steroid lama/GIO
- Hipertiroid- D M tipe I- imobilisasi- alkoholisme, obat heparin- Arthritis rheumatoid- Multiple myeloma
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CALCITRIOL
Homeostasis calcium dan pembentukan Tulang
Bone formation : osteoblast.
-Estrogen :R e n d a h
-Calcitriol
-Calcitonin
-Insulin,growth hormon
Bone Resorption : Osteoclast-Paratiroid hormon
-Estrogen : R e n d a h
-Steroid-I G F I-Tiroid Hormon
Patofisiologi osteoporosis PostPatofisiologi osteoporosis post menopause/ Primer tipe I
Calcium
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Pada thn awal menopause kehilangan massa tulangdapat mencapai15%dari
MASSA PUNCAK TULANGdan pada
10 thn sampai 15 thn post menopause dapat mencapai30-40%
Normal Osteoporosis
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CALCITRIOL sangat rendah
Calcium plasma rendah
Homeostasis calcium dan pembentukan Tulang
Bone formation : osteoblast.
-Estrogen : Rendah
-Calcitriol Rendah
-Calcitonin
-Insulin,growth hormon
Bone Resorption : Osteoclast-Paratiroid hormon :Meningkat-Estrogen: Rendah-Steroid-I G F I : Meningkat-Tiroid Hormon
Patofisiologi osteoporosis senilis/ primer tipe II
Calcium
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Osteoporosis Primer tipe II/Pada Usia lanjut
Usia lanjut
HOMEOSTASIS CALCIUM TERGANGGU
Hipocalcemia, Kejang otot,Osteoporosis
Fg. Ginjal Fg Hati Fungsi UsusS U V ESTROGENCalcitriol
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CALCITRIOL
Homeostasis calcium dan pembentukan Tulang
Bone formation :Pembentukan osteoblastmenurun.
-Estrogen : Rendah
-Calcitriol Rendah
-Calcitonin
-Insulin,growth hormon
Bone Resorption : Osteoclast-Hiperparatiroid sekunder-Estrogen: Rendah
-Steroid-I G F I : Meningkat-Tiroid Hormon
Patofisiologi osteoporosis oleh karena steroid/GIO
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Corticosteroids
Gastointestinal
Calcium absorptionUrinary calcium
excretion
Sex hormone effects:
Adrenal androgens
EstrogenTestosteroneCalcium
PTH ?Osteoclast
bone resorption
Osteoporosis
Osteoblast
bone formation
Muscle
mass
Effects on:
GH, IGF-1, TGF-
Corticosteroids induce bone loss through several mechanisms
(Lane & Lukert, CEM, 1998)
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GEJALA / Manifestasi klinis
Osteoporosis umumnya
tanpa gejala sampai orang
tsb mengalami patah
tulang.
Gejala yang paling umum:
- Subklinis :BMD,ALP,PIRIDINOLIN
- Kelainan bentuk tulangbelakang/ Kyphosis.
- Sakit punggung/ nyeri- Penurunan tinggi
badan
- PATAH TULANG
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Th i t f h i t t l i t i t
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Silva MJ, Gibson LJ. Bone1997:21;1919
Parfitt AM. Am J Med 1991; 91(Suppl5B):42S-46S.
The impo rtance of archi tectu ral integr i ty
10% decrease in BMD due toloss in trabecular number
equals
70% reduction in bone strength
10% decrease in BMD due to lossin trabecular thickness equals
20% reduction in bone strength
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Increasing age bears consequence of increased fracture.Rates in men are lower and at a later age than in women.
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Ax :- - Nyeri, kesemutan, Tambah bungkuk, Penurunan tinggi badan,
- patah tulang, minum obat corticosteroid yang lama, sakit ginjal
- sakit liver, merokok, alkohol,
Ph Dx :
-Kyphosis, nyeri tekan, krepitasi
Penunjang :
- Photo Rontgen Polos :Penurunan densitas massatulang terutama dinding depan corpusvertebrae,korteks menipis, trabekulae transversalis menghilang,Lebar Disc meningkat, cortex bikonkaf
- Quantitative ultrasound Densitometry
- Dual energy X Ray Absorbsiometry
- Bone marker ( Bone remodelling ): ALP, osteokalsinHidroxyproline, Piridinoline
- Histomorphometry
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Bone formation:
Calcium
Sodium fluoride
Anabolic steroid
Calcitriol
Estrogen
Anti resorption :
Bisphosphonate
Estrogen
Calcitriol
Calcitonin
SERM (Tamoxifen )
HRT ( Premarin )
Bone formation Anti Bone resorption
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Calcium H R T : Premarin S E R M : Kompetitif inhibisi pada uterus danpayudara, Agonis estrogen pada tulang
(Tamoxifen)
Biphosphonat: Risedronate : ACTONEL Kalsitonin
Kalsitriol: Calcit Flouride Steroid anabolik : Menurunkan bone turn over( Nandrolon, Stanozolol )
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Approach to management ofosteoporosis post menopause/primer tipe I
DietExerciseSunlight
Life-style issues
HRTPharmacotherapy
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cancer ?
May be contra indicatedH R T
ALTERNATIVE TREATMENT
PHYTOESTROGEN
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Approach to management ofosteoporosis senilis/ primer tipe II
Diet
ExerciseSunlightLife-style issues
HRTPharmacotherapy
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Approach to management ofosteoporosis Corticosteroid
DietExerciseSunlight
Life-style issues
HRTPharmacotherapy
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ESTROGEN : bone formation, Anti Resorption
CALCIUM : Material bone formation.
CALCITRIOL : absorption, deposition of Calcium.
Bone Formation :
Pharmacotherapy ??
Preventif pada Menopause, usia lanjut
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Ilustrasi Kasus
Identitas Penderita :- Nama : Ny.R- Umur : 76 tnn- Alamat : Perum Asabri- Agama : Islam- Pekerjaan : Ibu Rumah tangga
Anamnesa + Ph Dx:- Nyeri punggung, terus menerus, bertambahsaat buat gerak, berlangsung sejak 4 tahun yglalu.Ke dokter diberi obat prednison, ponstan.Nyeri tekan (+), Kiposis (+)
Penunjang : - Photo thorax :- Densitas Vertebrae menurun- Lebar Disc Space Meningkat- Vertebrae Bikonkaf
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T e r a p i
Calcium : 1500 mg/ Hari
Calcitriol : 2 x 0,25 micro gram / Hr
Biphosphonat : 35 mg/minggu selama 5 bln,
istirahat 1 bulan, kmd dilanjutkan
Calcitonin : 50 IU/ 2 hari sekali
Phytoestrogen : 2 x 1tablet/ Hr
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