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EPIDEMIOLOGY
Osteoporosis is a major public health problem, and
postmenopausal osteoporosis constitutes as a major part
of the problem.
Claus Christiansen, Am J Med 1993
Osteoporosis
A major
What is it?
A disease
What is it?
Hip
Introduction
Osteoporosis is a disease characterized
by low bone mass and microarchitectural
deterioration of bone tissue, leading to
enhance bone fragility and a consequent
increase in fracture risk
(WHO)
Senile Osteoporosis
Occurs
Etiology :
General factor predictive of osteoporosis :
1. Peak bone mass at maturity :
General / familial
Nutritional
Physical (activity status, exercise, etc)
Life style (alcohol, cigarettes, caffeine)
Medical (chronic disease, hypogonadal states, etc
Iatrogenic (corticosteroid, anticonvulsant, etc)
Orthopaedics Study Guide, Metabolic Bone Disease, 1999, p.885-889
Bone Mass
Development
Bone Mass
Bone Loss
male
Menopause
female
20
40
age
Age (year)
60
80
4. Risk factors
Genetic, life style, Medical, Iatrogenic
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
- Female sex
- Caucasian / Asian ethnicity
- Family history of osteoporosis
2. Life Style
3. Medical :
- Early menopause
- Gonadal hormone deficiency
states
- Eating disorders
- Chronic liver / kidney disease
- Malabsorption syndrome
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
4. Iatrogenic
- Corticosteroids
- Excessive thyroid hormone
- Chronic heparin therapy
- Radiotherapy to skeleton
- Long-term anticonvulsants
- Loop diuretics
Orthopaedics A Study Guide, Metabolic Bone Disease, 1999, p.885-889
DIAGNOSIS
History :
o ras, sex and age
o health status
o life style (alcohol, smoking)
o physical activity (sports)
o history of previous disease including administration of
drugs, previous fracture.
Physical Examination :
Body weight and height (BMI)
Extremities and spine including :
deformity, MMT and ROM
Laboratory findings :
o blood serum
o hormone
o Urine
LABORATORY FINDINGS :
Routine:
- Serum :
- Complete blood counts
- Electrolytes, creatinine, blood urea, nitrogen calcium
- Phosphorus, protein, albumin, alkaline phosphatase,
liver enzyme
- Protein electrophoresis
- Thyroid function tests
- Testoterone (men only)
- 24 hours urine :
- calcium
- Pyridinium cross-links
LABORATORY FINDINGS :
Spesial :
- Serum:
- 25 hydroxyvitamin D3
- 1,25 hydroxyvitamin D3
- intact parathyroid hormone
- osteocalcium (bone Gla protein)
- Urine :
- Immunoelectrophoresis
- Bence-Jones protein
IMAGING :
Radiology : plain X-ray
(especially the spine, hip and wirst)
The spine
The Hip
- Singh Index
The Wirst
Fracture risk
Teatment
> +1
very low
no treatment
densitometry with indication
-1 s/d 0
low
no treatment
densitometry after 5 years
- 1 s/d +1
low
no treatment
densitometry after 2 years
-1s/d -2,5
midle
prevention
densitometry after 1 years
< - 2,5
no fracture
high
osteoporosis treatment
continue prevention
densitometry after 1 years
< - 2,5
With fracture
very high
osteoporosis treatment
continue prevention
surgery with indication
densitometry after within
Prevention
Aging process is a natural process of a person
getting old
3 steps of osteoporosis prevention :
I. Up to the end of 3rd decade
where Peak Bone Mass should be
achieved
II. After the 3rd decade up to menopause /
Andropause
III. Senile, prevent from minor injury /
accident
1st Prevention :
Good nutrition
2nd Prevention
3rd Prevention
Prevent from accident
(minor injury could cause fracture)
Care giver especially after fracture
Operative intervention and bracing
Treatment
Nowadays there is a lot of medication
For osteoporosis such as :
- calcium and vitamin D
- calcitriol
- calcitonin
- bisphosphonate : generation : I III
such as (clorodronate, alendronate, and
risedronate (actonel))
- hormone : - anabolic
- sex hormone
- SEMs (Selective Modulator)
- SERM (Selective Estrogen Reseptor
Modulator : Raloxifene
(analogue of tamosifene)
SURGERY
Calcium
: 1500 mg / day
HRT
Dr. C. Deeply
Balita
Remaja
Dewasa
Hamil
Menyusui
Sebelum menopause
Selama menopause
Setelah menopause
400 700
1000 1500
750 1000
1500
2000
800 1000
1000 1200
1200 1500
mg
mg
mg
mg
mg
mg
mg
mg
/
/
/
/
/
/
/
/
hari
hari
hari
hari
hari
hari
hari
hari
BAHAN MAKANAN
Per Ons
Per Ons
Per Ons
40 gr
Per Ons
Per Ons
Per Ons
er Ons
Per Ons
Per Ons
Per Ons
1 gelas
1 gelas
1 gelas
1 gelas
1 gelas
20 gr
Teri nasi
mengandung 1000 mg Kalsium
Kepiting
210 mg
Kerang
133 mg
Dencis kaleng
200 mg
Kuning telur ayam
147 mg
Tempe
129 mg
Tahu
124 mg
Emping
100 mg
Bayam merah
347 mg
Kacang panjang
347 mg
Daun singkong
165 mg
Susu kental manis
275 mg
Susu segar
380 mg
susu krim penuh
290 mg
Susu non fat
480 mg
yurgort
200 mg
keju
100 mg
2. Kalsium Laktas
3. Kalsium fosfat
Catatan :
Nama Dagang
Ca-C 100 Sandoz
Calsan
Caxon-F
Calsium Sandoz
Epocaldi
Ca-C 1000 Sandoz
Calcidin
Calsium Sandoz
Calcidin
Calcalcin
Kalsium(mg)
327
1250
250
300
400
1000
100
2940
200
800
Falls
--Fracture