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    Dewy Shinta Pagala
    Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It is defined by the World Health Organization as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass of healthy young adults. Key factors that contribute to osteoporosis are peak bone mass attained during growth, rate of bone loss after maturity, and lifestyle factors such as nutrition, exercise, smoking, and medication use. Diagnosis involves assessing risk factors, performing physical exams to check for signs of fractures or height loss, and conducting bone mineral density tests such as dual-energy X-ray absorptiometry scans. Management focuses on lifestyle changes,

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    5 .

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    76 views28 pages
    Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It is defined by the World Health Organization as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass of healthy young adults. Key factors that contribute to osteoporosis are peak bone mass attained during growth, rate of bone loss after maturity, and lifestyle factors such as nutrition, exercise, smoking, and medication use. Diagnosis involves assessing risk factors, performing physical exams to check for signs of fractures or height loss, and conducting bone mineral density tests such as dual-energy X-ray absorptiometry scans. Management focuses on lifestyle changes,

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    Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It is defined by the World Health Organization as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass of healthy young adults. Key factors that contribute to osteoporosis are peak bone mass attained during growth, rate of bone loss after maturity, and lifestyle factors such as nutrition, exercise, smoking, and medication use. Diagnosis involves assessing risk factors, performing physical exams to check for signs of fractures or height loss, and conducting bone mineral density tests such as dual-energy X-ray absorptiometry scans. Management focuses on lifestyle changes,

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    76 views28 pages

    5 .

    Uploaded by

    Dewy Shinta Pagala
    Osteoporosis is a disease characterized by low bone mass and deterioration of bone structure, leading to an increased risk of fractures. It is defined by the World Health Organization as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass of healthy young adults. Key factors that contribute to osteoporosis are peak bone mass attained during growth, rate of bone loss after maturity, and lifestyle factors such as nutrition, exercise, smoking, and medication use. Diagnosis involves assessing risk factors, performing physical exams to check for signs of fractures or height loss, and conducting bone mineral density tests such as dual-energy X-ray absorptiometry scans. Management focuses on lifestyle changes,

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    of 28

    Osteoporosis

    Dr. Femi Syahriani, Sp.PD.


    Departement of Internal Medicine
    University of Hasanuddin
    Intoduction
    • Osteoporosis (OP): a reduction in the strength of
    bone leading to an increased risk of fractures.
    Loss of bone tissue is associated with
    deterioration in skeletal microarchitecture.
    • The World Health Organization (WHO): OP as a
    bone density that falls -2.5 standard deviations
    (SD) below the mean for young healthy adults of
    the same gender—also referred to as a T-score of
    –2.5
    • OP  “silent thief” and “silent disease”
    Intoduction
    • Age is not the only risk factor for osteoporosis.
    Lifestyle choices, certain diseases and even
    medications can lead to this condition.
    • A simple test known as a bone density scan can
    give important information about your bone
    health.
    • Newer medications can slow and even stop the
    progression of bones getting weaker, and can
    help decrease fracture risk.
    Intoduction
    • More than 1.5 million osteoporosis-related
    fractures occur each year in the United States.
    • Osteoporotic fractures  the femoral neck,
    the vertebral bodies, or the wrist.
    • Ninety percent (90%) of all hip and spinal
    fractures are related to osteoporosis.
    Intoduction
    • In Surabaya (1997) 26% pasca menapause
    women had OP
    • OP  OP primer and OP secunder
    Pathology and Pathophysiology
    • The pathophysiology of OP  genetic,
    hormonal, nutritional, and environmental
    influences. Some risk factors for this condition
    are well defined.
    • The bone mass of an individual in later life is a
    consequence of the peak bone mass accrued
    in utero and during childhood and puberty, as
    well as the subsequent rate of bone loss
    Pathology and Pathophysiology
    • Bones are an extremely dense form of
    connective tissue made up principally of the
    fibrous protein collagen, impregnated with a
    mineral phase of calcium phosphate crystals
    as well as other components such as water.
    • Although they are one of the hardest
    structures in the body, bones maintain a
    degree of elasticity due to their structure and
    material properties.
    Pathology and Pathophysiology
    • During development and growth, bone is
    produced by two main processes:
    intramembranous ossification, as occurs in
    skull bones; and endochondral ossification
    involving the growth plate, as occurs in limb
    bones.
    • Modeling is the process that results in the
    achievement of bones’ characteristic shape
    and overall structure
    Pathology and Pathophysiology
    Pathology and Pathophysiology
    • Tulang mengalami 2 macam pertumbuhan :
    Modelling dan Remodelling.
    • Kedua proses ini selalu berpasangan dan
    dalam keadaan normal selalu seimbang
    sehingga tidak akan terjadi defisit massa
    tulang.
    • The principal cell types within bone are the
    osteoclasts, osteoblasts, and osteocytes.
    Pathology and Pathophysiology
    ⁺
    Osteoclastic Bone Resorption
    Disbalance

    ⁻
    -
    Osteoblastic Bone Formation

    Loss of bone mass


    Decrease in total bone volume
    Change in bone architecture
    Risk for fragility & fractures
    Deformities
    Diagnosis

    Normal Bone Osteoporotic Bone


    Common factors predictive of OP
    Peak bone mass at maturation :
    • Genetic
    • Nutrition
    • Physical activity or exercise
    • Life style
    • Chronic disease
    • Iatrogenic (drug induced)
    Common factors predictive of OP

    Loss of bone mass pasca menopause


    Loss of bone massa due to aging
    Other risk factor.
    How to diagnosis OP
    • The clinical evaluation of OP is dedicated to identifying
    lifestyle risk factors for fracture, pertinent physical
    findings, and secondary causes of metabolic bone
    disease.
    • Evaluation of a person with or at risk for op : family
    history of metabolic bone disease, changes in height
    and weight, the quantity and frequency of weight-
    bearing exercise, level of sun exposure, previous
    fractures, reproductive history, endocrine disorders,
    dietary factors, tobacco smoking, alcohol intake,
    exercise, renal or hepatic failure, and past and current
    medications and supplements.
    How to diagnosis OP
    • Factors that increase the risk of falls :
    neuromuscular disease, gait instability, and
    unsafe living conditions.
    • History of bone pain is potentially useful if
    present, osteoporosis is not painful until the
    time of fracture (if then).
    How to diagnosis OP
    Physical Examination:
    • Accurate height measurement using an
    instrument known as a stadiometer is a vital part
    of the OP physical examination
    • Comparison of a patient’s current height and
    maximum height obtained in young adulthood
    (e.g., through reference to the patient’s driver’s
    license) is helpful in identifying height loss.
    • The loss of 2 inches (5 cm) in height is a fairly
    sensitive indicator of vertebral compression.
    How to diagnosis OP
    Physical Examination:
    • The number of missing teeth has been
    correlated with losses in BMD.
    • The neurological examination highlights
    muscular weakness or neurological
    compromise that could predispose to falls
    • Observation of the patient’s gait is a critical
    part of the examination.
    How to diagnosis OP
    Skeletal Imaging :
    • Conventional Radiographythe Singh index
    • Dual-Energy X-Ray Absorptiometry (DXA): T
    score dan Z score
    • Clasification of OP by WHO 1994
    Clasification T-Score
    Normal -1 atau lebih besar
    Osteopenia Antara 1- dan -2,5
    Osteoporosis -2,5 atau kurang
    Osteoporosis berat -2,5 atau kurang dan fraktur
    fragilitas
    How to diagnosis OP
    • WHO FRAX Tool 2008  www.shef.ac.uk/frax
    How to diagnosis OP
    Laboratory evaluation:
    Management
    • Education and Prevention
    • Excercise and Rehabilitation program
    • Pharmacology :
    1. Bisfosfonat 5. Vit. D
    2. Reloksifen 6. Calsitrol
    3. Terapi sulih Hormon 7. Calsium
    4. Calsitonin 8. Strontium renelat
    • Surgery
    Thank You
    MAJOR CAUSES OF
    OSTEOPOROSIS IN MEN

    Alcohol

    Primary Glucocorticoids ~45%


    35-40%
    Hypogonadism

    Other

    ~15-20%
    OTHER CAUSES OF
    OSTEOPOROSIS IN MEN

    • Immobilization
    • Gastrointestinal disorders • Osteogenesis imperfecta
    • Hypercalciuria • Homocystinuria
    • Anticonvulsants • Mastocytosis
    • Thyrotoxicosis
    • Primary
    Hyperparathyroidism
    • Neoplastic disease
    • Rheumatoid arthritis
    • Cushing’s disease
    Osteoporosis
    ⁺ -
    ⁻
    Disbalance
    Osteoclastic Bone Resorption
    Osteoblastic Bone Formation

    Loss of bone mass


    Decrease in total bone volume
    Change in bone architecture
    Risk for fragility & fractures
    8/31/2018 Deformities
    2973 NRS P&P-1
    /[email protected]/FCHS
    28

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