By Ehab Abusinna

OSTEOMALACIAOSTEOPOROSIS

RICKETS

welcome

OSTEOPOROSIS - WHO

Systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue with a consequent increase in bone fragility and susceptibility to fracture which usually involves the wrist ,spine, hip, pelvis, ribs or humerus.

Most common of all metabolic bone disorders Significant morbidity(50% for hip fractures)

and mortality(20% for hip fractures in 1 year) Lifetime Osteoporotic Fracture Risk(Caucasian)

Woman- 40% Men - 20% Preventive therapies available.

Osteoporosis

Low bone density Micro architectural deterioration Fractures

Osteoporosis

Target Sites for Osteomalacia

Remodeling bones run throughout the life

TYPES OF OSTEOPOROSIS

Primary Osteoporosis Postmenopausal Osteoporosis

Senile Osteoporosis

Secondary Osteoporosis Diet

Drug

Endocrine disease

Other Systemic Disorders.

Senile or post-menopausal – 95%Indiopathic

Primary Osteoporosis

SECONDARY OSTEOPOROSIS

Endocrine: cushing + exog steroidsHyperthyroidismHypogonadismHyperparathyroidismDm

ProclatinomaAcromegalyPreg & lactation

RENAL

C R F

Malabsorption, CeliacGastrectomyT P NHepatobiliary diseaseChronic hypophosphatemia

NUTRITION AND GIT

DRUGS

HeparinSteroidsAnti-convulsants

DietLow calcium intake Low vitamin D intake Excessive intake of protein,

sodium and caffeine

Inactive lifestyle

Smoking , Alcohol abuse

Risk factors…

RISK INCREASED BY:

F – sexMenopauseDecreased CaSmokingAlcoholInactivityWhite Race (↓ black)

• Osteoporosis, the "silent disease," has bone loss without symptoms. • Onset only occurs with sudden strains, bumps, or fall causes a fracture or a vertebra to collapse. • Collapsed vertebrae may initially be felt or seen in the form of severe back pain, loss of height, or spinal deformities such as kyphosis or stooped posture.

SYMPTOMS

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RICKETS

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OSTEOMALACIA – LOOSER ZONE

OSTEOMALACIA – LOOSER ZONE

CHEMISTRY: NORMALWHY ↑ALK, BUT NOT PERSISTENT

PREVENTION:

ExerciseGood Ca intakeNon-smoking

LIFESTYLE ISSUES

Tobacco- eliminate itFood – eat it Exercise – do it Fall Prevention – work on it

Avoid smoking, alcohol and excess soft drink and coffee

x

Eat a health diet

lean meat, fish, green leafy vegetables, and oranges and Off course Plenty Milk

Formation

Resorption

Healthy bone balance

• Prevent further bone loss

• Increase or at least stabilize bone density.

• Relieve pain and prevent fracture.

• Increase level of physical functioning

• Increase quality of life

Goals of management

TREATMENT

Ca 1200 mg/dayVitamin D:- 400-2000 IU / dayHRTBiphosphonatesCalcintoninS E R M SParathyroid hormone

Vertebral Fracture Cascade

COMPLICATIONS

FRACTURE , The most serious complication of Osteoporosis that leads to

Increased morbidity Increased mortality Decreased quality of life

THE TIP OF THE ICEBERG

ASSESSMENT MANAGEMENT

Each year, one in three Ontarians over the ageof 65 will take a serious tumble that may landthem in hospital with a broken hip. One in threeof those who do break their hip will die withina year. Two thirds will experience dementia-likesymptoms. Most will never see home again.

Osteoporosis, is it only for women??

OSTEOPOROSIS IN MENHAS ITS TIME COME?

Osteoporosis, only for older people??