INTRUDUCTION

OSTEOPOROSIS
PREVENTION SOCIETY
ESTABLISHMENT

Hazem Abdel Azeem

Prof. of Orthopedic Surgery, Cairo University
Cairo April 2005
 As more & more diseases become eradicated

Leading cause
of death will
become
Osteoporosis
“Hard” protects Soft Structure
Hard Structure should not be
left to fail
Age-related changes

After age 60, subperiosteal

area slowly increases but
medullary cavity enlarges
faster, resulting in net
decrease of cortical
thickness and mass
Underdiagnosed and Undertreated
“…osteoporosis is commonly not
diagnosed or treated appropriately…”
Follin SL et al. Pharmacotherapy. 2003;23:190-198.

“…large numbers of people with

osteoporosis are still not being
diagnosed…are not being treated.”
Schnitzer TJ. Diagnosis and Treatment for Osteoporosis:
Current Status and Expectations for the New Millennium.
Available at: http://www.medscape.com/viewprogram/605.
“Women are not aggressively treated for
osteoporosis after hip fracture…”
Kiebzak GM et al. Arch Intern Med. 2002;162:2217-2222.
 BE AWARE
of
The Silent Thief

The Deafening Silent Epidemic

Realizing The Scale Of
Progression
The Magnitude
The Demography
 Over Suspicion

Due to wrong awareness

propaganda
 A lifestyle conducive to osteoporosis
Body image – distorted

Milk intake – low Exercise – non existent

Smoking – on the rise

Steroid abuse – excessive

Health education – patchy

 DRUGS RELATED RISKS
• Smoking
• Glucocorticoids and ACTH
• Thyroxine • Tamoxifen
• Anticonvulsants • Medroxyprogester-
• Heparin
one acetate
• Lithium
• Aluminium
• Cytotoxic
• Gonadotrophin-RH agonists • Excess Vitamin D
• Drugs causing falls
• Hyperoxia
MORBIDITY OF OSTEOPOROSIS

Osteoporotic Bone Loss

Osteoporosis Normal
Dempster DW, et al. J Bone Min Res. 1986;1:15-21.
Reprinted with permission from the American Society for Bone and Mineral Research.
 PAINS
• MICROFRACTURES.
• LONG STANDING
KYPHOSIS.
• ASSOCIATED
OSTEOMALACIA.
• OSTEOPOROTIC
FRACTURES.
• MUSCULAR.
• FIBROMYOSITIS.
 FRACTURES
• FRAGILITY
FRACTURES.
• MINOR TRAUMA.
• COMMON SITES
– Spine.
– Proximal end of femur.
– Distal end of radius.
– Proximal end of humerus.
PROGRESSIVE KYPHOSIS
Assessment of osteoporosis (aim)

• Diagnosis.
• Identification of disorders mimicking
osteoporosis.
• Identification of risk factors.
• Methodology for prognosis.
• Selection of treatment.
• Baseline for response evaluation.
 Evolution of Diagnostic Facilities for
Osteoporosis
X-Ray

Densitometry

Laboratory; New Bone Markers

Bone Biopsy
Risk Factors Person

Densitometry diagnosed patient

X-Ray Diagnosed Patient

History of Low-Trauma
(Fragility) Fracture
 Conclusion

Everything about Osteoporosis on the RISE!!

• Patient numbers increase as life expectancy rises

• Increase risk factors
- Early menopause
- Increase smoking
- Increase use of steroids
- Increase sedentary life

• Increase in available options for treatment of Osteoporosis

• Increase in Research for development of new treatments
• Increase in awareness of Osteoporosis
• Increase in ways of surgical management (internal fixation,
replace tools, bone stimulation)
 Evolution of Medical Treatment Options for Osteoporosis

• 1986 – Calcitonin, HRT

• 1997 – Alendronate, Bisphosphonate daily launch
• 2001 – Risedronate, Bisphosphonate daily launch
• 2002
– Weekly Bisphosphonates launched
– Raloxifene, SERM launch
– WHI study highlights risk of HRT
• 2003 – Parathormone available
• And many more to come…..
Evolution of Surgical Treatment Options for Osteoporosis

Leave patient with fracture neck of

femur & advise patient to rest

Internal fixation or ways to replace

 High Costs :
How Many of Our Patients Have These Facilities?
Who is picking up the bill in
Egypt?

?
THE OUTLOOK IS WORSE IN
OUR EGYPTIAN SOCIETY
Inauguration & Evolution of
the Egyptian Osteoporosis
Prevention Society
(EOPS)
 Inaugurated 1999 – EOPS

Founders
– Prof. Samir El Badawi & Prof. Hazem Abdel Azeim
Board Members
– Prof. Ahmed Rashed, Prof. Omar Hussein, Prof. Ahmed
Mortegy, Prof. Amal El Badawi, Prof. Mohamed Hassan, Mr.
Hatem Sedky, Mrs Nafeesa Abed
General Assembly
– 300 Members
 AIMS
f the correct awareness among the medical & non-medical communities
f research work related to osteoporosis
f publications related to osteoporosis
ong scientific meetings both National & in conjunction with IOF, PAOS, & Mediterranean Osteoporosis Society
n with Pharmaceutical companies & scientific offices interested in the field of Osteoporosis
 Activities

• National Osteoporosis Conferences

• 2003 – PanArab Osteoporosis Society Meeting in
Egypt
• September 2005 – Annual National Osteoporosis
Prevention Society Conference
• Social events to propagate patient awareness
 Research
• Level of awareness of Osteoporosis
• Egyptian curve for BMD
• Steroid Induced Osteoporosis
• Discharge Program after fracture
• Osteoporosis in Males
 New Research Directions

HOW to

PREVENT TREAT
DIAGNOSE
EARLY

PREVENT FRACTURES &

SUBSEQUENT SEQUELAE PAIN
& DEFORMITIES
 HOWEVER we are still getting fractures
Maybe in older age
-
Maybe more than once (2ndry fractures)
-

So we must have
better ways of Management

1. Complete diagnosis (assessment)

2. Treatment of fractures
3. Prevention of further fractures
Change of Understanding of Osteoporosis
Osteoporosis

Fracture

X-ray

BMD
Bone Markers
Bone Quality

Bone Strength
 Bone Strength Depends on Three Elements

BMD

Bone
Strength
Bone Turnover Bone Quality

“Osteoporosis is defined as a skeletal disorder characterized by

compromised
bone strength predisposing a person to an increased risk of fracture.”
NIH Consensus Development Panel, JAMA. 2001;285(6):785-795
THANK YOU