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Epidemiology, Management,
Prevention
Definition
Osteoporosis is a progressive,
Definition
Bone strength primarily reflects the
Epidemiology -Worldwide
Osteoporosis is estimated to affect 200
Epidemiology -Worldwide
Worldwide, 1 in 3 women over
24.3% osteoporotic
60-69 yrs : 27% osteopenic
62% osteoporotic
70-80 yrs : 21.5 osteopenic
73.8% osteoporotic
Osteoporosis in postmenopausal Saudi women using dual x-ray
bone densitometry . MahmoudI. El-Desouki,
SAUDI MEDICAL JOURNAL)
Epidemiology Of
Osteoporosis in KSA
483 post menopausal Saudi women in
El-Douski,Saudi Med J
Bottom-line
Osteopenia and osteoporosis
Physiology
Bone modelling
Begins with the development of the
skeleton during fetal life and continues until
the end of the second decade
Bone remodelling
Occurs from fetal life through to skeletal
maturity,
It maintains the mechanical integrity of the
skeleton by replacing old bone with new.
This constant process of turnover enables
Physiology
In the adult skeleton, approximately 510%
of the existing bone is replaced every year
through remodelling
The maintenance of a normal, healthy,
mechanically competent skeletal mass
depends on keeping the process of bone
resorption and formation in balance.
Failure to match bone formation with bone
resorption results in net bone loss.
This is what occurs in osteoporosis, as a
Heredity
Sex
Dietary
Endocrine factors (gonadal sex
hormones and adrenal androgens
Exposure to risk Factors
Evaluation/Diagnosis.
Optimal evaluation consists of:
Establishing the diagnosis of
osteoporosis on the basis of bone
mass assessment
Establishing the fracture risk
Determining the need for
instituting therapy.
History and a physical examination to
evaluate fracture risks; should
include assessment for loss of height
and change in posture.
Osteoporosis Diagnosis:
The Dual-energy X-ray
Absorptiometry (DXA) report
provides Bone Mineral content
in a given area of Bone
This gives BMD in grams per
square centimeter(g/cm2)
o Screening:
Osteoporosis screening at
PHC
Hypogonadism
Fragility fracture
High risk medication use
Rheumatoid arthritis
Chronis inflame conditions
Cushing disease
malabsorption syndrome
Uncontrolled
hyperthyroidism
Primary hyperthyroidism
OtherRefer
disorders
associated
for DXA
with rapid
bone loss/
Screening
fracture
Management
B. Pharmacologic measures.
Treat secondary causes of osteoporosis, and associated
disorders
Treat pain, discomfort and other associated morbidity
Increase bone mass.
Drugs for osteoporosis primarily reduce bone turnover
by inhibiting osteoclast activity.
The selection of any of the drugs used for osteoporosis
should be individualized based on the patient
characteristics, efficacy, and health economics.
There is no agent that is suitable for all patients, and
clinical judgment should always be exercised.
Referral for expert opinion is warranted
Management
1. Calcium and Vitamin D:
Should not be used as the sole treatment of
Management
VITA MIN D
Premenopausal, men <50 yr and
Management
2. Alendronate [ Drug Class:
Bisphosphonates] Approved for prevention and treatment of
Prevention
Initiatives should be directed at the following
measures:
Optimize nutrition in the youth to achieve high
peak bone mass.
Encourage adequate intake of calcium and
Vitamin D.
Identify and treat subjects with Vitamin D
deficiency, especially children, females in the
reproductive age group, and the elderly.
Recommend regular weight bearing exercise.
Avoidance of tobacco smoking and excessive
alcohol intake.
Prevention
Assess every postmenopausal woman for
Resources
International Osteoporosis Foundation
http://www.iofbonehealth.org/
Saudi Guidelines for Osteoporosis Prevention
and Treatment 2014
Guidelines for Prevention and Management of
Osteoporosis in Adults at KFSH&RC -2003
2015 Guidelines for Osteoporosis in Saudi
Arabia: Recommendations from the Saudi
Osteoporosis Society. Ann Saudi Med 2015;
35(1): 1-12