Osteoporosis – B. Pharma 2nd Semester Pathophysiology notes pdf

Osteoporosis

Osteoporosis

Objective

At the end of the lecture student will be able to

       Explain osteoporosis

       Define pathogenesis of osteoporosis

       Describe the Factors affecting osteoporosis

       Briefly explain the treatment of osteoporosis

Osteoporosis

Definition

         Clinical

       Loss of bone mass sufficient to significantly increase  the risk of fracture

        Diagnostic

     T score – number of standard deviations above or  below the mean for a similar healthy 30 year old

·        Normal BMD = T: 0 to -1

·        Osteopenia BMD = T: -1 to -2.5

·        Osteoporosis BMD = T: less than -2.5

     Z score – number of standard deviations above or  below the mean for the patients age, sex and ethnicity

Epidemiology of Osteoporosis

        United States

     10 million individuals with osteoporosis

     34 million individuals with osteopenia

        Fracture Risks over age 50

     50% of women will have an osteoporosis-related fracture

     25 % of men will have an osteoporosis related fracture

        Estimated costs

       Direct health care $14 billion each year

Pathogenesis of Osteoporosis

        Peak bone mass

        Etiology Bone loss

        Age

        Secondary causes

Peak Bone Mass

        Genetically determined

–    70-75%

     Driven by sex hormones during puberty

     Depends on site measured – spine, femur, radius

        Ethnicity

     Chinese American later than Caucasians

        Women

     Peak accrual ages 11-15

     95 per cent achieved by late teens

        Men

     Peak accrual later teens

     Maximum spine age 20

     Radius and femur by mid twenties

Factors Affecting Peak Bone Mass

        Delay or Failure of puberty

     Primary Hypogonadism

        Turners syndrome

        Klinefelter syndrome

        Absent cervix, uterus, cervix and/or vagina

        Cryptorchidism

        Chemotherapy, Radiotherapy

        Chronic systemic diseases

     Secondary Hypogonadism

        Kallmann syndrome

        CNS tumors, infiltrative disorders

        Malnutrition

        Chronic systemic illness

Etiology of Bone loss in Osteoporosis

Etiology of Bone loss in Osteoporosis

Estrogen Deficiency

        Women

     Occurs earlier

     At menopause bone loss rates to increase by 2 to 6 fold

     For subsequent 6-8 years

     Impairs calcium absorption from gut

        Men

     Testosterone declines age

     Estrogen declines age

     Both androgens and estrogen contribute

Fracture Risk with Aging

Fracture Risk with Aging

Secondary Causes of Accelerated Bone-loss/Osteoporosis

        Inherited disorders

     Osteogenesis imperfecta tarda

     Thallasemia

        Amenorrhea

     Eating disorders

     Low weight

     Excess Exercise

     Female athlete triad

        Energy deficiency

        Low bone mineral density

        Amenorrhea

     Premature ovarian failure

        Respiratory

     Cystic fibrosis

        Gastrointestinal

     Celiac sprue

     Post Gastric by pass

     Inflammatory bowel disease

        Renal

     Idiopathic hypercalciuria

     Chronic renal failure

        Post organ transplant

     Immunosuppressive therapy

        Endocrine

     Hyperthyroidism

     Hyperparathyroidism

     Cushing’s syndrome

     Hypogonadism

     Vitamin D deficiency

          Rheumatology

      Rheumatoid arthritis

     Seronegative athropathies

        Lifestyle

       Smoking

      Alcohol

        Drugs

     Glucocorticoids

     Cyclosporine

     Anti seizure medications

        Phenobarbital

        Phenytoin

     Heparin

     Chemotherapy

        Aromatase inhibitors

     Thyroxine

        Over replacement

Diagnosis of Osteoporosis

         Approach to patient

        Investigations

     Bloods

     Urine

     Imaging

     FRAX use

        Calcium and Vitamin D

Osteoporosis Investigations

        Bloods-Basic

     CBC

     Electrolytes and eGFR

     Serum calcium and phosphate

     TSH

     Testosterone (Men)

     Serum protein electrophoresis

     Bone markers (consider)

        Urine

     24 hour urine

     Volume

     Creatinine and calcium

Bone Mineral Density Testing

       Bone mineral density testing

     Important means of assessing fracture risk

     Not stand alone test

        Other risk factors have impact on fracture risk

     occasionally more significant impact than bone density results alone

     Glucorticoids

        All known risk factors should be considered when deciding  to treat patients

     Mostly treating patients based on risk

     No overt disease

        We need better tools for assessing fracture risk

Summary

        Osteoporosis is an important public health problem

          Accurate diagnosis and treatment requires the use of bone densitometry.

        Radiologists play a central role in the diagnosis and  management

     of this disease:

     measuring bone density

      diagnosing fractures

     pointing out secondary causes of bone loss

FAQs

1. Can men get osteoporosis?

Yes, men can develop osteoporosis, although it is more common in women.

2. How is osteoporosis diagnosed?

Osteoporosis is diagnosed through bone density tests, with Dual-Energy X-ray Absorptiometry (DXA) being one of the most commonly used methods.

3. What are the most common medications for treating osteoporosis?

Common medications for osteoporosis include bisphosphonates, hormone therapy, and denosumab.

4. Are there natural remedies for preventing osteoporosis?

A balanced diet, regular exercise, and lifestyle changes can help prevent osteoporosis.

5. What is the best age to start focusing on bone health?

It’s never too early to start focusing on bone health, but the earlier, the better. Building strong bones during childhood and adolescence can reduce the risk of osteoporosis later in life.

1 thought on “Osteoporosis – B. Pharma 2nd Semester Pathophysiology notes pdf”

Leave a comment