Professional Documents
Culture Documents
Umar Zein
FK UNPRI
Cortical Bone
Dense and compact
Runs the length of the long bones, forming a hollow
cylinder
Trabecular bone
Has a light, honeycomb structure
Trabeculae are arranged in the directions of tension and
compression
Occurs in the heads of the long bones
Also makes up most of the bone in the vertebrae
Osteons
Bone Cells
Osteocytes
Trapped osteoblasts
In lacunae
Osteocytic osteolysis
Osteoblasts
Make collagen
Activate nucleation of hydroxyapatite
crystallization onto the collagen matrix,
forming new bone
As they become enveloped by the
collagenous matrix they produce, they
transform into osteocytes
Stimulate osteoclast resorptive activity
Osteoclasts
Matrix - Osteoid
Mineral
in cycles
first resorption than
bone formation
The calcium content
of bone turns over
with a half-life of 1-5
years
Phase I
Signal from osteoblasts
Stimulation of osteoblastic precursor
cells to become osteoclasts
Process takes 10 days
Phase II
Osteoclast resorb bone creating cavity
Macrophages clean up
Phase III
New bone laid down by osteoblasts
Takes 3 months
Pathways of Differentiation of
Osteoclasts and Osteoblasts
Hormonal Influence
Vitamin D
Parathyroid Hormone
Calcitonin
Estrogen
Androgen
Vitamin D
Parathyroid Hormone
Calcitonin
Actions of Calcitonin
Definition
A systemic skeletal
disease characterized by
low bone mass and micro
architectural deterioration
of bone tissue lead to
bone fragility and
susceptibility to fracture
Prevalence of osteoporosis
Osteopenia
Osteoporosis
Female
Age > 50
year
37-50%
13-18%
Male
Age > 50
year
28-47%
3-6%
Incidence of osteoporotic
Fx
Vertebral
Fracture
Forearm
Fracture
Hip
Fracture
No Bones About It
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Pathogenesis
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Pathogenesis
Pathogenesis
Quic kTime and a TIF F (Unc ompressed) dec ompressor are needed to see this pic ture.
Microdamage
Peak bone
mass
Quic kTime and a TIF F (Unc ompressed) dec ompressor are needed to see this pic ture.
Precipitating
factors
Loss of
Estrogen
Diagnosis of
osteoporosis
Diagnosis of Osteoporosis
Physical examination
Measurement of bone mineral
content
Dual X-ray absorptiometry (DXA)
Ultrasonic measurement of bone
CT scan
Radiography
Physical examination
Osteoporosis
Height loss
Body weight
Kyphosis
Humped back
Tooth loss
Skinfold
thickness
Grip strength
Vertebral fracture
Arm span-height
difference
Wall-occiput
distance
Rib-pelvis
distance
Physical examination
Physical examination
LR +ve
95% CI
Wt < 51 kg
7.3
5.0-10.8
Tooth < 20
3.4
1.4-8.0
RP distance < 2 FB
3.8
2.9-5.1
WO distance > 0 cm
4.6
2.9-7.3
Humped backed
3.0
2.2-4.1
Physical examination
No single maneuver is sufficient to rule
in or rule out osteoporosis or vertebral
fracture without further testing
T score
< 1 SD below
>/= -1
1-2.5 SD below
< -1
> -2.5
Osteoporosis
Severe osteoporosis
</= -2.5
Ultrasonic measurement
Broad-band ultrasound
attenuation or ultrasound
velocity
No radiation exposure
Cannot be used for
diagnosis
Preferred use in
assessment of fracture
risk
CT scan
True volumetric study
Most useful in cancellous
bone assessment
Avoid effect of
degenerative disease
Drawback
High cost
Plain radiography
Q ui ckT
i me and a TI FF (Uncompressed) decompressor are needed to see thi s pi ct ure.
Low sensitivity
High availability
Subclinical vertebral
fracture is a strong risk
factor for subsequent
fractures at new
vertebral site and other
sites
Age
Estrogen deficiency
Testosterone deficiency
Family history/genetics
Female sex
Low calcium/vitamin D intake
Poor exercise
Smoking
Alcohol
Low body weight/anorexia
Hyperthyroidism
Hyperparathyroidism
Prednisone use
Liver and renal disease (think about vit d synthesis)
Low sun exposure
Medications (antiepileptics, heparin)
Malignancies (metastatic disease; multiple myeloma can present as osteopenia!)
Hemiplegia s/p CVA/ immobility
Fracture Reduction
Osteoporosis Treatment:
Bisphosphonates
Bisphosphonate Associated
Osteonecrosis (BON)
Jaw osteonecrosis
Underlying significant dental disease
Usually associated with IV formulations
Case reports associated with oral
formulations
Bisphosphonates: Contraindications
Renal failure
Esophageal erosions
Raloxifene
FDA recommended
Decrease bone resorption like estrogen
No increased risk cancer (decrease risk
breast cancer)
Increase in vasomotor symptoms
associated with menopause
Teriparatide
Why PTH when well known association with
hyperparathyroidism and osteoporosis???
INTERMITTENT PTH: overall improvement in
bone density
Reducing Fractures
Hip Protectors
Falls Reduction
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