OSTEOPOROSIS PRESENTATION-1 Year 4 Internal Medicine Notes

OSTEOPOROSIS PRESENTATION-1 Year 4 · Internal Medicine Collection: 4TH YEAR ALL NOTES / IMED / IMED 4.3 / NGUGI -- Slide 1 Wesley Nyabera Happiness Njambi Slide 2 National Osteoporosis Foundation A disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to bone fragility and an increased susceptibility to fractures. Bone with lower density and higher fracture risk Definition: Slide 3 The World Health Organization’s (WHO) definitions of osteoporosis is based on BMD( bone mineral density) measurements: WHO definition: Slide 5 More than 10 million adults age 50 years and older had osteoporosis and more than 43 million had low bone mineral density (BMD) Globally, osteoporosis is by far the most common metabolic bone disease, estimated to affect over 200 million people worldwide The risk for osteoporosis increases with age as BMD declines Women are at a significantly higher risk for osteoporosis. Half of all postmenopausal women will have an osteoporosis-related fracture during their lifetime osteoporosis has a female-to-male ratio of 4:1. whites (especially of northern European descent) and Asians are at increased risk Epidemiology Slide 6 Osteoporosis is categorized as primary or secondary. Primary osteoporosis Primary osteoporosis is the most common form of osteoporosis. It is divided further divided into: juvenile osteoporosis idiopathic osteoporosis- further subdivided into postmenopausal (type I) and age-associated or senile (type II) osteoporosis. Postmenopausal osteoporosis is primarily due to estrogen deficiency. Senile osteoporosis is primarily due to an aging skeleton and calcium deficiency. Etiology Slide 8 Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis. Renal hypercalciuria is one of the most important secondary causes of osteoporosis and treatable with thiazide diuretics Secondary osteoporosis Slide 11 Risk Factors Slide 13 Composition of bone Bone has both organic and inorganic components. Organic components include: protein collagen and the specialized cells( osteoblasts, osteoclasts and osteocytes. Inorganic components mainly consists of calcium phosphate. Slide 17 Osteoporosis occurs when there is an imbalance between bone resorption and bone formation.\n\nBone resorption(osteoclast) Bone formation(osteoblast) Slide 18 Osteoporosis occurs because of a defect in attaining peak bone mass and/or because of accelerated bone loss.\n In normal individuals, bone mass increases during skeletal growth to reach a peak between the ages of 20 and 40 years but falls thereafter.\n In women there is an accelerated phase of bone loss after the menopause due to estrogen deficiency, which causes uncoupling of bone resorption and bone formation, such that the amount of bone removed by osteoclasts exceeds the rate of new bone formation by osteoblasts. Pathophysiology Slide 19 Age­ related bone loss is a distinct process that accounts for the gradual bone loss that occurs with advancing age in both genders. Bone resorption is not particularly increased but bone formation is reduced and fails to keep pace with bone resorption.\n Accumulation of fat in the bone marrow space also occurs because of an age­ related decline in the ability of bone marrow stem cells to differentiate into osteoblasts and an increase in their ability to differentiate into adipocytes. Slide 20 Osteoporosis does not become clinically apparent until a fracture occurs and so is sometimes referred to as the “silent disease.”\n Two-thirds of vertebral fractures are painless, although patients may complain of the resulting stooped posture and height loss.\n Vertebral fracture is the most common Clinical Presentation Slide 21 Osteoporotic spinal fracture may present with: acute back pain\ngradual onset of height loss\nkyphosis with chronic pain.\n The pain of acute vertebral fracture can occasionally radiate to the anterior chest or abdominal wall( can be mistaken for a myocardial infarction or intra­ abdominal pathology) but worsening of pain by movement and local tenderness both suggest vertebral fracture.\n Peripheral osteoporotic fractures present with:\nlocal pain Tenderness Deformity often after an episode of minimal trauma.\n In patients with hip fracture, the affected leg is shortened and externally rotated. Slide 22 History- assess for risk factors Physical examination Investigations Diagnosis Slide 23 Baseline laboratory studies Complete blood count: anemia Serum chemistry levels Liver function tests Thyroid-stimulating hormone level: Thyroid dysfunction has been associated with osteoporosis 25-Hydroxyvitamin D level: Vitamin D insufficiency can predispose to osteoporosis Serum protein electrophoresis: Multiple myeloma may be associated with osteoporosis 24-hour urine calcium/creatinine: Hypercalciuria may be associated with osteoporosis Testosterone (total and/or free) and luteinizing hormone/follicle-stimulating hormone: Male hypogonadism is a