1. SOELARTO REKSOPRODJOSOELARTO REKSOPRODJO
Division of Orthopaedic & TraumatologyDivision of Orthopaedic & Traumatology
Faculty of Medicine, Univ. of IndonesiaFaculty of Medicine, Univ. of Indonesia
Dr. Cipto Mangunkusumo – JakartaDr. Cipto Mangunkusumo – Jakarta
Simposium SehariSimposium Sehari
““Penanganan Nyeri Tulang Belakang Terkini”Penanganan Nyeri Tulang Belakang Terkini”
Graha Sindang Reret, Garut, 29 Mei 2004Graha Sindang Reret, Garut, 29 Mei 2004
2.
3. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
INTRODUCTIONINTRODUCTION
Declaration of Bone and Joint DecadeDeclaration of Bone and Joint Decade
2000 – 2010 by the WHO was positively2000 – 2010 by the WHO was positively
respons by professional as well socialrespons by professional as well social
association by nearly all developed andassociation by nearly all developed and
developing countries including Indonesiadeveloping countries including Indonesia
4. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
What is the Bone and Joint Decade ?What is the Bone and Joint Decade ?
It is a worldwide effort to advance under-It is a worldwide effort to advance under-
standing and treatment of muscuolskeletalstanding and treatment of muscuolskeletal
conditions and to promote researchconditions and to promote research
Patients, physicians, medical specialtyPatients, physicians, medical specialty
societies, allied health professionals andsocieties, allied health professionals and
health organizations are urging their nationshealth organizations are urging their nations
worldwide to focus attention on the disordersworldwide to focus attention on the disorders
which affect millions of peoplewhich affect millions of people
5. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
IRA (Indonesian Rheumatology Association)IRA (Indonesian Rheumatology Association)
was the first professional association inwas the first professional association in
Indonesia, at their meeting in Jakarta,Indonesia, at their meeting in Jakarta,
May 2000 responded the declaration, whichMay 2000 responded the declaration, which
was announced by the Minister of Health RIwas announced by the Minister of Health RI
6. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
In the same year :In the same year :
The Woman Association founded YATUSIThe Woman Association founded YATUSI
(Yayasan Tulang Sehat Indonesia)(Yayasan Tulang Sehat Indonesia)
June 2000June 2000
The study group of osteoporosis FKUI – RSCMThe study group of osteoporosis FKUI – RSCM
founded the PEROSI (Perhimpunanfounded the PEROSI (Perhimpunan
Osteoporosis Indonesia), 28 Oktober 2000Osteoporosis Indonesia), 28 Oktober 2000
7. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
The President of the Republic of IndonesiaThe President of the Republic of Indonesia
declared the participation of Indonesia,declared the participation of Indonesia,
read by the Minister of Health at the Goldenread by the Minister of Health at the Golden
anniversary of RSO Prof. DR. R. Soeharsoanniversary of RSO Prof. DR. R. Soeharso
in Solo, August 2001in Solo, August 2001
8. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Goals of the Bone and Joint DecadeGoals of the Bone and Joint Decade
1.1. ToTo raise awarenessraise awareness of the growing burden ofof the growing burden of
musculoskeletal disorders on societymusculoskeletal disorders on society
2.2. ToTo empower patientsempower patients to participate in theirto participate in their
own careown care
3.3. ToTo promote cost – effective prevention andpromote cost – effective prevention and
treatmenttreatment
4.4. ToTo improve prevention and treatmentimprove prevention and treatment of muskulo-of muskulo-
skeletal disorders through medical researchskeletal disorders through medical research
9. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
BONE AND JOINTBONE AND JOINT
Bone and Joint is part of the musculo-Bone and Joint is part of the musculo-
skeletal system, function as a locomotorskeletal system, function as a locomotor
apparatus; disorders and diseases mayapparatus; disorders and diseases may
disturb the ADLdisturb the ADL
10. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Disorders or diseases of musculoskeletalDisorders or diseases of musculoskeletal
system is classified as follows :system is classified as follows :
Congenital anomaliesCongenital anomalies
Inflammation / infectionInflammation / infection
TraumaTrauma
Tumor / cancerTumor / cancer
Degenerative diseaseDegenerative disease
Metabolic diseaseMetabolic disease
MiscellaneousMiscellaneous
11. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Disorders or diseases of bone and jointDisorders or diseases of bone and joint
will widely affect socio-economic and ADLwill widely affect socio-economic and ADL
(example :(example :
- USA in 1995 : 36 million people- USA in 1995 : 36 million people
the cost of treatment for musculoskeletalthe cost of treatment for musculoskeletal
disorders was USD $ 210 billion)disorders was USD $ 210 billion)
- Musculoskeletal impairment are the- Musculoskeletal impairment are the
number 1 (one) reported category ofnumber 1 (one) reported category of
impairment and the number 1 (one) reasonimpairment and the number 1 (one) reason
people visit the doctorpeople visit the doctor
12. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Natural history of musculoskeletalNatural history of musculoskeletal
diseases through 3 stages of functionaldiseases through 3 stages of functional
disorders :disorders :
1.1. ImpairmentImpairment
2.2. DisabilityDisability
3.3. HandicapHandicap
13. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Not all disorders and diseases of musculo-Not all disorders and diseases of musculo-
skeletal either congenital or acquiredskeletal either congenital or acquired
will recover 100%will recover 100%
It needs rehabilitation especially toIt needs rehabilitation especially to
improve functionimprove function
14. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
The goal is maximum rehabilitationThe goal is maximum rehabilitation
of patient as a wholeof patient as a whole
15. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Although there are many disease orAlthough there are many disease or
disorders of the musculoskeletal, butdisorders of the musculoskeletal, but
it seems the topics of the Bone & Jointit seems the topics of the Bone & Joint
decade is more on the process ofdecade is more on the process of
aging such as (degenerative disease) :aging such as (degenerative disease) :
OsteoporosisOsteoporosis
OsteoarthritisOsteoarthritis
16. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Degenerative process :Degenerative process :
All tissue or organs will reduceAll tissue or organs will reduce
their function 1% per year aftertheir function 1% per year after
the 3the 3rdrd
decadedecade
(the 1% rule of Andreas & Tobin)(the 1% rule of Andreas & Tobin)
17. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
As a whole there is slowly affection ofAs a whole there is slowly affection of
the tissues / organs :the tissues / organs :
The eye : Vision : cataract, hypermetropThe eye : Vision : cataract, hypermetrop
The ear : DeafnessThe ear : Deafness
The skin : Dry and wrinkledThe skin : Dry and wrinkled
The urinary tract : - IncontinentThe urinary tract : - Incontinent
- hypertrophy prostate in men- hypertrophy prostate in men
The GI tract : - Incontinent, resorptionThe GI tract : - Incontinent, resorption ↓↓
The genital : Frigidity, impotencyThe genital : Frigidity, impotency
The mental : Depression, dementiaThe mental : Depression, dementia
The nerve : ReflexThe nerve : Reflex ↓↓
Bone & Joint : osteoporosis / osteoarthritisBone & Joint : osteoporosis / osteoarthritis
18. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
OSTEOPOROSISOSTEOPOROSIS
PEROSI is a group of doctor in multidisciplinePEROSI is a group of doctor in multidiscipline
medical sciences interested in problem ofmedical sciences interested in problem of
osteoporosisosteoporosis
It is now a associate member of IOF (InternationalIt is now a associate member of IOF (International
Osteoporosis Foundation)Osteoporosis Foundation)
The patron of IOF is : Queen Rania of JordanThe patron of IOF is : Queen Rania of Jordan
19. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
““Strong bones build strong lives, andStrong bones build strong lives, and
strong lives build strong future ……….,strong lives build strong future ……….,
we must do all we can to make thatwe must do all we can to make that
strength a reality for all”strength a reality for all”
Queen Rania, Lisbon 10 –14 May 2002Queen Rania, Lisbon 10 –14 May 2002
20. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Research in Indonesia :Research in Indonesia :
Prof. DR. Djoko Roeshadi, dr. Sp.B., Sp.BOProf. DR. Djoko Roeshadi, dr. Sp.B., Sp.BO
DR. Ichramsyah A.R., Sp.OG, KERDR. Ichramsyah A.R., Sp.OG, KER
21. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Osteoporosis is a “silent disease”Osteoporosis is a “silent disease”
meaning no significant clinical symptomsmeaning no significant clinical symptoms
unless a minor trauma produces fractureunless a minor trauma produces fracture
A good observation of mild dull achingA good observation of mild dull aching
of the back, reduce in height and kyphoticof the back, reduce in height and kyphotic
deformity are the early signs of osteoporoticdeformity are the early signs of osteoporotic
especially in post menopausal womenespecially in post menopausal women
22. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
WHO definition (1991) :WHO definition (1991) :
““Osteoporosis is a disease characterizedOsteoporosis is a disease characterized
by low bone mass and microarchitecturalby low bone mass and microarchitectural
deterioration of bone tissue, leading todeterioration of bone tissue, leading to
enhanced bone fragility and a consequentenhanced bone fragility and a consequent
increase in fracture risk”increase in fracture risk”
23. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Gold standard to detect osteoporosis :Gold standard to detect osteoporosis :
- Densitometry- Densitometry
- WHO criteria :- WHO criteria :
Normal : 1SD from TScoreNormal : 1SD from TScore
Osteopenia : -1SD to –2,5SD from TScoreOsteopenia : -1SD to –2,5SD from TScore
Osteoporosis : less than –2,5SD from TScoreOsteoporosis : less than –2,5SD from TScore
(severe osteoporosis : associated a fracture)(severe osteoporosis : associated a fracture)
24. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
The Interpretation of DEXAThe Interpretation of DEXA
T Score Bone Loss Fracture RiskT Score Bone Loss Fracture Risk
0 to –1 None None0 to –1 None None
-1 to –2-1 to –2 Moderate SmallModerate Small
-2 to –3-2 to –3 Severe ModerateSevere Moderate
Less than –3 Very severe SevereLess than –3 Very severe Severe
Orthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889Orthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889
25. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
4 Sets of factors as the cause of osteoporosis4 Sets of factors as the cause of osteoporosis
1.1. Genetic / familialGenetic / familial
NutritionalNutritional
Physical activityPhysical activity
Life styleLife style
Health / disease history with the use of drugsHealth / disease history with the use of drugs
2.2. Bone loss post menopauseBone loss post menopause
3.3. Bone loss with agingBone loss with aging
4.4. RiskRisk
26. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
WOD and NOD 20 OctoberWOD and NOD 20 October
2002 :2002 : Theme :Theme :
““ Seberapa jauh anda peduliSeberapa jauh anda peduli
terhadap tulang andaterhadap tulang anda ““
2003 : “2003 : “ Tulang kuat mulai dari sekarangTulang kuat mulai dari sekarang ””
27. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
BMD / BMC will reach maximum atBMD / BMC will reach maximum at
the end of the 3the end of the 3rdrd
decade :decade :
(Peak Bone Mass)(Peak Bone Mass)
28. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Prevention is divided into :Prevention is divided into :
Primary :Primary : Before osteoporosis, to reachBefore osteoporosis, to reach
maximum PBMmaximum PBM
Secondary : -Secondary : - After detected as osteoporosis/After detected as osteoporosis/
osteopenia (avoid external factor)osteopenia (avoid external factor)
-- If already fracturedIf already fractured
29. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
OSTEOARTRHITISOSTEOARTRHITIS
Is a degenerative process non inflammatoryIs a degenerative process non inflammatory
disease of the joint characterized by degradationdisease of the joint characterized by degradation
of articular cartilage and spur formation at the edgeof articular cartilage and spur formation at the edge
of the articular surfaceof the articular surface
(a lay man will call =(a lay man will call = PengapuranPengapuran))
30. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
There are a lot of terminologies forThere are a lot of terminologies for
disorders or diseases of the jointdisorders or diseases of the joint
RA : Rheumatology Arthritis (RA : Rheumatology Arthritis (encokencok))
Infective arthritis : - StaphylococcusInfective arthritis : - Staphylococcus
- Tb, etc- Tb, etc
Gouty arthritis, etcGouty arthritis, etc
31. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
Mostly affected the elderly peopleMostly affected the elderly people
(more than 50 years of age, obese,(more than 50 years of age, obese,
and weight bearing joint), stiffnessand weight bearing joint), stiffness
and pain after a rest following a longand pain after a rest following a long
period of activitiesperiod of activities
32. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
A multi factoral etiology which causeA multi factoral etiology which cause
degradation of articular cartilagedegradation of articular cartilage
such as :such as :
Instability of joint as a biomechanicalInstability of joint as a biomechanical
process : wear and tear (use abuse)process : wear and tear (use abuse)
Immunology and inflammation reactionImmunology and inflammation reaction
Stress oxydatives cause destructionStress oxydatives cause destruction
of cartilage, etcof cartilage, etc
33. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
DIAGNOSISDIAGNOSIS
HistoryHistory
Physical Examination (PE)Physical Examination (PE)
ImagingImaging
34. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
MANAGEMENTMANAGEMENT
PT : - Strengthening exercisePT : - Strengthening exercise
- ROM- ROM
- Non weight bearing exercise /- Non weight bearing exercise /
hydrotherapyhydrotherapy
BracingBracing
Operative : - ArthroscopyOperative : - Arthroscopy
- Arthrodesis- Arthrodesis
- Joint Replacement- Joint Replacement
35. PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010
PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS
INCONCLUSIONINCONCLUSION
Bone and joint decade 2000 – 2010 has beenBone and joint decade 2000 – 2010 has been
declareddeclared
Important of awareness concerning the problemImportant of awareness concerning the problem
of sosio-economic by empowering patient toof sosio-economic by empowering patient to
participate in their own careparticipate in their own care
Participation of professional association to raiseParticipation of professional association to raise
quality of life by :quality of life by :
prevention, treatment base on researchprevention, treatment base on research
(Evidence Base Medicine)(Evidence Base Medicine)
