1. OSTEOPOROSIS
Presented By:
Shabana Khatoon
M.Pharm 2nd Year

2. Osteoporosis
• Disease that causes bones to become thin,weak and
easy to break.
• Bone get weaker when there is low level of calcium,
phosphorus and other minerals in the bones and
results in low bone density.

3. Normal
Moderate
Severe

4. • The reduction of bone mass with distortion of the
microarchitecture is termed osteoporosis.
• Reduction in the mineral content is termed
osteopenia.

5. OSTEOPOROSIS

6. 1,500,000
0
500,000
1,000,000
1,500,000
2,000,000
Osteoporotic
Fractures
*
513,000
Heart Attack
**
228,000
Stroke
† 184,300
Breast Cancer
‡
Annualincidenceofcommondiseases
Frequency of Common
Medical Events in Women

7. •Osteoporosis is a health threat for an estimated 44 million
Americans.
•Of that 44 million :
•10 million individuals already have the disease
•80% of these are women
•34 million more are estimated to have low bone mass
and increased risk for osteoporosis.
Prevalence
.
• osteoporosis is often thought of as
an older person's disease, it can
strike at any age.

8. Bone density can be temporarily lost during breastfeeding. Several
studies have shown that recovering full bone density occurs within
six months after weaning.
Bone loss during breastfeeding?
•Women have a hip fracture rate two to
three times higher than men.
•A woman's risk of hip fracture is equal
to her combined risk of breast, uterine
and ovarian cancer.
OSTEOPOROSIS IN WOMEN

9. TYPES OF OSTEOPOROSIS
Primary Osteoporosis
Secondary Osteoporosis

10. .
1. Rheumatologic disorders
•Rheumatoid arthritis,
•Ankylosing spondylitis
Etiology
2. INHERITED DISORDERS
•Osteogenesis imperfecta
•Glycogen storage diseases

11. .
3. Nutritional and
gastrointestinal
disorders
•malnutrition,
•parenteral nutrition,
•gastrectomy,
Etiology
4. Endocrine
disorders
•hyperparathyroidism
•insulin-dependent
diabetes mellitus,
•adrenal insufficiency

12. Detection: Bone Mineral Density Tests
DXA (Dual Energy X-ray Absorptiometry) spine, hip or total body
pDXA (Peripheral Dual Energy X-ray
Absorptiometry)
wrist, heel or finger
SXA (single Energy X-ray
Absorptiometry)
wrist or heel
QUS (Quantitative Ultrasound) heel, shin bone and kneecap
QCT (Quantitative Computed
Tomography)
spine
pQCT (Peripheral Quantitative
Computed Tomography)
wrist
RA (Radiographic Absorptiometry) hand
DPA (Dual Photon Absorptiometry) spine, hip or total body
SPA (Single Photon Absorptiometry) wrist
Type
of Test
Area
tested

13. RISK FACTORS
• Amenorrhea
• Anorexia
• Bulimia
• Diet low in calcium
• Low testosterone in men
• Certain medication

14. Osteoporosis classification
• WHO criteria:
– T-score < –1.0 = normal
– T-score > –1.0–2.5 = osteopenia
– T-score > –2.5 = osteoporosis

15. Therapeutic Agents Used in
Osteoporosis
• Inhibitors of bone
resorption:
– Calcium
– Estrogens +/-
progest
– SERMs
– Bisphosphonates
– Calcitonin
• Stimulators of bone
formation
– PTH
– Fluoride
A. Normal Spine
B. Moderately
Osteoporotic Spine
C. Severely Osteoporotic
Spine

16. Management of underlying
disease
• Non pharmacological
• Pharmacological

17. Non pharmacological
management
• Adequate diet – in proteins, calories, calcium,
Vitamin D
• High impact physical activity :
 Jogging – increases bone density
 Stair climbing – increases bone density
 Regular exercises – helps to increase strength
and reduce risk of falling.
 Balanced exercises – reduce falls

18. • Cessation of smoking
• Stop or reduce alcohol

19. Pharmacological
• Anti resorptive drugs : Bisphosphonates,calcium and
vitamin.
SERM – Raloxifene
Estrogen
Calcitonin
: PTH - Teriparatide

20. Mechanism of Action:
•inhibition of the production of essential lipid
compounds inside osteoclasts
•decreased osteoclast activity
•induction of cell death.
• decreases bone turnover
•slowing the rate at which new bone
remodeling units are formed
•reducing the depth of resorption.
• increase in bone mass over time.
Bisphosphonates
1. Alendronate (brand name
Fosamax®)
2. Ibandronate (brand name Boniva®)
3. Risedronate (brand name
Actonel® )

22. Calcium and vitamin D :
Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk
Calcium and vitamin D :
Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk
Calcium and vitamin D :
Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk of non-vert
Calcium and vitamin D :
Calcium and vitamin D Supplementation with 1200mg of calcium and 800iu of vitamin D has been shown to significantly reduce the risk of non-vert
Calcium and vitamin D :
• Calcium and vitamin D Supplementation with 1200mg
of calcium and 800iu of vitamin D has been shown to
significantly reduce the risk of non-vertebral
fractures, including hip fracture. There is also
evidence that calcium and vitamin D taken in these
benefits are due to vitamin D, calcium or a
combination of both. vitamin D alone protects
against hip fracture.
•

23. SELECTIVE ESTROGEN RECEPTOR
MODULATORS(SERMs)
• Mechanism of action – increase osteoblast activity &
reduction in osteoclast activity.
• Eg.Raloxifene(evista)
• Decrease bone resorption
• Prescribed to low risk of spinal fractures in women
after menopause.

24. Estrogen/Hormone Therapy
(ET/HT)• FDA approved for:
– Prevent osteoporosis
– Treatment of moderate/severe symptoms of
vaginal atrophy associated with menopause.

25. Hormone Replacement Therapy (HRT )HRT
is available in many different forms which
provide oestrogen, cyclical oestrogen and
progestogen or both hormones in a
continuous combined product daily tablets,
patches, implants, Gel nasal spray.
Eg.A synthetic steroid, tibolone (Livial) is also
available .

26. Calcitonin
• FDA-approved for:
– Treatment of osteoporosis in women who are > 5
years postmenopausal
– Adjunctive therapy for hypercalcemia
• Mechanism:
– Peptide composed of 32 amino acids which binds to
osteoclasts and inhibits bone resorption
– Promotes the renal excretion of calcium, phosphate,
sodium, magnesium and potassium by decreasing
tubular reabsorption

27. Calcitonin – Clinical Efficacy
Has been shown to increase spinal bone mass and
may decrease risk of vertebral fracture
• Less effective than bisphosphonates in treatment
of osteoporosis
• Beneficial, short-term effect on acute bone pain
after osteoporotic fracture (vertebral)

28. • PARATHYROID HORMONE( PTH)-
• FDA-approved for:
– Treatment of osteoporosis in postmenopausal women at
high risk for fracture.
– Treatment of primary osteoporosis.
• Mechanism of action- It stimulates
osteoblast activity & enhance bone
formation.

29. • Eg: Teriparatide
• Increase bone mass.
• Increase bone microarchitecture.
• Injection derived from of PTH.
• Use in extremely severe form of osteoporosis.
• Side effect : nausea,headache,leg cramps.

30. PTH and Alendronate: Combining
Treatments Shows No Bone Density
Advantage :
• PTH and Alendronate: Combining Treatments Shows
No Bone Density Advantage Combining the bone-
building treatment parathyroid hormone (PTH) with
alendronate, a drug that slows bone loss, produces
no significant improvement in bone mineral density
(BMD) beyond that produced by the individual drugs,
according to two new studies involving
postmenopausal women and men with low BMD. The
two studies, reported in the September 25 issue of
the New England Journal of Medicine and supported
by the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), one of
the National Institutes of Health, both tested BMD in

31. • . The two studies, reported in the September 25
issue of the New England Journal of Medicine and
supported by the National Institute of Arthritis and
Musculoskeletal and Skin Diseases (NIAMS), one of
the National Institutes of Health, both tested BMD in
the spine and hip. BMD, a common indicator of bone
health, is used to diagnose the bone-weakening
disease osteoporosis, detect low bone mass before
the disease develops and help predict the risk of
future fractures.

32. RICKETS &
OSTEOMALACIA
Def.: reduction in bone mineralization !

33. OSTEOMALACIA,RICKETS
Normal bone metabolism
• CALCIUM
99% in bone.
Main functions- muscle /nerve function, clotting.
Plasma calcium- 50% free, 50% bound to albumin.

34. OSTEOMALACIA,RICKETS
Normal bone metabolism
• PHOSPHATE
85% in bone.
Functions-metabolite and buffer in enzyme systems.
• Plasma phosphate mainly unbound.
Daily requ. 1-1.5g/day

35. OSTEOMALACIA,RICKETS
Regulation of Calcium & Phosphate Metabolism:
Peak bone mass at 16-25 years.
Bone loss 0.3- 0.5% per year (2-3% per year after 6th decade).
1. Parathyroid Hormone (PTH)
2. Vitamin D3
3. Calcitonin
4. Other Hormones:
Estrogen: Prevents bone loss
Corticosteroids: Increases bone loss
Thyroid hormones: Leads to osteoporosis
Growth hormones: Cause positive calcium balance
Growth factors

38. RICKETS, OSTEOMALACIA
CAUSES:
1. Nutritional deficiency
1. Vit D
2. chelators of calcium- phytates, oxalates, phosphorous
3. Antacid abuse, causing reduced dietary phosphate binding
2. GI Absorption defects
1. Post gastrectomy
2. Biliary disease (reduced absorption of Vitamins )
3. Small bowel disease
4. liver disease
3. Renal tubular defects
4. Renal osteodystrophy
5. Miscellaneous causes

39. RICKETS, OSTEOMALACIA
CLINICAL FEATURES:
• Rickets -
Tetany , convulsions, failure to
thrive, restlessness, muscular
flaccidity. Flattening of skull
(craniotabes), Thickening of wrists
from epiphyseal overgrowth, Stunted
growth, Rickety
rosary, spinal curvature, Coxa
vara, bowing, # of long bones
• Osteomalacia, - Aches and pains, muscle weakness loss of

40. • Glucosamine sulfate is a naturally occurring chemical
found in the human body. It is in the fluid that is
around joints. Glucosamine is also found in other
places in nature. For example, the glucosamine
sulfate that is put into dietary supplements is often
harvested from the shells of shellfish. Glucosamine
sulfate used in dietary supplements does not always
come from natural sources. It can also be made in a
laboratory.

41. These additional ingredients are frequently chondroitin
sulfate, MSM, or shark cartilage.
How does it work?
Glucosamine sulfate is a chemical found in the
human body. It is used by the body to produce a
variety of other chemicals that are involved in
building tendons, ligaments, cartilage, and the thick
fluid that surrounds joints.
In some people with osteoarthritis, the cartilage
breaks down and becomes thin. This results in more
joint friction, pain, and stiffness.

42. Thank You