1. OSTEOPOROSIS
ANITA SRIWATY PARDEDE SKM

2. OSTEOPOROSIS
KEROPOS TULANG
MASALAH KESEHATAN
(KURANG DISADARI)

3. Osteoporosis
• The most common metabolic bone disorder
• A large, silent epidemic, afflicting the whole world
• Insidious & progressive :
→ frequently diagnosed only after a fracture
• Cause enormous socio – economic impact
( Ang, K.C 2005)
• The exact pathogenesis remains unclear
• Impairement of calcium absorption is one of its
primary cause
( Dechant, K.L et al 1994 )

5. Osteoporosis
• Ditandai dengan:
– Massa tulang yang berkurang
– Deteriorasi struktur tulang (mikroskopis)
• Tulang jadi rapuh - risiko fraktur ↑

6. MASSA TULANG
• PUNCAK
KEPADATAN
MASSA TULANG
MAKSIMAL + USIA
30 TAHUN
• KONSEP MASSA
TULANG RENDAH,
TULANG TULANG FAKTOR RISIKO PATAH TULANG
DEWASA USIA LANJUT

7. TULANG :
PEMBENTUKAN MASSA TULANG
PUNCAK MASSA TULANG
REMODELLING TULANG
- KEHILANGAN MASSA TULANG
WANITA : 45 – 50 %
PRIA : 20 – 30 %

8. Faktor Genetik
Bentuk tubuh, gaya hidup
Status nutrisi
Menopause
Penyakit
Perubahan hormonal
Akibat usia
Trauma ringan
MASSA Puncak Massa Penurunan Massa Sangat Rentan
TULANG Tulang Tulang Terhadap Fraktur
0 20 40 50 60 70 80 100
Usia ( tahun ) Takao Suzuki, 2001

9. FAKTOR RISIKO PADA
OSTEOPOROSIS
TIDAK DAPAT DIMODIFIKASI DAPAT DIMODIFIKASI
• JENIS KELAMIN • POSTUR TUBUH KURUS
• USIA LANJUT (WANITA) • JATUH BERULANG
• RAS KAUKASIA (KULIT PUTIH) • AKTIFITAS FISIK KURANG
• RIWAYAT PATAH TULANG • KEKURANGAN
ESTROGEN
• KEKURANGAN KALSIUM
• PEROKOK
• PEMINUM ALKOHOL
• TINGKAT KESEHATAN
BURUK

10. Osteoporosis
Kriteria
Normal Nilai BMD < 1 SD di bawah nilai rata-rata dewasa
muda
Osteopenia Nilai BMD 1 – 2.5 SD d bawah nilai rata-rata
Osteoporosis Nilai BMD > 2.5 SD di bawah nilai rata-rata
Osterporosis Nilai BMD > 2.5 SD di bawah nilai rata-rata
berat + ada ≥ 1 fraktur osteoporosis

13. Osteoporosis in Men
A public health concern :
• Age – spesific incidence of fractures is
increasing in men
• Prevalence of spinal fractures are similar in
women
• Over the next 15 yrs, 30 % of all hip fractures
will occur in men
• Mortality after spinal & hip fractures is higher
than in women
( Ebeling, P.R at al 2001 )

14. Osteoporosis in Men cont’d
• As devastating as in women
• Detection & treatment in men are dismal
– Not as extensively as in woman
• International Society for Clinical
Densitometry, 2003 :
≥ 70 yrs : regular BMD
– T score < - 2 : treatment of OP & other risk factors

16. The Osteoporosis Continuum
Kyphotic
Healthy spine
spine
50 Menopausal 55+ Postmenopausal 75+ Kyphotic
Experiencing At greater risk for vertebral At risk for
vasomotor fracture than any other hip fracture
symptoms type of fracture

17. Fraktur Vertebra
• Fraktur vertebra terjadinya lebih awal dari fraktur
lain.

18. Fraktur Vertebra

19. Masa Tulang Patah Nyeri Kelainan Bentuk Kecacatan
Rendah Tulang
Kualitas Hidup

20. PENCEGAHAN
1. PRIMER
2. SEKUNDER
PRIMER :
• NUTRISI YANG BAIK
• POLA HIDUP AKTIF
• HINDARI FAKTOR RISIKO
• TES UNTUK DETEKSI DINI
• UPAYA-2 KHUSUS :
(OBAT-OBAT TERTENTU)

22. FAKTOR NUTRISI :
1. CUKUP KALSIUM
2. CUKUP VIT.D
3. KURANGI FOSFAT
4. CUKUP PROTEIN
5. BATASI KAFEIN
6. HINDARI ALKOHOL
7. KURANGI GARAM, GULA
8. HENTIKAN ROKOK
POLA HIDUP AKTIF :
KURANG GERAK PROGRAM LATIHAN FISIK

25. Osteoporosis Exercise
Program, 1998 :
• Improve gait, balance, coordination,
propioception, reaction time, and key –
muscles strength
→ prevent falls
• Increase bone – mass / preserve bone –
mass
→ prevent osteoporosis
“keep both young & older person moving”
( Oliver, D. et al. 2005 )

27. PENCEGAHAN SEKUNDER :
• SUDAH ADA OP SEBELUM ADA
PATAH TULANG
• PENCEGAHAN PRIMER + OBAT-2AN
(ESTROGEN, BISFOSFONAT, DLL)

28. JATUH PADA USIA LANJUT
FAKTOR FAKTOR EKSTRINSIK
INSTRINSIK
KONDISI FISIK OBAT-2AN YANG
DAN DIMINUM
KEJIWAAN
PENURUNAN ALAT-2 BANTU
PENGLIHATAN & JATUH BERJALAN
PENDENGARAN
PERUBAHAN LINGKUNGAN
PERSYARAFAN, GAYA YANG TIDAK
BERJALAN, REFLEK MENDUKUNG
BERDIRI

29. Falls In The Elderly
• A common problem
• 30 % - 50 % ≥ 65 in the community, female > male
• 70 % occurs at home, 50 % from environmental
hazard
• Majority occur with mild to moderate activity
• Compared with children, 10x to be hospitalized, 8x
more likely to die
∀ ≤ 10 % result in fracture, especially hip fracture
• May be a non spesific presenting sign of acute
illness / acute exacerbation of a chronic disease

30. Fall cont’d
• The true geriatric giant : an indication for a
more detailed assessment
( Davidson, C. 2000 )
• Psychologic impact of a fall : post-fall anxiety
– Fear of falling → activity restriction, dependance
& increasing immobility →
further risk factor : muscle atrophy, poorer
balance, deconditioning
→ greater risk of falling

31. Cycle of Osteoporosis
Fall
Old Age Osteoporosis Fracture
Immobility
• Strong association : Osteoporosis, Fall,
Fracture
→ must be managed together
– Preventing both : osteoporosis & fall

32. KOMPLIKASI PATAH TULANG
SIKLUS OSTEOPOROSIS
RUDA PAKSA
USIA LANJUT OSTEOPOROSIS PATAH TULANG
MOBILITAS BERKURANG
• ASESMEN PENYEBAB JATUH
• ASESMEN PATAH TULANG YANG TERJADI

33. Indonesian Rheumatic Association’s Recommendation :
Drug Treatment in Osteoporosis
Kelompok risiko tinggi Patah tulang dengan
Atau faktor risiko rudapaksa minimal atau
kekurangan massa tulang
Merubah gaya hidup
diet, latihan fisik, merokok
Pengukuran kepadatan tulang
(Bone Densitometri)
Diatas + 1 SD + 1 SD sp –1 SD -1 SD sp –2,5 SD Dibawah –2,5 SD
Ulang 5 th lagi Ulang 1 th lagi Estrogen
Estrogen Bisfosfonat Kalsitriol Kalsitonin
Source : Harry Isbagio et al 2002

34. Calcitriol
• Photosynthesis of vitamin D :
– Occurred on earth, over 750 millions years
– Vertebrates, including human, obtain most of
their vit. D, from exposure to sunlight
– Sunlight :
• High energy ultraviolet B radiation : photolysis 7
dehydro calciferol → pre vit D3, leaves the epidermal
cell membrane → circulation
• Requires two hydroxylations processes in
the liver & kidney
→ biologically active metabolite :
1.25 (OH)2 D3
“CALCITRIOL”

35. The Primary Role of Calcitriol
• The main regulator of intestinal
calcium absorption → active
absorption
• Responsible for calcium homeostasis
& mineralisation of the bone
• Stimulate bone spesific protein’s
production : osteocalcin

36. Charaterizes of Type II OP
• Decreased calcium absorption,
particularly ≥ 70 yrs :
Age – related decline in serum levels of
calcitriol :
– Decreased capacity of the ageing skin to
synthezise vit. D3
– Decreased renal hydroxylase activity with
ageing
– Decreased osteoblast function
calcitriol is the logical course of
treatment in the elderly

38. UPAYA
PENCEGAHAN
&
PENGOBATAN

40. Never too late to
Prevent a Fracture