1) The document discusses osteoporosis, including the challenges it presents, its prevalence, risk factors, diagnosis, complications, management principles, and treatment goals. 2) Key points include that osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, leading to fragility and increased risk of fractures. It affects millions worldwide, with over 50% of women and 20% of men experiencing fractures due to osteoporosis in their lifetimes. 3) Diagnosis involves bone mineral density tests to measure bone density and predict fracture risk. Treatment aims to prevent further bone loss and fractures, relieve pain and deformities, and improve quality of life.

1. Welcome BICC|27th July, 2010

2. Osteoporosis: Challenges, When & How to Treat DRAFT Aclasta Brand Book Osteoporosis: Challenges to meet Prof. Muhammad Shahiduzzaman Prof & Head, Department of Orthopaedics and Traumatology Dhaka Medical College Hospital

4. Bone Homeostasis

5. Bone remodeling

6. Definition and classification of osteoporosis

7. Prevalence

8. Risk Factors and presentation

9. Diagnosis

10. Consequences

11. Management principle

12. Treatment goalOsteoporosis: Challenges to meet| BICC | 27th July, 2010

14. protein collagen & specialized cells called osteoclasts, osteoblasts, and osteocytes

15. Inorganic component:

16. Mainly as calcium phosphate, in the form of HydroxyapatiteOsteoporosis: Challenges to meet| BICC | 27th July, 2010

18. the situation when the body requires and achieves an equal amount of bone resorption and bone formation

19. the amount of bone eroded by osteoclasts is equal to the amount of bone produced by osteoblasts, thereby producing a stable net mass of bone in the body Homeostasis Osteoporosis: Challenges to meet| BICC | 27th July, 2010

21. It is the body’s way of maintaining bone homeostasis.

22. 5 Stages:

23. Initiation,

24. Resorption,

25. Reversal,

26. Bone formation and

27. Completion of remodeling. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

28. Remodeling: Activation Osteoclast precursor cells are attracted to a bone site and penetrate the bone lining cells. These osteoclast precursor cells then form activated osteoclasts that align themselves in direct contact with mineralized bone matrix. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

29. Remodeling: Resorption The osteoclasts erode a cavity by removing mineral and organic components from the bone. The osteoclasts eventually die. This completes the resorption phase. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

30. Remodeling: Revarsal Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

31. Remodeling: Formation Cells of unknown origin prepare the bone surface for new bone formation by smoothing the surface of the cavity and depositing a thin layer of a cement-like substance. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

32. Remodeling: Resting The lining cells rest on the bone surface until the next cycle of bone remodeling begins. Some osteoblasts become osteocytes. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

33. Remodeling timeline Osteoporosis: Challenges to meet| BICC | 27th July, 2010

34. Osteoporosis Challenges of Osteoporosis Osteoporosis: Challenges to meet| BICC | 27th July, 2010

37. Juvenile osteoporosis.

38. Idiopathic osteoporosis

39. Postmenopausal osteoporosis

41. Diet

42. Drugs

43. Endocrine disorder

44. Other Systemic DisorderOsteoporosis: Challenges to meet| BICC | 27th July, 2010

45. Osteoporosis Losing bone with years

46. Prevalence “Osteoporosis, the silent thief of your bone” Osteoporosis: Challenges to meet| BICC | 27th July, 2010

48. 80 % of those suffering from osteoporosis are women.

49. Affects 75 million persons in the US, Europe and Japan.

50. Over 50% of women aged 50 years or older and 20% of men will suffer an osteoporosis-related fracture within their remaining lifetimeOsteoporosis: Challenges to meet| BICC | 27th July, 2010

52. Older age

53. Family history of osteoporosis or broken bones

54. Being small and thin

55. History of broken bones

56. Low sex hormones

57. Low estrogen levels in women, including menopause

58. Missing periods (amenorrhea)

59. Low levels of testosterone and estrogen in menOsteoporosis: Challenges to meet| BICC | 27th July, 2010

61. Low calcium intake

62. Low vitamin D intake

63. Excessive intake of protein, sodium and caffeine

64. Inactive lifestyle

65. Smoking , Alcohol abuse

66. Certain medications

67. steroid , anticonvulsants etc

68. Certain diseases

69. anorexia nervosa, rheumatoid arthritis, gastrointestinal diseases and others Osteoporosis: Challenges to meet| BICC | 27th July, 2010

71. Vertebral (spinal) fractures may initially be felt or seen in the form of

72. Persistent, unexplained back pain

73. Loss of height

74. Spinal deformities such as kyphosis or stooped posture. Osteoporosis: Challenges to meet| BICC | 27th July, 2010

76. BMD test is done to diagnose and predict fracture risk and to monitor therapy.

77. For patients on pharmacotherapy, it is typically performed 2 years after initiating therapy and every 2 years thereafter; however, more frequent testing may be warranted in certain clinical situations.Osteoporosis: Challenges to meet| BICC | 27th July, 2010

79. “Gold-standard” for BMD measurement.

80. Measures “central” or “axial” skeletal sites: spine and hip.

81. May measure other sites: total body and forearm.

82. Validated in many clinical trials.

83. Available in Bangladesh.Osteoporosis: Challenges to meet| BICC | 27th July, 2010

86. Increased mortality

87. Decreased quality of life Osteoporosis: Challenges to meet| BICC | 27th July, 2010

88. Complications… Wrist fracture men 1 in 40 (2.5%) women 1 in 6 (16%) Spinal fracture men 1 in 20 (5%) women 1 in 6 (16%) Hip fracture men 1 in 17 (6%) women 1 in 6 (17.5%) Osteoporosis: Challenges to meet| BICC | 27th July, 2010

89. Management principle Osteoporosis: Challenges to meet| BICC | 27th July, 2010

91. such as which maintain bone mass Calcium, Vitamin D

92. Anti-resorptive agents

93. which inhibit bone resorption Bisphosphonates

94. Anabolic agents,

95. which stimulate bone formation and, in turn, increase bone mass.Osteoporosis: Challenges to meet| BICC | 27th July, 2010

97. Increase or at least stabilize bone density

98. Prevent further fractures

99. Relieve deformity (e.g., kyphoplasty)

100. Relieve pain

101. Increase level of physical functioning

102. Increase quality of life Osteoporosis: Challenges to meet| BICC | 27th July, 2010

103. Thank You