Metabolic Bone Disease and Osteoporosis.pptVIP

Osteoporosis Natasa Janicic M.D. Assistant Professor Georgetown University Hospital Osteoporosis The most common metabolic bone disorder Systemic skeletal disease characterized by: Low bone mass Microarchitectural deterioration of bone tissue Increased bone fragility and susceptibility to fracture 3-D Micro CT:Healthy vs Osteoporotic Bone Pathophysiology of Osteoporosis Bone remodeling occurs throughout an individual’s lifetime In normal adults, the activity of osteoclasts (bone resorption) is balanced by that of osteoblasts (bone formation) With the onset of menopause (mid-forties or fifties), diminishing estrogen levels lead to excessive bone resorption that is not fully compensated by an increase in bone formation Bone Remodeling Contributors to Bone Strength Bone size, BMD, and mineralization play a role Bone turnover rates affect the quality of bone Preservation of bone architecture plays a major role in determining bone strength Why Recognize Treat Osteoporosis? To Prevent Fractures 1.5 million fractures/yr $10 billion direct costs 300,000 hip fractures/yr 20% die 25% confined to long-term care facilities 50% long-term loss of mobility Why Recognize Treat Osteoporosis? Less than 5% of hip fractures are evaluated for osteoporosis! (NIH Health report, 2001) Osteoporosis Postmenopausal Osteoporosis Who to Treat When to Treat What Therapy For How Long National Osteoporosis Foundation Guidelines for Bone Density Testing All women aged 65 or older All postmenopausal women under age 65 who have one or more additional risk factors Postmenopausal women who present with fractures USPSTF makes no recommendation for or against routine screening in women under age 60 WHO Criteria for Diagnosis One-Minute Treatment Decision Therapy Decision Treat all patients with an existing fracture High Risk- Treat Moderate Risk - Treat if other risk factors Low Risk- Check again in 1-2 years T-Score * Below -2.0 -1.5 to -2.0 Above -1.5 Combined Effect