Download osteoporosis

Salman Bin AbdulAziz University
College Of Pharmacy
OSTEOPOROSIS
Dr Abd Motaal
Ph D, Clinical Pharmacology
Department of Clinical Pharmacy
Mohammad Ruhal Ain
R Ph, PGDPRA, M Pharm (Clin. Pharm)
Department of Clinical Pharmacy
Case 1
K..M is a 72-year-old retired train driver who was admitted to hospital six months
ago after fracturing his hip, when his foot got caught on a floor mat at home. Bill
has been reluctant to walk every evening since this fall. He has been a smoker for 30
years and smokes 15 cigarettes every day.
He lives alone in the self-catered accommodation part of a retirement village and
has lost about 5 kg of weight in the past few months. His diet has deteriorated
since his wife passed away two years ago.
His daughter accompanies him to visit his GP, as she is concerned about his
recent weight loss.
His current medicine history includes ramipril 5 mg once daily in the morning
for well controlled hypertension, he ‘s taking omeprazole for a year and
occasionally temazepam 10 mg at bedtime to help him sleep.
On examination
blood pressure is 115/78 mmHg and he has no significant family medical history.
His vitamin D level is moderately deficient (22 nmol/L) and a bone mineral
density test T-score in the hip is –1.8 and in the spine is –2.7, confirming a
diagnosis of osteoporosis.
Define osteoporosis ?
Bone disorder characterized by
low bone mineral density (BMD),
impaired bone architecture, and
compromised bone strength predisposing to increased
fracture risk.
Osteoporosis effects women more than men ?
True/ False
Osteoporosis effects women more than men ?
True/ False
Postmenopausal White women have 50% lifetime chance of
developing osteoporosis-related fracture, whereas men have
20% lifetime chance.
Pathophysiology
- Men and women begin to lose bone mass starting in third
or fourth decade because of reduced bone formation.
•Mechanism of post-menopause osteoporosis in women ?
Estrogen deficiency during menopause increases osteoclast activity,
increasing bone resorption more than formation.
•Etiology of osteoporosis in males ?
secondary causes and aging
•How aging can cause osteoporosis ?
Age-related osteoporosis occurs because of
hormone, calcium, and vitamin D deficiencies
leading to accelerated bone turnover and reduced
osteoblast formation.
Define
Osteoblast?
Osteoclast?
Drug induced osteoporosis ?
• Whish one of the following medication can be a cause of
Mr. K.M condition ?
1.Omeprazole
2.Ramipril
3.temazepam
Drug induced osteoporosis ?
• Whish one of the following medication can be a cause of
Mr. K.M condition ?
1. Omeprazole (PPI)
2. Ramipril (ACE inhibitor)
3. Temazepam (Benzodiazepines- hypnotics)
•Chronic kidney disease can cause osteoporosis ? (True/ False)
•Chronic kidney disease can cause osteoporosis ? (True/ False)
True
MCQ !
• K.M risk factors include the following except ?
a. Smoking
b. Male gender
c. Advance age
d. PPI use
MCQ !
• K.M risk factors include the following except ?
a. Smoking
b. Male gender
c. Advance age
d. PPI use
RISK FACTORS
• Low BMD
• Female sex
• Advanced age
• Race/ethnicity
• History of previous low trauma (fragility) fracture
• Osteoporotic fracture in first-degree relative
• Low body weight or body mass index
• Premature menopause (before age 45)
• Secondary osteoporosis (especially rheumatoid arthritis)
• Past or present systemic oral glucocorticoid therapy
• Current cigarette smoking
• Alcohol intake of 3 or more drinks per day
• Low calcium intake
• Low physical activity
• Minimal sun exposure
PREVENTION AND SCREENING
•……………………….. (test) can be used for the measurement of
BMD
Measurement of BMD at peripheral sites (forearm, heel, and
phalanges) with ultrasound or dual-energy x-ray
absorptiometry (DXA) scan used for screening and to
determine need for further testing.
Diagnosis
Means of Confirmation and Diagnosis
•Presence of low-trauma fracture, or
•Central hip or spine DXA scan using World Health
Organization (WHO) T-score thresholds
T-scores from DXA measurement of central
(hip and spine):
Normal bone mass: Greater than –1
Osteopenia: –1 to –2.4
Osteoporosis: At least –2.5
Clinical Presentation /Signs and Symptoms
•Fragility fracture may be first sign of osteoporosis; fractures
can occur after bending, lifting, falling, or independent of
any activity.
•Most common fracture sites are vertebrae, proximal femur,
and distal radius (wrist or Colles fracture).
•Two thirds of patients with vertebral fractures
asymptomatic; the remainder present with back pain that
radiates down leg after new vertebral fracture.
Clinical Presentation /Signs and Symptoms
•Pain usually subsides after 2–4 weeks, but chronic
residual low back pain may persist.
•Patients with nonvertebral fractures frequently present
with pain, swelling, and reduced function and mobility at
fracture site.
•Physical examination findings include postural changes
(kyphosis) and loss of height (more than 1.5 in [3.8 cm]).
Fill in the blanks Question
•Postural changes- kyphosis means……………………………………….?
•Most common fracture site ……………………………………………………?
•Two thirds of patients with vertebral fractures are
……………………………….?
•Fragility fracture may be first sign of osteoporosis;
fractures can occur after ………………………., ……………………….,
…………………….. Or ……………………………?
Fill in the blanks Question
•Postural changes- kyphosis means abnormal curvature of
thoracic spine?
•Most common fracture site are vertebrae, proximal femur,
and distal radius?
•Two thirds of patients with vertebral fractures are
asymptomatic?
•Fragility fracture may be first sign of osteoporosis;
fractures can occur after bending, lifting, falling, or
independent of any activity?