DR. dr. Bintang Soetjahjo, Sp.

OT (K)
Pekan Ilmiah Tahunan Perosi 2018
Surabaya, 26-27 October 2018
Knowing Osteoporotic Condition

Knowing The Risk Factors

How to Screening

How to Prevent
 Systemic skeletal disease characterized by low bone mass and
microarchitectural deterioration of bone tissue, leading to
enhanced bone fragility and a consequent increase in fracture risk

WHO  Bone Mineral Density (BMD) at the hip and/or the spine with T-Score < -2.5
 Asia is predicted ↑. 2025 : incidence of hip
fracture 37% of all hip fractures
 Caucasians women > 50 years : 7.9% to 22.6%
 PEROSI (2009) : 2 out of 5 Indonesians are at
risk of osteoporosis
 Osteoporosis can be clinically silent
 Without Screening & Preventing  Morbidity
& Mortality
Shin, Chan Soo, et al. Prevalence and risk factors of osteoporosis in Korea: A community-based cohort study with lumbar spine
and hip bone mineral density. 2010. Suwon: Elsevier
 PRIMARY SECONDARY

Type I Type II
• Post menopause • Senile • Bone loss,
• Most Prevalent • Related to Aging because of
• Women within 5- • ↓ active Vitamin D another disease
20 yrs after • Both Men and
menopause Women > 70 y.o
• ↑ resorption due
to ↓ estrogen
Baron R. et al. J Clin Endocrinal Metab. 2012; 97.311-325
 • Low BMI
• Advancing age • Sedentary lifestyle
• Female sex • Excessive alcohol
• White or Asian (> 2 drinks per
race day), caffeine, and
• Family history of tobacco use
osteoporotic • Low calcium /
fractures vitamin D intake
• Early menopause • Inadequate sun
exposure

Bernabei, Roberto. et al. Screening, diagnosis and treatment of osteoporosis: a brief review. Clinical Cases in Mineral and Bone Metabolism
2014; 11(3): 201-207
Inadequate intake of calcium and vitamin D
among the majority of women surveyed was
confirmed. The highest percentage of women
represented profile VIII: attitudes towards
prevention of osteoporosis, characterized by
insufficient exposure to sunlight and a diet
deficient in both calcium and vitamin D
exercise at younger ages appears to
have a significant role in preventing
bone loss or osteoporosis in the elderly.
Our study confirmed these observations
by clearly showing that physical activity
was positively correlated with high BMD
Moderate to intense exercises, performed in a high
speed during short intervals of time, in water or on the
ground, can be part of a program to prevent and treat
postmenopausal osteoporosis.
our findings suggested that frequency of coffee
consumption was independently and significantly
associated with osteoporosis. The prevalence of
osteoporosis was more common in Chinese
postmenopausal women who did not consume coffee.
This study suggests that a change in preference for
coffee consumption might be beneficial in the
prevention of osteoporosis in Chinese postmenopausal
women
Who Should I Screen ?

• All women aged ≥ 65 years

• Men ≥ 65 years or women aged
≤ 65 years should be screened
for the presence of risk factors

USPSTF (U.S. Preventive Services

Task Force) :
• Men ≥ 65 years or women ≤ 65 years
should be screened for the presence of
risk factors
 SCREENING

• Outcome of interest : Fracture Risk!

• Facilitate treatment before osteoporotic fracture occurrence

• Most guidelines recommend BMD measurement with Dual-

energy X-ray Absorptiometry (DXA) on hip and spine (Gold
Standard)
• Quantitative USG
• Quantitative CT
• Laboratory
Kling, Juliana M. et al. Osteoporosis Prevention, Screening, and Treatment: A Review. JOURNAL OF WOMEN’S HEALTH Volume 23, Number
7, 2014
DXA

• Advantages:
• Non invasive
• Low level radiation exposure
• Short test time
• Disadvantages:
• Inability to accurately compare results and
bone architecture from one center to another
 Don’t take calcium supplements for 24 hours
before the exam
 If you’ve had an injection of barium or
contrast  wait 7 days
 Avoid wearing clothes with metal zippers,
belts, or buttons
 Interpretation

T - SCORE Z - SCORE

Below -2.0, means

that you have less
bone mass than
someone your age
 QUANTITATIVE USG (QUS)

Wider accessibility to public, Portable, Easier to handle,

Lower in cost, No radiation. In developing countries with poor
accessibility to DXA, QUS could be used as an effective
screening tool for early detection of osteoporosis.
 QUANTITATIVE CT (QCT)

The usefulness of computed tomography for

measurement of bone mineral lies in its ability to provide
a quantitative image and, thereby, measure trabecular,
cortical, or integral bone, centrally or peripherally
LABORATORY
Interval Screening :
• No guidelines have been issued regarding screening
intervals due to insufficient data. The USPSTF suggests
a minimum of 2 years between screenings to reliably
measure BMD change because of limitations in test
precision
• For women with moderate osteopenia, screening every
5 years may be sufficient, and for women with
advanced osteopenia, screening should likely be
performed yearly.
 Adequate combined calcium and
vitamin D

Antiresorptive therapy

Prevention Weight-bearing exercise

Strategies

Tobacco avoidance

Moderate alcohol intake

 Adequate combined calcium and
vitamin D

• Provides sufficient levels for bone

formation and bone density maintenance
• USPSTF : against daily supplementation
with 400IU or less of vitamin D3 and 1,000
Prevention mg or less of calcium for the primary
Strategies prevention of fractures
• Vitamin D sources  sunlight exposure,
fortified foods, egg yolks, saltwater fish,
liver, and supplements
• Calcium intake above 1,200 to 1,500 mg/day
 increased risk of cardiovascular disease
and nephrolithiasis
 Antiresorptive therapy

• Antiresorptive medications or selective

estrogen-receptor modulators can be
initiated in patients with osteopenia
Prevention who have significant risk of
osteoporosis
Strategies
 Weight-bearing exercise

• Improves agility, posture, balance, and

strength to prevent falls
• Specifically, non-weight-bearing, high-
Prevention force exercise (e.g., lower-limb,
progressive-resistance strength
Strategies training) was the most effective exercise
for femur neck BMD.
• Combination exercise programs were
the most effective for the spine
 Tobacco & Alcohol avoidance

• Tobacco and excessive alcohol intake

are detrimental to bone health
• Amount of daily alcohol intake that is
Prevention harmful is unclear
• Institute for Clinical Systems
Strategies Improvement (ICSI) guidelines :
 > 1 unit/day for women and > 2
units/day for men is harmful
 > 3 units/day as a risk factor
“ It takes more to
reverse a disease
than it Does to
prevent it.”