OSTEOPOROSIS
R. Djokomoeljanto
Bagian Ilmu Penyakit Dalam
Fakultas Kedokteran Undip
Semarang
Bodyweight
Life-style
Genetic
Sex
hormon
Diseases
Cushing S
Clucocort th
Hyperthyroidi
sm
Diabetes M
Increase
bone loss
Protein
Alcohol
Caffeine
Thinness
Inactivity
Cigarette sm
Bedrest
Positive
family histr
Female sex
Early menop
Oophorect.
Postmenop.
Amenorrhoe
Decrease
bone loss
calcium
Obesity
High activity
Race (black)
Pregnancy
Unknown
effect on
bone loss
phosphate
Normal activity
Osteoporosis :
Primary or evolution :
osteoporosis type I (postmenopausal)
osteoporosis type II (senile)
Type I
(postmenopausal)
6:1
51 65
trabec > cortic
spinal, radius
fast, accelerated
decrease
resorption >
estrogen loss
low
Type II
(senile)
2:1
75
trab=cort
hip
gradual
increase
formation <
ageing
important
Corticosteroid treatment
Postmenopausal
Anticonvulsant treatment
Hyperparathyroidism
Thyrotoxicosis
Smoking
Nullipara
Alcohol abuse
Inactivity
OPG being to act as a dummy receptor for the OPG ligand (=OPGL,
RANKL). OPGL bind RANK-rec.activator initiate OC activation and
subsequent bone resorbtion.
Corticosteroid dose
(corticosteroid induced osteoporosis CSIOP)
Treatment of CSIOP
Anti-resorptive therapy: calcitrol and calcitonin
bisphosphonate treatment (alendronate 5-10 mg daily for 48
weeks increases spine / hip BMD
Bone promoters. PTH as true-bone-anabolic effect The most
active part of PTH is hPTH (1-34) improves lumbar BMD as
high as 35% (CT trabecular) or 11% (DEXAtrabecular and
cortex) trabecular bone is very responsive to PTH
treatment
HRT improves slightly.
1 week
1 month
6 months
1 year
5 years
Replacement(<7.5
mg/day)
+/-
10 mg /day
+/-
++
15 mg/day
+/-
++
+++
20 mg/day
+/-
++
+++
+++
>30 mg/day
++
+++
+++
+++
Summary
Osteoporosis is the disease of tomorrow. The consequence
is incapacitating and costly
Prevention program is the most effective way. By increasing
the peak-bone-mass, adequate calcium intake, weight bearing
exercise, regulate the good diet, avoiding drugs that is known
to cause osteoporosis osteoporosis can be prevented. This
disorder affect mosly postmenopausal women. Care must be taken
with corticosteroid treatment. Highdose which is shown by the
depressed pituitary function may cause corticosteroid induced
osteoporosis
Although prvention is better than cure, varios medications
Are now available that effectively treat or prevent osteoporosis
By understanding the pathophysiology of osteoporosis it is
expected that rational use of treatment will be followed.