OSTEOARTITIS

Oral Medications

Oral NSAIDs are associated with

a dose-dependent risk of
gastrointestinal, cardiovascular,
hematologic, hepatic, and renal
adverse events (AEs).11 The risk
of gastrointestinal side
effects can be lessened by
using a cyclooxygenase
(COX)-2 selective NSAID
(Celebrex) or by combining
non-selective NSAIDs with
proton pump
inhibitors.12Concerns
aboutcardiovascular events with
COX-2 selective NSAIDs have
limited the use of this class of
medications in patients who have
cardiovascular risk factors.13
brace
ARTITIS PIRAI /
GOUT
Gambaran mikroskop asam urat
berbentuk jarum
OSTEOPOROSIS
OSTEOPOROSIS
OSTEOPOROSIS

OSTEOPOROSIS

INCIDENCE: 1 in 3 women and 1 in 12 men.

TYPES :
I. (postmenoposal): thin trabicular bone
55-75y
f:m 6:1
II. Senile : thin both trabicular & cortical bone
70-85 y
2:1
OSTEOPOROSIS

RISK FACTORS + CAUSES :!

I.POST MENOPOSAL & SENILE (primary)
-sessation of estrogen or androgen
- bad nutritional habits during productive years (15-45yr)
(low calcium content food , smoking,alcohol,soda drinks.
- genetics (inheritance) & race (cocasian female)

II.Secondary :
1.medications: steroids,chronic heparin use,anticonvusants,chemotherapy.
2.immobilisation
3. Medical conditions: Anorexia Nervosa, RA, Early menopause,Hyperthyroidism, hyperparathyroidism,
hypogonadism Transplantation, Cushings disease/syndrome, Chronic
kidney, lung or GI diseases
OSTEOPOROSIS
OSTEOPOROSIS

The Gold standard test in clinical practice is measurement of Bone Mineral Density
(g/cm3), of the vertebral spine and the hip. This is as recommended by the
National Osteoporosis society. Only vertebral measurements can be used to
assess effectiveness of treatment at present.
1. DEXA scans
2. Radiographic Absorptiometry
3. Single Photon X-ray absorptiometry (SPA)
4. Quantitative Computer tomography
5. Quantitative Ultrasound
OSTEOPOROSIS
OSTEOPOROSIS
TREATMENT OF ESTABLISHED OSTEOPOROSIS:
CALCIUM + VIT. D SUPPLEMENTS

Minimum daily intake of calcium should be achieved.

Should only be prescribed if this is not achieved by diet.
Vit D in all elderly institutionalized osteoporotics is
recommended.

RDA Calcium = 1400 mg

RDA Vit. D = 600-800 IU.
OSTEOPOROSIS
BISPHOSPHONATES:
Synthetic analogues of inorganic pyrophosphate. Inhibit bone resorption
by osteoclasts
Alendronate (Fosamax)
Reduces the incidence of hip, wrist and vertebral fractures in
postmenopausal women (statistically significant)
Contraindications-Abnormalities of oesophagus, renal problems
Dose -10mg daily at least 30 mins before breakfast and sit upright
for at least 30 mins
Disodium Etidronate (Didronel)
Etidronate is effective in reducing vertebral fracture (statistically
significant). Dose- disodium etidronate 400mg once daily.
RICKETS, OSTEOMALACIA

CAUSES:
1. Nutritional deficiency
1. Vit D
2. chelators of calcium- phytates, oxalates, phosphorous
3. Antacid abuse, causing reduced dietary phosphate binding
2. GI Absorption defects
1. Post gastrectomy
2. Biliary disease (reduced absorption of Vitamins )
3. Small bowel disease
4. liver disease
3. Renal tubular defects
4. Renal osteodystrophy
5. Miscellaneous causes
RICKETS, OSTEOMALACIA

CLINICAL FEATURES:
Rickets - Tetany , convulsions,
failure to thrive, restlessness, muscular flaccidity.
Flattening of skull (craniotabes), Thickening of
wrists from epiphyseal overgrowth, Stunted growth,
Rickety rosary, spinal curvature,
Coxa vara, bowing, # of long bones

Osteomalacia, - Aches and pains, muscle weakness loss of height, stress #s.
RICKETS, OSTEOMALACIA

XRAY FINDINGS:

RICKETS Thickening
and widening of physes,
Cupping of metaphysis, Wide
metaphysis, Bowing of diaphysis,
Blurred trabeculae.
RICKETS, OSTEOMALACIA

INVESTIGATIONS:

BLOOD TESTS Calcium Reduced,

Phosphate reduced
Alkalline Phosphatase increased Urinary excretion
of calcium diminished

Calcium phosphate products (= serum [Ca] x serum [PO4]) normally 30. In rickets
and osteomalacia is less than 24
RICKETS, OSTEOMALACIA

MANAGEMENT:
Depends on the cause

Nutritional Vitamin D deficiency

Dietary chelators of calcium
Phytates
Oxalates Phosphorus deficiency (unusual)

Antacid abuse
Treatment- vitamin D (5000u) and Calcium (3g/day)