Osteoporosis: From Bench To Bedside

Osteoporosis: From Bench To Bedside

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Description: “Osteoporosis is a systemic skeletal disease characterized by low bone density and microarchitectural deterioration of bone tissue with a consequent increase in bone fragility” Hip fracture: the major public health problem- Medical catastrophe: 1) 10-20% mortality 2) survivors: 25% move to nursing home, 50% unable to walk independently. Bone Biology: Not static: continuous remodeling, new skeleton every 15-20 years- 98% matrix (90% collagen type1), 2% cells, Responds to weight-bearing, Responds to hormonal stimuli, Formation and resorption coupled.

 
Author: Rivka Dresner-Pollak MD (Senior) | Visits: 549 | Page Views: 868
Domain:  Medicine Category: Therapy 
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Contents:
OSTEOPOROSIS: FROM BENCH
TO BEDSIDE
Rivka Dresner-Pollak MD
Endocrine Service
Hadassah-Hebrew University Medical Center
Jerusalem

What will be discussed:







Osteoporosis - definition
Principles of bone biology
Osteoporosis – pathopysiology
Osteoporosis – clinical risk factors
Osteoporosis - diagnosis – DXA
Therapeutic options – current and future

Osteoporosis: Definition
Normal Bone
Normal Bone

Osteoporotic Bone
Osteoporotic Bone

WHO Definition
WHO Definition
“Osteoporosis is a systemic skeletal disease characterized by low bone
“Osteoporosis is a systemic skeletal disease characterized by low bone
density and microarchitectural deterioration of bone tissue with a
density and microarchitectural deterioration of bone
consequent increase in bone fragility”
consequent increase in bone fragility”

Mother & Daughter

VERTEBRAL FRACTURES

HIP FRACTURES

Hip fracture: the major public health
problem
Medical catastrophe:
1) 10-20% mortality
2) survivors:
--25% move to nursing home
--50% unable to walk independently

Age-specific and Gender-specific Incidence of
vertebral, hip, and wrist fractures
50% of women
20% of men >50 yr
will sustain a fracture
For a white woman:
1/6 life time risk of hip #
1/9 life time risk of breast Ca

Mortality
20% in 1st year after hip #
P. Sambrook, Lancet 2006
367:2010-2018

Bone Biology
Not static: continuous remodeling, new skeleton
every 15-20 years
• 98% matrix (90% collagen type1)
• 2% cells
• Responds to weight-bearing
• Responds to hormonal stimuli
Formation and resorption coupled

Bone Biology

PEAK BONE MASS

Accelerated loss-menopause

Determinants of Peak Bone Mass or
“Senile Osteoporosis is a Pediatric Disease”
• Genetic Factors accounting for 60-70% of variation
(candidate genes: vitamin D receptor, collagen type 1,
estrogen receptor, BMP-2)
• Hormones : sex hormones, GH
• Life style:
• Diet – calcium and vitamin D intake, calories
• Physical exercise
• Cigarette smoking, alcohol, Carbonate beverages

BONE MASS

RATE OF BONE
RESORPTION

PEAK BONE MASS

RATE OF
BONE FORMATION

Factors effecting Bone resorption and
Formation
Cytokines: IL-1, IL-6, TNF-α
Hormones: estrogen, testosterone, parathyroid
hormone, thyroid hormone, vitamin D,
cortisol, growth hormone
Growth factors: BMP-2. FGF 23, IGF-1

Medical Conditions Associated with Bone
Loss
• Inflammatory: Rheumatoid arthritis
• Endocrine: hyperparathyroidism,
hyperthyroidism, Cushing’s syndrome, Diabetes
• Gastrointestinal : Celiac (in men!), inflammatory
bowel disease, cystic fibrosis
• Chronic Renal disease
• Vitamin D deficiency

Drugs associated with Bone Loss








Heparin
Immunosuppressant – steroids, cyclosporine
Depo medroxyprogesterone acetate
Vitamin A, synthetic retinoids,
Proton pump inhibitors
Chemotherapy
Aromatase inhibitors for breast cancer, GnRH
analogs for prostate cancer

Osteoporosis
diagnosis by :
Bone Density Determination
DXA
Fragility fracture

Diagnosis of Osteoporosis
.

‫מדידת צפיפות עצ‬

‫צילו רנטג של‬
‫עמוד השדרה‬

The role of peripheral (calcaneous) US: The T-score measured is
Different than the T-score measured in DXA
Not for diagnosis or monitoring of therapy.
If T-score in peripheral US is