Metabolic bone disease

Dr santosh kumarAssistant professorMedical unit 2

Definition The term “metabolic bone disease” denotes thoseConditions producing diffusely decreased bone densityAnd diminished bone strength.

Osteoporosis

Essential of diagnosis Asymptomatic to severe backache from vertebral fractures. Spontaneous fractures often discovered incidentally on radiography; loss of height. Serum PTH, calcium, phosphorus, and alkaline phos- phatase usually normal. Serum 25-hydroxyvitamin D levels often low as a comorbid condition. Demineralization, especially of spine, hip, pelvis, and wrist

Definition It is defined as low bone mass and micro-architecturaldestructions of Bone tissue leading fragility and fracture of bone.Bone is normally mineralized but decrease in quantity ,quality and Structural Integrity.

Peak bone mass and bone loss are regulated by genetic(80%) and environmental factor (20%),genetic like (ESR1)oestrogen receptor

gene,(LRP5)lipoprotein related receptor gene In normal individual 20-40years bone

formation is increased but fall after that. After menopause is an accelerated phase of

bone loss.

pathophysiology

Post menopausal osteoporosis Osteoporosis in men Steroid induced osteoporosis Pregnancy associated osteoporosis Other causes

variety

Hypogonadism Hyperthyroidism Hyperparathyroidism Cushings syndrome Etc

Endocrine disease

Inflammatory bowel disease Ankylosing spondylitis RA Etc

Inflammatory disease

Malabsorption syndrome Chronic liver disease Others causes

Gasterointestinal disease

Corticosteroids Thyroxine over –replacement Gonadotrophin-releasing hormone agonist Sedative Anticonvulsant drugs Alcohal excess Heparin others

drugs

Myeloma Homocystinuria Anorexia nervousa High trained athletes HIV infection Immobilisation Poor diet /low birth weight

miscellaneous

Asymtomatic until fracture occurs. Osteoporotic spinal fracture present back pain or gradual onset of height loss and kyphosis

with chronic pain. in hip fracture affected leg shortened and

externally rotated. Some time on bony pain in old age or

menupause Incidental osteopenia in xrays performed foe

other reasons.

Sign and symptoms

InvestigationsX rays of bone related limbRoutine profile of bloodSerum calcium level Alkaline phosphatase levelBone density like radiographs, DXA sccaning

Management of osteoporosis

• Assess risk factors• If present, proceed to DXA (may not be necessary In all patients with fragility fractures).• Exclude secondary causes in patients with osteoporosis

In patients with previous fragility fracture And those aged over 65 years with BMD T

Score < -2.5 measured by DXA

• Offer lifestyle advice (e.g. exercise, diet, smoking cessation)• Offer treatment: First-line option alendronate or risedronate Also-raloxifene in woman with vertebral osteoporosis -Teriparatide in woman with very severe osteoporosis, or if intolerant to other therapies Give calcium and vitamin D supplements where appropriate

In younger patients with BMD T score < -2.5(measured by DXA, hip + spine)

• Assess need for treatment based on age and other independent risk factors• Offer lifestyle advice• Offer treatment as above, if appropriate

In frail older individuals

• Offer lifestyle advice• Fall risk assessment and advice where appropriate• Give calcium and vitamin D supplements• Hip protectors for individuals in nursing homes

Thanks