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OSTEOPOROSIS. Prepared By Dr. MOHSEN A. GHAFFAR Consultant Orthopaedic Surgery Al Jedaani Group Of Hospitals. Bone Composition. Inorganic Matter : Mineral forms approximately 70% of bone mass . About 95% of mineral phase is calcium hydroxyapatite , the

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Prepared By


Consultant Orthopaedic Surgery

Al Jedaani Group Of Hospitals

bone composition
Bone Composition
  • Inorganic Matter :

Mineral forms approximately 70% of bone mass .

About 95% of mineral phase is calcium hydroxyapatite, the

remaining 5% bone apatite impurities containing carbonate

in high concentration and small amount of magnesium,sod-

ium, potasium, strontium , flouride and chloride .

  • Organic Matter :

This forms 30% of bone mass .

It is formed of water(5-8%) and organic matrix .

Organic matrix is formed of collagen and non-collagenous proteins (98%) and bone cells (2%) .

bone cells
Bone Cells
  • Osteoblast: This is responsible for bone formation ,and

Control of bone metabolism .

  • Osteocyte: This the mature bone cell , responsible for

nutrition of bone and ion exchange between

bone and blood .

  • Osteoclast: This is the active agent in bone resorption

and resposible for bone remodeling .

bone modeling and remodeling
Bone Modeling and Remodeling

Two distinct processes are responsible for the architecture of bone , modeling and remodeling .

  • Modeling:This is a process of coordinated bone formation and resorption with change in the shape of bone like what happens during growth of bone in childhood and in case of callus formation during healing of fractures .
  • Remodeling : This is a coupled process of bone formation and bone resorption which occur simultaneously without change in the shape of bone.The idea is to renew the bone continuously to withstand the new stresses applied on it , and to maintain the bone mass .
  • Bone modeling and remodeling occur through out life,with positive balance towards bone formation in young age and towards bone resorption in old age (Osteoporosis ) .

Deficiency in both organic and inorganic elements of bone , this happens when the rate of bone resorption exceeds rate of bone formation.


Deficiency in the inorganic element only ,i.e defective

mineralization , i.e abnormal bone tissue .

  • OSTEOPENIA refer to loss of bone mass, which is the amount of bone tissue per unit volume of bone .

Osteopenia is a normal feature of ageing, so within certain limits it is a physiological process . Beyond these limits the condition is pathological and progress to osteoporosis or osteomalacia .

  • Osteoporosis is the most common skeletal disorder in the world .
  • Both sexes are affected as they age, but women are more susceptible .
  • It is genetically related .
  • Racial variation is known .
causes of osteoporosis
Causes Of Osteoporosis
  • Primary (Idiopathic or Involutional) :

- Type-1(Postmenopausal): It occursin women after menopause . Estrogen deficiency plays a primary

role It is associated with vertebral crush and distal radius fractures .

- Type-2(Senile): occurs in men and women over

the age of 70, female to male ratio 2: 1

  • Secondary : Associated with other pathological conditions like endocrinal disorders, drug therapy, hematologic disorder, mechanical disorder , metabolic collagen disturbance or nutritional disorder .
causes of secondary osteoporosis
Causes Of Secondary Osteoporosis
  • Endocrinal :

Cushing syndrome ,thyrotoxicosis , hyperparathyroidism , hypogonadism , diabetes mellitus .

  • Drug therapy :

Glucocorticoids,thyroxine,heparin, diuretics,cytotoxic drugs

  • Mechanical :

Fracture immobilisation, bed rest , sedentary life , paralysis

  • Nutritional :

Malabsorption, chronic liver disease ,organ transplantation

  • Haematological :

Sickle cell anaemia , thalassemia

  • Neoplastic :

Leukaemia , multiple myeloma

  • Collagen disorders :

Osteogenesisimperfecta , homocystinuria


Osteoporosis is a silent and progressive disorder .

It is discovered only accidentally during routine check

up or after X-Ray in cases of trauma .

Components of diagnosis are:

  • History
  • Complete clinical examination
  • Radiographic diagnosis
  • Bone Density(Mass) Measurement
  • Biochemical Tests
  • Bone Biopsy( Histomorphometry)

- Complaint : pain diffuse or localized with or without trauma

- Associated Symptoms :malaise,loss of weight or height,hot

flushes,neck swelling, palpitation ,epigastric pain ,disturbed

bowel habits,renalpain,dysuria,jointpain,psychiatric upsets

- Menstrual History: amenorrhoea (menopause , pregnancy , lactation )

-Medications : glucocorticoids, thyroxine , anti-coagulant , anti-metabolites, antiacids , contraceptives

- Dietary History: daily intake of milk, protein, indigestion.

- Life style, sedentary life, smoking, alcohol .

- Family History .

radiographic diagnosis
Radiographic Diagnosis
  • A) Spine :

- Radiolucency : is increased in the center of vertebral body

- Trabecular pattern is changed :Thin and sparse trabeculae some trabeculae are lost , porosity and thinning of the cortex

- Shape is changed (Deformity): Wedge , Biconcavity or Compression

  • B) Proximal Femur :

Trabecular pattern is altered ,thin cortex, pathological


  • C) Tubular Bone :

Diffuse thinning of the cortex, subperiosteal erosions , radiolucent areas or striations

bone density measurement bone densitometry
  • Indications :

- To diagnose current osteoporosis

- To establish future fracture risk

- To monitor effect of treatment

  • Techniques :

- Single photon absorptiometrySPA

- Dual photon absorptiometryDPA

- Dual X-ray absorptiometryDXA

- Quantitative computed tomography QCT

- Quantitative ultrasound measurement QUS

laboratory tests

No specific biochemical profile for primary osteoporosis . The diagnostic importance of laboratory tests is to explore causes of secondary osteoporosis .

  • Routine tests :complete blood count,electrolytes,creatinine, blood urea nitrogen, calcium, phosphorus, protein ,albumin, alkaline phosphatase , liver enzymes .
  • Special tests :

- Parathyroid function test

- Vitamin D metabolites

- Adrenal function tests

- Tests for malabsorbtion

- Biochemical markers of bone turnover

bone biopsy histomorphometry
  • Uses :

- Evaluation of the rate of bone turnover in case of unusual

forms of osteoporosis(young adult, idopathic osteoporosis)

- To exclude other forms of bone disease ,if the diagnosis is

not sure

  • Technique

- Static histomorphometry

- Dynamic histomorphometry