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OSTEOPOROSIS

OSTEOPOROSIS. PENGENALAN * Satu keadaan & bukan penyakit Kejadian  @ wanita  umur Jumlah jisim tulang/kalsium badan wanita  dpd lelaki Sepanjang hayat wanita hilang 40% kalsium @ rangka tulang Boleh dikawal TETAPI tiada rawatan. B. DEFINISI

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OSTEOPOROSIS

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  1. OSTEOPOROSIS PENGENALAN * Satu keadaan & bukan penyakit Kejadian @ wanita  umur Jumlah jisim tulang/kalsium badan wanita  dpd lelaki Sepanjang hayat wanita hilang 40% kalsium @ rangka tulang Boleh dikawal TETAPI tiada rawatan

  2. B. DEFINISI • Kegangguan metabolik tulang – konten kalsium tulang  > rapuh & mudah patah ( Abram W.R. et al 1995) C. INSIDEN * Wanita > lelaki (>65 tahun) * Wanita @ Postmenopausal ( Kessenich, 1997)

  3. D. KLASIFIKASI (2) • PRIMER • Berkaitan dgn hormon Estrogen • 2 jenis 1.1. Jenis 1 • Postmenopausal Osteoporosis • Wanita 6X lebih dpd lelaki • Berlaku # vertebral (crush) & Colles

  4. 1.2. Jenis 2 * Senile Osteoporosis * Kehilangan tulang secara beransur-ansur * Wanita 2x lebih dpd lelaki * Fraktur femoral & vertebra 2. SEKUNDER * < 5% kejadian kes postmenopausal osteoporosis * Peratusan tinggi @ wanita & lelaki muda

  5. * Berkaitan dgn faktor: i. Kekurangan Vitamin D ii. Calcitonin iii. Parathyroid hormon iv. Thyroxine v. Cortisol vi. Alkoholisme vi. Immobilisasi vii. COAD viii. Chronic renal failure ix. DM x. Hepatic disease

  6. xi. Malabsorption syndrom xii. Osteomalacia xiii. Rheumatoid arthritis xiv. Scurvy xv. Systemic mastocytosis xvi. Hiperparathyroidism xvii. Neoplasma – multiple myeloma/carcinoma xviii. Terafi dgn Corticosteroid xix. Kekurangan Estrogen

  7. xx. Hypercortisonism xxi. Hypogonadism xxii. Hyperprolactinemia ( Abram W.R. et al, 1995) E. FAKTOR PENGDISPOS • Kekurangan / kehilangan Ca, Potasium, protin & Vit D • Immobilisasi & kekurangan latihan (latihan melambat kehilangan tulang & bantu membuat densiti tulang)

  8. Kekurangan Estrogen - kehilangan Ca @ matrik tulang • Kegangguan Endokrine spt: i. Excess glucortocoid ii. Male hypogonadism iii. Hiperparathyroidism • Penyakit spt: i. Malignancy ii. Hepatic insufficiency & terafi dgn heparin iii. Gastrectomy & Histerektomi

  9. iv. Rheumatoid arthritis v. Acromegaly vi. COAD vii. Chronic renal failure viii. Infeksi ix. Kecederaan & sinovitis • Ubat-ubatan: i. Steroid ii. Thyroxin iii. Heparin

  10. iv. Frusemide v. Tetracycline vi. Anticonvulsion vii. Aluminium containing antacid. • Merokok • Alkohol • Premature menopausal & menopausal berpanjangan

  11. F. TANDA & SIMPTOM * Kehilangan ketinggian * Dowager’s hump back- Kyphosis * Sakit belakang * # vertebra, wrist, hip, rib & leher femur * Kesakitan @ kawasan fraktur * Kompresi @ turus vertebra

  12. * Kehilangan berat * Spasme otot * Benjol abdomen & * Konstipasi G. DIAGNOSA i. Radiographic measurement of bone density ii. Laboratory biochemical marker iii. Bone Biopsy

  13. H. KOMPLIKASI i. Fraktur ii.  kualiti kehidupan (Bed ridden) iii. Kemurungan v. Aktiviti sosial  vi. Implikasi kewangan vii. Kematian (Komplikasi)

  14. PENCEGAHAN * Strategi terbaik * Bermula dari zaman kanak- kanak melalui: i. Pemakanan berzat & seimbang ii. Latihan & aktiviti fizikal – - mengekal & mencegah kehilangan jisim tulang iii. Vitamin D – bentuk Ca iv. Gaya hidup sihat

  15. * Terafi dgn Estrogen – kurang insiden & perkembangan osteoporosis. * Berhenti merokok & minuman alkohol – cegah kehilangan kalsium dlm tulang J. RAWATAN i. UMUM * Matlamat – berhenti kehilangan matrik tulang utk cegah #

  16. Tiada rawatan – hanya memelihara, tingkat densiti tulang & kekal kualiti tulang • Berhenti merokok & kurang mengambil alkohol • Kalsium 1500 mgm OD • Sodium Fluoride 60 – 80 mgm • Vitamin D 400 iu • Rawat penyakit penyebab osteoporosis sekunder

  17. Ganti hormon Estrogen, Calcitonin, Alendronate sodium & Raloxifene hydrochloride – melambat menopause. ii. RAWATAN SETEMPAT * Sokongan belakang – brace * Latihan & aktiviti fizikal * Pengurusan fraktur – ORIF

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