OSTEOPOROSIS AND OSTEOMALACIA

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OSTEOPOROSIS AND OSTEOMALACIA

• Prof. Mohamad S. Al-Hadramy
• Professor of Medicine/Consultant
• King Abdulaziz University
• Jeddah, Saudi Arabia

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• F. 19-year-old presented with difficulty in
  walking for many years, especially going
  upstairs. She felt parasthesia in hands feet
  and occasional spasm. P/E waddling gait.
• Ca 1.8 mmol/l (2.1-2.6) P 0.54 mmol/l
  (0.7-1.4). Alk Phos 562 ( - 125).
• What other test results you need?

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• Alb Urea PTH

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• What signs for low Ca would you look for?
• Chovestick
• Trouseau 4 min.

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OSTEOMALACIA

• Raised bone turnover
• Failure of mineralization
• Most common cause decreased Vitamin D
• Darker skin more susceptible

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• Less common
• Heriditary resistance to Vitamin D
• 1 a-hydroxylase def.
• Familial X-linked hypophosphatemia
• Mesynchymal tumours produce phosphatonin

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Radiology

• Subperiosteal resorption of phalanges
• Looser zones
• Brown cysts

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Chemistry

• Decreased corrected Ca
• (40-Alb) x 0.02 Ca
• Decreased P Why?
• Decreased urinary Ca
• Decreased 25 (oH) Vit. D

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Treatment

• 1000 2000 IU Vitamin D/day 500 1000 mg of
  Ca/day. Rarely 50,000 100,000 u/d or 1 a 0.5
  2.5 µg/day . shorter acting to decrease tox.
• Check Ca Q 2-4 weeks
• Phosphate for hypophosph Rickets

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OSTEOPOROSIS

• Low bone density
• Microarchitectural deterioration
• ? fractures

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• Balance between bone formation and bone resorption

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• Max bone mass at 25 35 years
• Increased by exercise and good Ca intake. Later
  bone mass ?, especially with ?oestrogens
  (Menopause).

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Dx T score. What is it?

• Normal T 1
• Osteopenia -1gt T -2.5
• Osteoporosis T lt - 2.5
• Severe osteoporosis T lt-2.5 with 1 or more
  fragility, fractures

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Chemistry normalWhy ?alk, but not persistent
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Primary Osteoporosis

• Senile or post-menopausal 95
• Indiopathic

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Secondary Osteoporosis

• Endocrine
• Cushing exog steroids
• Hyperthyroidism
• Hypogonadism
• Hyperparathyroidism
• DM
• Proclatinoma
• Acromegaly
• Preg lactation

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Connective Tissue

• Osteogenesis inperfecta
• Marfan
• Homocystinuria

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Drugs

• Heparin
• Steroids
• Anti-convulsants

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Renal

• C R F

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Nutrition and GIT

• Malabsorption, Celiac
• Gastrectomy
• T P N
• Hepatobiliary disease
• Chronic hypophosphatemia

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Elite female athletes and anorexia nervosa
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Risk increased by

• F sex
• Menopause
• Decreased Ca
• Smoking
• Alcohol
• Inactivity
• Leanness
• White Race (? black)

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Signs Symptoms

• Asymptomatic unless
• Back pain
• ? Height
• Kyphosis
• Effect especially in
• Dorsalverts
• Femoral neck
• Distal radius

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DD Lytic lesions

• Ca breast, Lung, Kidney, Thyroid
• Prostate ? wall sclerosis
• MM ? generalized thinning

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Prevention

• Exercise
• Good Ca intake
• Non-smoking

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Screening

• Screen post-menopausal
• F gt64 or with multiple risk factors (e.g.,
  ?weight, fragility fractures
• Frag of limb or spine post fall from standing
  height or less

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TREATMENT

• Ca 1200 mg/day
• Vitamin D- 400-2000 IU / day
• HRT
• Biphosphonates
• Calcintonin
• S E R M S
• Parathyroid hormone

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Thank You !