OSTEOPOROSIS IN MALAYSIA

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OSTEOPOROSIS IN MALAYSIA

• Wan Dalila Binti Wan Ishak
• Siti Ijtimayah Binti Kahalit

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introduction

• Osteoporosis is a disease in which bones become
  fragile and more likely to break. If not
  prevented or if left untreated, osteoporosis can
  progress painlessly until a bone breaks.
• These broken bones, also known as fractures,
  occur typically in the hip, spine, and wrist.
• Any bone can be affected, but of special concern
  are fractures of the hip and spine. A hip
  fracture almost always requires hospitalization
  and major surgery.
• It can impair a person's ability to walk
  unassisted
• may cause prolonged or permanent disability or
  even death.
• Spinal or vertebral fractures also have serious
  consequences, including loss of height, severe
  back pain, and deformity

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HIP
SPINE
WRIST
HIPS
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• Osteoporosis makes your bones weak and more
  likely to break.
• Anyone can develop osteoporosis, but it is common
  in older women.
• As many as half of all women and a quarter of men
  older than 50 will break a bone due to
  osteoporosis

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what causes osteoporosis at the 1st place

• Bones are living tissues that must be constantly
  rebuilt via a two part process, by which both of
  osteoblast and osteclast function normally.
• Osteoclasts and osteoblasts are activated by
  parathyroid hormone (PTH) which signals
  osteoclasts to pull calcium from the bones.
  Calcitonin is the hormone that stimulates
  osteoblasts to deposit calcium into the bones.
  The problems begin when the delicate balance
  between PTH and Calcitonin is disrupted.

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Who is at RisK ??

• Risk factors you cannot change include
• Gender. Women get osteoporosis more often than
  men.
• Age. The older you are, the greater your risk of
  osteoporosis.
• Body size. Small, thin women are at greater risk.
  
• Ethnicity. White and Asian women are at highest
  risk. Black and Hispanic women have a lower risk.
  
• Family history. Osteoporosis tends to run in
  families. If a family member has osteoporosis or
  breaks a bone, there is a greater chance that you
  will too.

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• Other risk factors are
• Sex hormones. Low estrogen levels due to missing
  menstrual periods or to menopause can cause
  osteoporosis in women. Low testosterone levels
  can bring on osteoporosis in men. During
  menopouse,bone loss can range from 4 to 8
• Calcium and vitamin D intake. A diet low in
  calcium and vitamin D makes you more prone to
  bone loss. In Malaysia most people hate drinking
  milk and hence increase their probability towards
  osteoporosis
• Medication use. Some medicines increase the risk
  of osteoporosis.
• Too Much acidity in Food. As the blood must be a
  neutral pH, your body pulls calcium from the
  bones to neutralize the acidity. This is often
  the major factor in the development of
  osteoporosis

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• Activity level. Lack of exercise or long-term bed
  rest can cause weak bones.
• Smoking. Cigarettes are bad for bones, heart, and
  lungs.
• Drinking alcohol. Too much alcohol can cause bone
  loss and
• broken bones.
• Lack of magnesium may be the cause of
  osteoporosis.
• Calcitonin relies on magnesium to function
  properly. When we lack magnesium, the balance
  between PTH and calcitonin tilts too far toward
  PTH. This results in excessive stimulation of
  osteoclasts, which causes net bone loss.
  Magnesium suppresses the hormone that tells your
  body to pull calcium from the bones, and
  stimulates the hormone that tells the body to put
  calcium in your bones.

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• In Malaysia, it is estimated that over 1 million
  people are at risk from osteoporosis, out of
  which 20 are men.
•  

Reported by Arthritis Foundation ,Malaysia
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SyMPTOmpS

• Osteoporosis is called the
• "silent disease
• because bone is lost with no signs. You may not
  know that you have osteoporosis until a strain,
  bump, or fall causes a bone to break.

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DiagnosE

• A bone mineral density test (called a DXA) is the
  best way to check your bone health. This test
  can
• Diagnose osteoporosis
• Check bone strength
• See if treatments are making the bones stronger.
• Bone densitometry
• Bone Mass measurement
• Spine X-ray

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PREVENTION

• Enough calcium intake daily 800-1000 mg, also
  other important nutrients proteins, zinc, mg
  vitamin D for healthy and strong bone
• Vitamin D is important in absorption of Ca
  from food and incorporate it into bones
• 1 glass of high Ca milk 500 mg Ca
• Bone examination free during World Osteoporosis
  Day access risk of loss of mass of bone
• Exercises but not excessive!!! (3-4 times a week)
• Exercise alters hormonal balances,
  favoring the hormones that protects bone
• So, walk rather than ride,
• climb the stairs rather than using
  lift,
• stand rather than sit when
  appropriate P

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4. Campaign to increase awareness among the
civilians regarding osteoporosis.
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• 4. Importance of good posture
• Proper way to sit - Support your lower back
  with a pillow or by a straight high-backed
  chair. When driving or reading, avoid bending the
  neck forward. When rising from a chair, do it
  slowly.
• Proper way to walk and stand - Keep your head
  high, look forward with the chin in. Pull your
  shoulders back, pull your stomach in to maintain
  the natural arch of the lower back, and tighten
  your buttocks. Wear low-heeled shoes with rubber
  soles
• Proper way to lift - You must bend your knees
  when lifting heavy objects to avoid backstrain
  and further compression fractures. Use your Leg
  muscles rather than your back!

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• 5. Avoid taking too much coffee, tea or
  chocolate, because they help in loss of Ca.
• High protein will reduce the ability of Ca
  resorption.
• Alcohol destroys cells forming bone.
• Smoking reduces estrogen
• It is important to remember that we cannot avoid
  hormonal and genetic factor thus, we control the
  environment and diet factor, so that we can
  overcome the osteoporosis problem.

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TREATMENT

• Calcium and vitamin D intake reduce fractures
  by maintaining BMD (bone mineral density)
• Vitamin D is necessary for our body to
  absorb calcium
• optimum intake combination of
  dietary Ca source and Ca in pills form
• Physical activity essential for bone growth
• and
  maintenance
• - improves
  muscle strength and balance, thus, decrease the
  risk of fracture and falls
• Bisphosphontes - a type of medication known
• as antiresporptive medications, taken
  orally or in
• injectable form
• - prevent
  bone loss by inhibiting the normal function of
  cells called osteoclasts. These are the cells
  responsible for removing old bone.

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• - Side effects of bisphosphonates include
  muscle and joint pain, nausea, and heartburn
• - common bisphosphontes fosamax, reclast,
  boniva
• 4. Calcitonin - is naturally made in your body
  when blood calcium levels are high. Thus, retains
  calcium within the skeleton, rather than
  replenish the calcium in the bloodstream.
• - administered by a nasal spray.
• - Side effects - runny nose, headaches and
  nose
• bleeds.

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• Estrogen Treatment (ET) or Hormone Treatment (HT)
  
• - effective treatments for preventing bone
  loss and reducing risk of fracture.
• - Unfortunately, ET increased the risk of
  uterine cancer, therefore used in patients with
  prior hysterectomy (remove uterus)
• - Concerns about increased risk of breast
  cancer, stroke, and blood clots have surrounded
  the use of these medications for osteoporosis.
  Therefore, the FDA recommends the use of ET/HT
  only if other medications cannot be used and
  there is a significant risk of osteoporosis.

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STATISTICS

• Osteoporosis-related fractures have been
  recognized as a major health problem,
  particularly in the elderly. In 1997, the
  incidence of hip fracture in Malaysia among
  individuals above 50 years of age was 90 per 100
  000. Hip fractures are associated with a high
  morbidity and mortality rate of up to 20 in the
  first year.
•  
• The majority who survive are disabled and only
  25 will resume normal activities. The direct
  hospitalization cost for hip fracture in 1997 is
  estimated conservatively at RM 22 million.

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ACKNOWLEDGEMENT

• http//www.cancersupportivecare.com/osteotherapy.h
  tmlexercise
• http//drpakar.blogspot.com/2008/11/keperluan-kals
  ium-wanita.html
• http//www.geocities.com/uitm_ot/osteoporosis.htm
• http//www.msd-malaysia.com/content/corporate/dise
  ase/osteoporosis.html
• http//orthopedics.about.com/od/osteoporosistreatm
  ent/p/medications.htm