Thread by @helthy_dose

اليوم موضوعنا من اشهر واهم مواضيع العظام 😍اللي هو
#Osteoporosis
#هشاشةالعظام
تعالوا نشوف تفاصيل المرض في هذا الثريد 👇🏼

ايش يعني هشاشة عظام ؟ Osteoporosis
is a bone disorder characterized by low bone density, impaired bone
architecture, and compromised bone strength predisposing to fracture.

Pathophysiology
Two cells are responsible for promoting bones health:
⭕️osteoblast (promotes the
formation of bone tissues) خلايا بناءة
⭕️osteoclast (promotes bone breakdown) خلايا هادمة
Osteoporosis occurs when the resorption (bone breakdown) exceeds the formation.

Normally Bone formation exceeds bone breakdown during the early stages of life. Bone mass peaks between 18-25 years old.

Later, in both men and women,
bone formation 🏻 starts to gradually decrease at the age of 30-40

During menopause women undergoes additional phase of bone mineral density loss due of estrogen deficiency:
⭕️causing increase in osteoclast activities.
🙎🏻‍♂️Males are at lower risk of osteoporosis than women

Two classifications of osteoporosis:
1️⃣Primary osteoporosis (age-related)
no known cause.
It results from hormone
ca or vit.D deficiencies
2️⃣Secondary osteoporosis
Caused by drugs or other diseases.
Such as corticosteroids, thyroid hormon ereplacement ,antiepileptic drug use.

Risk Factors العوامل المؤثرة
❇️ Low bone mineral density
👱🏻‍♀️Female sex.
👵🏻Advanced age
Race/ethnicity
History of previous low trauma.
Low body weight or body mass index.
Premature menopause (before 45 years old)

2️⃣ Secondary osteoporosis
(especially rheumatoid arthritis)
❇️Past or present systemic oral glucocorticoid therapy.
🥛 🏃🏽 Low calcium intake and physical activity
☀️ Minimal sun exposure.

Diagnosis التشخيص

Physical examination
bone pain, postural changes, and loss of height (greater than 3.8 cm)
قصر الطول اكثر من ٣.٨ سم
(DXA)is the diagnostic standard ⭐️ ✅
Measurement of hip and spine BMD with dual energy x-ray absorptiometry.

FRAX tool 🧑🏻‍🔬
which uses theses factors to predict the percent probability of fracture in the next 10 years⭕️
(age, race/ethinicity, sex, previous fragility fracture, parent history of hip fracture, BMI, glucocorticoid use, current smoking, alcohol, rehumatoid arthritis)

Garvan calculator: uses four risk factors
(age, sex, low-trauma fracture, and falls)
It calculates 5 and 10 year risk estimates of any major osteoporotic and hip fracture

T-score copmare the patient BMD to the mean BMD of a healthy, young (20 to 29 year old), sex matched, white refernce population.
Normal bone mass is 💪
T-score above -1
low bone mass (osteopenia) is
T-score between -1 and -2.4
osteoporosis is
T-score at or below -2.5

Goal of therapy
💢The primary goal is prevention منع حدوث المرض
Optimizing peak bone mass when young✅
After low bone mass or osteoporosis develops ➡️ stabilize/improve bone mass and strength and prevent fractures 🏃🏽
💢Goals in patients with osteoporotic fractures include

Non-pharmacological treatment ❓
balanced diet with adequate intake of calcium and vitamin D 🥛
Recommended Dietary Allowances and Upper Limits👇🏼

🍺 Alcohol consumption should not exceed 1or2 drinks/day for women and 2or3 drinks/day for men

☕️ caffeine intake should be limited to two or fewer servings per day.

Smoking cessation🚫

Weight-bearing aerobic and strengthening exercises can improving muscle strength, coordination, balance, and mobility 💪

Fall prevention programs can decrease ✅falls, fractures
✅nursing home, hospital admissions

Vertebroplasty & kyphoplasty
new techniques for pain caused by vertebral body compression fractures

🛑Pharmacological treatment
💊Antiresorptive therapy
1-Calcium supplementation: Maintains or increases BMD. Maximum single doses of 600 mg or less of elemental calcium are recommended.
.

2-Vit D supplementation: Maximizes intestinal cal absorption and BMD, supplementation provided with daily non- prescription (vitamin D3) products. Higher dose prescription (vitD2) regimen given weekly, monthly, or quarterly may be used for replacement and maintenance therapy.

3- Bisphosphonates: inhibit bone resorption and become incorporated into bones, giving them long biological half-lives of up to 10 years. (Alendronate, Ibandronate, Risedronate, and Zoledronic acid).

RANK ligand inhibitor
#Denosumab: inhibits osteoclast formation and increases osteoclast
apoptosis. Indicated for treatment of osteoporosis in women and men at high risk for fracture.

💊Estrogen agonist/antagonist and tissue selective estrogen complex
1- Raloxifene: is an estrogen agonist on bone receptors but an antagonist at breast receptors. It is approved for prevention and treatment of postmenopausal osteoporosis.

2- Bazedoxifene: is an estrogen agonist/antagonist that combined with conjugated equine estrogens making it selective estrogen complex. It is approved for prevention of postmenopausal osteoporosis and vasomotor menstrual symptoms.

3- Calcitonin: is an endogenous hormone released form thyroid gland when serum ca is elevated. Salmon calcitonin is used clinically because it is more potent and longer lasting than mammalian form. Indicated for osteoporosis treatment for women at least 5 years past menopause

💊Anabolic therapy
Teriparatide: is recombinant human product that increases bone
formation, bone remodeling rate, and osteoclast number and activity. Indicated for postmenopausal women at high risk for fracture, men with idiopathic or hpogonadal osteoporosis at high risk.

men or women intolerant to other osteoporosis medications, and patients with glucocorticoid induced osteoporosis.

outcomes
📍Central DXA BMD:
taken 2 years after initiating medication therapy and repeated every 2 years until BMD is stable
 
📌At each visit:
✏️Assess medication adherence and tolerance at each visit
✏️Ask patients about possible fracture symptoms

من لا يشكر الناس لا يشكر الله حابين نقدم شكر لأعضاء فريق جرعة ترياق ككل وشكر خاص لكتابة المحتوى:

1Asmaa Alamri @Asmaa_Alamri00
Abeer Aljohani @Abeer_Raed
Asalah Alshamrani @a9oolah
Banan Aleid @Banana_alEid
@morethandana Dana Bukhowah
Khuld Aloufi

Raad Awad Alqarni
@phRaad1
Reem Alsulaymani @deer_256

والاشراف على المحتوى العلمي وتخطيطه:
بقيادة
@drantisaad د.سعد
ونائبيه :
@morooj_3 د.مروج
@heroxide د.خزنه سعد

وفريق دار تجهيز الثريد
بقيادة بدور @ibodor_
اعضائها:
ساره @saraaal9_
محمد @mbashammakh96
وبأشراف :
د.رنا الشمري @rana_alshlagy

شكر خاص لفريق التصميم📸
الليدر أمل احمد
@AmalHKO
أفراح الخالدي
@faroh119
شوق العنزي
@PharmD_52