SlideShare ist ein Scribd-Unternehmen logo
1 von 28
Downloaden Sie, um offline zu lesen
Endo Bridge 2013

OSTEOPOROSIS:
EPIDEMIOLOGY AND DIAGNOSIS
Dilek Gogas Yavuz,MD
Marmara University School of Medicine
Section of Endocrinology and Metabolism
Istanbul ,Turkey
Silent disease until complicated by fractures
Osteoporosis: silent epidemic
385 pts with fragility fractures
Have you ever heard of osteoporosis?

NO:20%

YES:80%

Do you think that the fracture you
have experienced could be due to
fragility of your bones?

NO:73 %

YES:27 %

Chavalley et al. Osteoporosis Int 2002;13:450
Definition of osteoporosis
NIH Consensus Development Conference, March 2000

A skeletal disorder characterized by
 Compromised bone strength
 An increased risk of fracture
Bone strength =bone density+ bone quality

normal

osteoporosis

Low bone mass and microarchitectural deterioration
Osteoporosis Is a Serious
Public Health Problem
Every 3 second
an osteoporotic
fracture occcur

• Worldwide, osteoporosis causes more than
8.9 million fractures annually
• Osteoporosis affects an estimated 75 million people in
Europe, USA and Japan, 2.2 million in Australia, 70
million in China

only 10 to 20%
are diagnosed and treated
Prevalance of osteoporosis in men and women
by gender-spesific scores

Osteoporosis is estimated to affect 200 million women worldwide
approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of
women aged 80 and two-thirds of women aged 90
Schuit et al. Bone 2004;34:195
Prevalance of Osteoporosis
 Over 50% of women and 30-45% of

men over age 50 have
osteopenia/osteoporosis
 Men over age 60 has 25% risk

osteoporotic fracture
 70% over age 80 have osteoporosis

At age 50
lifetime risk of
fracture is

1:2 women
1:5 men
Osteoporotic Fractures in Women:
Comparison with Other Diseases
2000
*annual

incidence all ages
estimate women 29+
‡annual estimate women 30+
•1996 new cases, all ages

Annual incidence x 1000

† annual

1500

1000

1 500 000*
250 000
hip
250 000
forearm
250 000
other sites

513 000†

500

0

750 000
vertebral

Osteoporotic
Fractures

228 000‡

Heart
Attack

Risk of osteoporotic fracture in 1 year is greater
than combined risk of heart attack, stroke, and
breast cancer.

184 300•

Stroke

Breast
Cancer

Hip fracture incidence alone
exceeds that of breast cancer.

Riggs BL, Melton LJ. Bone 1995
Heart and Stroke Facts, 1996, American Heart Association
Cancer Facts & Figures, 1996, American Cancer Society
Osteoporotic Fractures in Men and Women
As with women, hip fractures in men increase dramatically with age

Distribution
of Fractures

Cooper C, Melton LJ. Trends Endocrinol Metab. 1992;3:224–229.
osteoporosis epidemiology and diagnosis
Consequences of fractures
• Death
10%-20% inrease in mortality with hip fractures

• Disability
hip fractures
20% of patients require long-term nursing home care
60% of patients fail to return to prefracture level of function
vertabral fractures
chronic back pain,kyphosis,height loss, impaired pulmonary function

• Reduced quality of life
• Loss of independence
Clinician’s Guide To The Prevention And Treatment Of Osteoporosis
US Department Of Health And Human Sciences
Diagnosis of Osteoporosis
• Based on T score (T Score : standart deviation by which the
individual’s BMD differs from the mean value expected in young
healthy individuals)

• Operational definition of osteoporosis: BMD -2.5 SD or
more below the Young female adult mean
• Reference technique :DXA

• Reference site: femoral neck
• Applies to men and to women
Osteoporosis international 2013;24:23-57
WHO criteria for diagnosis of
osteoporosis
T-score : Difference expressed as standard deviation compared to
young reference population

T score
normal
osteopenia
osteoporosis

-1.0 and above
-1.0 and -2.5
-2.5 and below

Severe (established)
osteoporosis

-2.5 and below ,plus one
or more osteoporotic
fracture(s)

Kanis et al. J Bone Mineral Res 1994;9:1137
WHO classification with a T-score cannot be
applied to:

• premenopausal women
• men under age 50
• children

Z score

Low Z-score (less than -2.0) has been suggested by some to increase
likelihood of secondary osteoporosis
Who Should Have a Bone Density Test?
 Women age 65 and older and men age 70 and older
 Younger postmenopausal women and men ages

50–69 with clinical risk factors
 Adults who have a fracture after age 50
 Adults with a condition (e.g., rheumatoid arthritis)
or taking a medication (e.g., glucocorticoids)
associated with low bone mass or bone loss

1. Sweet MG, et al. Am Fam Physician. 2009;79(3):193-200.
2. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis.
www.nof.org. Accessed February 2013.
BMD measurements to predict future fracture risk
has a high specificity but a low sensitivity

Most women with hip fractures do not have a T score < -2.5
Wainwright et al JCEM 2005;90:2787
BMD and fracture risk
BMD alone is less optimal as an intervantion

• The fracture risk varies markedly
in different countries ,but T-score
varies by a small amount
• Any given T-score to fracture risk
in women from any one country
Depends on age
• Fracture risk depends of clinical
risk factors

For any BMD, fracture risk higher
in the elderly than in the young

10 –year probability of hip fracture in women
according to age and T-score for femoral neck
BMD

Osteoporosis int 2013,24:23-57
Clinical Risk Factors that Affect Fracture Risk
Fractures and weight

Compston JE et al. Am J Med 2011;124:1043
Fracture risk assessment
Risk engines
Relative fracture risk

BMD

10-year absolute fracture risk

Risk Engines

• Garvan fracture risk calculator
• Q fracture

• FRAX
FRAX
• Computer -based algorithm (http://www.shef.ac.uk/FRAX)
• Objective: To estimate fracture risk in order to help with
treatment decisions

• Rationale: BMD+CRFs predict fracture risk better than
either alone
• Calculates the 10 year probability of a major fracture (hip,
clinical spine,humerus,wrist) and 10-year probability of
hip fracture

• designed only for postmenopausal women and men over
the age of 40 who have not previously received boneprotective therapy
osteoporosis epidemiology and diagnosis
osteoporosis epidemiology and diagnosis
Categorization Based on 10-year Fracture Risk

Absolute fracture risk in 10 years:
low:
<10%
moderate:
10-20%
high:
>20%
Limitations of FRAX™
WHO Fracture Probability Tool
 Not valid in patients on treatment
 Only hip BMD is considered
 Risk is “yes/no” – there is no consideration of “dose”
(e.g., fractures, glucocorticoids, smoking, alcohol)
 Not all risk factors are included (e.g., falls)
 “Major osteoporotic fracture” is not the same as all
osteoporotic fractures

 Clinical judgment is required
Watts NB, et al. J Bone Miner Res 2009;24:975-979.
osteoporosis epidemiology and diagnosis
 Ostoeporosis is a serios health problem

 Osteoporotic fractures are expected to rise
 Lack of awareness
 Risk assesment
 Prevenion of fractures
Thank you

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Osteoporosis
Osteoporosis Osteoporosis
Osteoporosis
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Osteoporosis updates 20190328
Osteoporosis updates 20190328Osteoporosis updates 20190328
Osteoporosis updates 20190328
 
Osteoporosis- Prevention and Management
Osteoporosis- Prevention and ManagementOsteoporosis- Prevention and Management
Osteoporosis- Prevention and Management
 
Management of osteoporosis
Management of osteoporosisManagement of osteoporosis
Management of osteoporosis
 
osteoporosis
osteoporosisosteoporosis
osteoporosis
 
Osteoporosis an update-Dr Selim
Osteoporosis an update-Dr SelimOsteoporosis an update-Dr Selim
Osteoporosis an update-Dr Selim
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Osteoprosis
OsteoprosisOsteoprosis
Osteoprosis
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...
Safe surgical dislocation for femoral head fractures.dr mohamed ashraf,dr rah...
 
Osteoporosis prevention and management
Osteoporosis prevention and managementOsteoporosis prevention and management
Osteoporosis prevention and management
 
osteoporosis
osteoporosisosteoporosis
osteoporosis
 
Determinants of Osteoporosis
Determinants of OsteoporosisDeterminants of Osteoporosis
Determinants of Osteoporosis
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Teriparatide in osteoporosis
Teriparatide in osteoporosisTeriparatide in osteoporosis
Teriparatide in osteoporosis
 
Webinar on Osteoporosis by Hinduja Hospital
Webinar on Osteoporosis by Hinduja HospitalWebinar on Osteoporosis by Hinduja Hospital
Webinar on Osteoporosis by Hinduja Hospital
 
Avascular Necrosis of the Femoral Head
Avascular Necrosis of the Femoral HeadAvascular Necrosis of the Femoral Head
Avascular Necrosis of the Femoral Head
 
Recent advances in osteoporosis
Recent advances in osteoporosisRecent advances in osteoporosis
Recent advances in osteoporosis
 

Andere mochten auch

osteoporotic Fragility fractures treatment
osteoporotic Fragility fractures treatmentosteoporotic Fragility fractures treatment
osteoporotic Fragility fractures treatmentHarjot Gurudatta
 
Osteoporosis.ppt
Osteoporosis.pptOsteoporosis.ppt
Osteoporosis.pptShama
 
Patients sent to other hospitals following the administration of therapeutic ...
Patients sent to other hospitals following the administration of therapeutic ...Patients sent to other hospitals following the administration of therapeutic ...
Patients sent to other hospitals following the administration of therapeutic ...Josh Evans
 
Nmt 631 bone densitometry
Nmt 631 bone densitometryNmt 631 bone densitometry
Nmt 631 bone densitometryljmcneill33
 
Beyond IPEM 91 Dexa
Beyond IPEM 91 DexaBeyond IPEM 91 Dexa
Beyond IPEM 91 DexaJosh Evans
 
Tiroid hastalıkları poliklinik için notlar
Tiroid hastalıkları poliklinik için notlarTiroid hastalıkları poliklinik için notlar
Tiroid hastalıkları poliklinik için notlarDilek Gogas Yavuz
 
Trombofililer ve Gebelik - www.jinekolojivegebelik.com
Trombofililer ve Gebelik  - www.jinekolojivegebelik.comTrombofililer ve Gebelik  - www.jinekolojivegebelik.com
Trombofililer ve Gebelik - www.jinekolojivegebelik.comjinekolojivegebelik.com
 
DEXA 2013 presentation
DEXA 2013 presentationDEXA 2013 presentation
DEXA 2013 presentationMuntazir Mehdi
 
Bone mineral density (bmd) test
Bone mineral density (bmd) testBone mineral density (bmd) test
Bone mineral density (bmd) testapoorvaerukulla
 
Bone Mineral Density
Bone Mineral DensityBone Mineral Density
Bone Mineral DensityZarooon
 
Radiation Protection
Radiation ProtectionRadiation Protection
Radiation ProtectionRakesh Ca
 

Andere mochten auch (20)

osteoporotic Fragility fractures treatment
osteoporotic Fragility fractures treatmentosteoporotic Fragility fractures treatment
osteoporotic Fragility fractures treatment
 
Osteoporosis.ppt
Osteoporosis.pptOsteoporosis.ppt
Osteoporosis.ppt
 
Remember the favor of allah
Remember the favor of allahRemember the favor of allah
Remember the favor of allah
 
Menopoz - www.jinekolojivegebelik.com
Menopoz - www.jinekolojivegebelik.comMenopoz - www.jinekolojivegebelik.com
Menopoz - www.jinekolojivegebelik.com
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Postmenopozal hormon kullanımı ne zaman kime
Postmenopozal hormon kullanımı   ne zaman kimePostmenopozal hormon kullanımı   ne zaman kime
Postmenopozal hormon kullanımı ne zaman kime
 
Patients sent to other hospitals following the administration of therapeutic ...
Patients sent to other hospitals following the administration of therapeutic ...Patients sent to other hospitals following the administration of therapeutic ...
Patients sent to other hospitals following the administration of therapeutic ...
 
Nmt 631 bone densitometry
Nmt 631 bone densitometryNmt 631 bone densitometry
Nmt 631 bone densitometry
 
Osteoporosis & BMD Test
Osteoporosis & BMD TestOsteoporosis & BMD Test
Osteoporosis & BMD Test
 
Beyond IPEM 91 Dexa
Beyond IPEM 91 DexaBeyond IPEM 91 Dexa
Beyond IPEM 91 Dexa
 
Tiroid hastalıkları poliklinik için notlar
Tiroid hastalıkları poliklinik için notlarTiroid hastalıkları poliklinik için notlar
Tiroid hastalıkları poliklinik için notlar
 
Dexa chinmay
Dexa chinmayDexa chinmay
Dexa chinmay
 
Trombofililer ve Gebelik - www.jinekolojivegebelik.com
Trombofililer ve Gebelik  - www.jinekolojivegebelik.comTrombofililer ve Gebelik  - www.jinekolojivegebelik.com
Trombofililer ve Gebelik - www.jinekolojivegebelik.com
 
DEXA 2013 presentation
DEXA 2013 presentationDEXA 2013 presentation
DEXA 2013 presentation
 
Dexa scan
Dexa scanDexa scan
Dexa scan
 
Bone mineral density (bmd) test
Bone mineral density (bmd) testBone mineral density (bmd) test
Bone mineral density (bmd) test
 
Osteoporoz ve Süt
Osteoporoz ve SütOsteoporoz ve Süt
Osteoporoz ve Süt
 
Bone Mineral Density
Bone Mineral DensityBone Mineral Density
Bone Mineral Density
 
Radiation Protection
Radiation ProtectionRadiation Protection
Radiation Protection
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 

Ähnlich wie osteoporosis epidemiology and diagnosis

Osteoporosis_Women's_Health_6.ppt
Osteoporosis_Women's_Health_6.pptOsteoporosis_Women's_Health_6.ppt
Osteoporosis_Women's_Health_6.pptSpesialistulangAnak
 
IMAGING IN OSTEOPOROSIS.pptx
IMAGING IN OSTEOPOROSIS.pptxIMAGING IN OSTEOPOROSIS.pptx
IMAGING IN OSTEOPOROSIS.pptxvandana bansal
 
Osteoporosis & Fractures - a view
Osteoporosis & Fractures - a viewOsteoporosis & Fractures - a view
Osteoporosis & Fractures - a viewARPUTHA SELVARAJ A
 
Cost-effective Treatment and Fracture Risk
Cost-effective Treatment and Fracture RiskCost-effective Treatment and Fracture Risk
Cost-effective Treatment and Fracture Riskdemiss
 
Osteoporosis in Elderly People.pptx
Osteoporosis in Elderly People.pptxOsteoporosis in Elderly People.pptx
Osteoporosis in Elderly People.pptxAhmed Mshari
 
Ckd-MBD & osteoporosis the management dilemma
Ckd-MBD  & osteoporosis the management dilemma Ckd-MBD  & osteoporosis the management dilemma
Ckd-MBD & osteoporosis the management dilemma Ayman Seddik
 
Osteoporosis%203rd%20yr[1]
Osteoporosis%203rd%20yr[1]Osteoporosis%203rd%20yr[1]
Osteoporosis%203rd%20yr[1]cotitoblue
 
Osteoporosis and osteomalacia
Osteoporosis and osteomalaciaOsteoporosis and osteomalacia
Osteoporosis and osteomalaciaBalqees Majali
 
Managment of glucocorticoids induced osteoprosis
Managment of glucocorticoids induced osteoprosisManagment of glucocorticoids induced osteoprosis
Managment of glucocorticoids induced osteoprosisMarwa Besar
 
Osteoporosis Nutriforce Training HIMAGIKA
Osteoporosis Nutriforce Training HIMAGIKAOsteoporosis Nutriforce Training HIMAGIKA
Osteoporosis Nutriforce Training HIMAGIKAssuser192ba01
 
Osteoporosis in men
Osteoporosis in menOsteoporosis in men
Osteoporosis in menMsccMohamed
 
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility Fractures
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility FracturesDr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility Fractures
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility FracturesSteven R. Goldstein
 

Ähnlich wie osteoporosis epidemiology and diagnosis (20)

Shafei osteoporosis
Shafei osteoporosisShafei osteoporosis
Shafei osteoporosis
 
Osteoporosis_Women's_Health_6.ppt
Osteoporosis_Women's_Health_6.pptOsteoporosis_Women's_Health_6.ppt
Osteoporosis_Women's_Health_6.ppt
 
IMAGING IN OSTEOPOROSIS.pptx
IMAGING IN OSTEOPOROSIS.pptxIMAGING IN OSTEOPOROSIS.pptx
IMAGING IN OSTEOPOROSIS.pptx
 
Osteoporosis & Fractures - a view
Osteoporosis & Fractures - a viewOsteoporosis & Fractures - a view
Osteoporosis & Fractures - a view
 
Cost-effective Treatment and Fracture Risk
Cost-effective Treatment and Fracture RiskCost-effective Treatment and Fracture Risk
Cost-effective Treatment and Fracture Risk
 
Osteoprosis: Evaluation, Management and Prevention by Dr Shahjada Selim
Osteoprosis: Evaluation, Management and Prevention by Dr Shahjada SelimOsteoprosis: Evaluation, Management and Prevention by Dr Shahjada Selim
Osteoprosis: Evaluation, Management and Prevention by Dr Shahjada Selim
 
Osteoporosis in Elderly People.pptx
Osteoporosis in Elderly People.pptxOsteoporosis in Elderly People.pptx
Osteoporosis in Elderly People.pptx
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Ckd-MBD & osteoporosis the management dilemma
Ckd-MBD  & osteoporosis the management dilemma Ckd-MBD  & osteoporosis the management dilemma
Ckd-MBD & osteoporosis the management dilemma
 
Rheumatology Highlights 2012
Rheumatology Highlights 2012Rheumatology Highlights 2012
Rheumatology Highlights 2012
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Osteoporosis%203rd%20yr[1]
Osteoporosis%203rd%20yr[1]Osteoporosis%203rd%20yr[1]
Osteoporosis%203rd%20yr[1]
 
Osteoporosis
OsteoporosisOsteoporosis
Osteoporosis
 
Osteoporosis and osteomalacia
Osteoporosis and osteomalaciaOsteoporosis and osteomalacia
Osteoporosis and osteomalacia
 
Managment of glucocorticoids induced osteoprosis
Managment of glucocorticoids induced osteoprosisManagment of glucocorticoids induced osteoprosis
Managment of glucocorticoids induced osteoprosis
 
Osteoporosis Nutriforce Training HIMAGIKA
Osteoporosis Nutriforce Training HIMAGIKAOsteoporosis Nutriforce Training HIMAGIKA
Osteoporosis Nutriforce Training HIMAGIKA
 
Updates on osteoporosis treatment
Updates on osteoporosis treatmentUpdates on osteoporosis treatment
Updates on osteoporosis treatment
 
Osteoporosis in men
Osteoporosis in menOsteoporosis in men
Osteoporosis in men
 
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility Fractures
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility FracturesDr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility Fractures
Dr Steven R. Goldstein - Osteoporosis, Poor Bone Health, Fragility Fractures
 
Osteoporosis a
Osteoporosis aOsteoporosis a
Osteoporosis a
 

Mehr von Dilek Gogas Yavuz

osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu
osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzuosteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu
osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzuDilek Gogas Yavuz
 
Hirsutizm ayırıcı tanısı
Hirsutizm ayırıcı tanısıHirsutizm ayırıcı tanısı
Hirsutizm ayırıcı tanısıDilek Gogas Yavuz
 
Diyabette Glisemik Dalgalanma
Diyabette Glisemik DalgalanmaDiyabette Glisemik Dalgalanma
Diyabette Glisemik DalgalanmaDilek Gogas Yavuz
 
Vakalarla subklinik hipotiroidi
Vakalarla subklinik hipotiroidiVakalarla subklinik hipotiroidi
Vakalarla subklinik hipotiroidiDilek Gogas Yavuz
 
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIM
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIMHİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIM
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIMDilek Gogas Yavuz
 
Diagnosis of diabetes mellitus
Diagnosis of diabetes mellitus  Diagnosis of diabetes mellitus
Diagnosis of diabetes mellitus Dilek Gogas Yavuz
 
Tiroid hastalıkları genel bakış -diş hekimliği dersi
Tiroid hastalıkları  genel bakış -diş hekimliği dersiTiroid hastalıkları  genel bakış -diş hekimliği dersi
Tiroid hastalıkları genel bakış -diş hekimliği dersiDilek Gogas Yavuz
 
Insulin: kimlere nasıl ne zaman
Insulin: kimlere nasıl ne zamanInsulin: kimlere nasıl ne zaman
Insulin: kimlere nasıl ne zamanDilek Gogas Yavuz
 
iç Hastalıkları Fizik Muayene (Medikal) kitabı
iç Hastalıkları Fizik Muayene (Medikal) kitabıiç Hastalıkları Fizik Muayene (Medikal) kitabı
iç Hastalıkları Fizik Muayene (Medikal) kitabıDilek Gogas Yavuz
 

Mehr von Dilek Gogas Yavuz (20)

osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu
osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzuosteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu
osteoporoz ve metabolik kemik hastalıkları tanı ve tedavi kılavuzu
 
Endokrin Vakalar 3
Endokrin Vakalar 3Endokrin Vakalar 3
Endokrin Vakalar 3
 
Prediyabet ve metformin
Prediyabet ve metforminPrediyabet ve metformin
Prediyabet ve metformin
 
Hirsutizm ayırıcı tanısı
Hirsutizm ayırıcı tanısıHirsutizm ayırıcı tanısı
Hirsutizm ayırıcı tanısı
 
Diyabette Glisemik Dalgalanma
Diyabette Glisemik DalgalanmaDiyabette Glisemik Dalgalanma
Diyabette Glisemik Dalgalanma
 
Vakalarla subklinik hipotiroidi
Vakalarla subklinik hipotiroidiVakalarla subklinik hipotiroidi
Vakalarla subklinik hipotiroidi
 
Tıpta Uzmanlık Secimi
Tıpta Uzmanlık SecimiTıpta Uzmanlık Secimi
Tıpta Uzmanlık Secimi
 
Beslenme temel ilkeler 2014
Beslenme temel ilkeler 2014Beslenme temel ilkeler 2014
Beslenme temel ilkeler 2014
 
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIM
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIMHİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIM
HİPERKALSEMİ VE HİPOKALSEMİYE YAKLAŞIM
 
Diagnosis of diabetes mellitus
Diagnosis of diabetes mellitus  Diagnosis of diabetes mellitus
Diagnosis of diabetes mellitus
 
Tiroid hastalıkları genel bakış -diş hekimliği dersi
Tiroid hastalıkları  genel bakış -diş hekimliği dersiTiroid hastalıkları  genel bakış -diş hekimliği dersi
Tiroid hastalıkları genel bakış -diş hekimliği dersi
 
Vitamin d güncelleme 2013
Vitamin d güncelleme 2013Vitamin d güncelleme 2013
Vitamin d güncelleme 2013
 
Insulin: kimlere nasıl ne zaman
Insulin: kimlere nasıl ne zamanInsulin: kimlere nasıl ne zaman
Insulin: kimlere nasıl ne zaman
 
Acil hastaya yaklasim
Acil hastaya yaklasimAcil hastaya yaklasim
Acil hastaya yaklasim
 
Endokrin vakalar 1. sayı
Endokrin vakalar 1. sayıEndokrin vakalar 1. sayı
Endokrin vakalar 1. sayı
 
iç Hastalıkları Fizik Muayene (Medikal) kitabı
iç Hastalıkları Fizik Muayene (Medikal) kitabıiç Hastalıkları Fizik Muayene (Medikal) kitabı
iç Hastalıkları Fizik Muayene (Medikal) kitabı
 
Vakalarla hipotiroidi
Vakalarla hipotiroidiVakalarla hipotiroidi
Vakalarla hipotiroidi
 
Gebelikte hipotiroidi
Gebelikte hipotiroidiGebelikte hipotiroidi
Gebelikte hipotiroidi
 
endokrin vakalar- 2. sayı
endokrin vakalar- 2. sayıendokrin vakalar- 2. sayı
endokrin vakalar- 2. sayı
 
Statin ve diyabet riski
Statin ve diyabet riskiStatin ve diyabet riski
Statin ve diyabet riski
 

Kürzlich hochgeladen

historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu Medical University
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets barmohitRahangdale
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfMedicoseAcademics
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communicationskatiequigley33
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptxWINCY THIRUMURUGAN
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Peter Embi
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentsaileshpanda05
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyMedicoseAcademics
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfHongBiThi1
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Vaikunthan Rajaratnam
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...Shubhanshu Gaurav
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxkomalt2001
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)kishan singh tomar
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologyDeepakDaniel9
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionkrishnareddy157915
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.pptRamDBawankar1
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxMAsifAhmad
 

Kürzlich hochgeladen (20)

historyofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusanguhistoryofpsychiatryinindia. Senthil Thirusangu
historyofpsychiatryinindia. Senthil Thirusangu
 
Role of Soap based and synthetic or syndets bar
Role of  Soap based and synthetic or syndets barRole of  Soap based and synthetic or syndets bar
Role of Soap based and synthetic or syndets bar
 
Red Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdfRed Blood Cells_anemia & polycythemia.pdf
Red Blood Cells_anemia & polycythemia.pdf
 
Using Data Visualization in Public Health Communications
Using Data Visualization in Public Health CommunicationsUsing Data Visualization in Public Health Communications
Using Data Visualization in Public Health Communications
 
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
Immune labs basics part 1 acute phase reactants ESR, CRP Ahmed Yehia Ismaeel,...
 
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptxANATOMICAL FAETURES OF BONES  FOR NURSING STUDENTS .pptx
ANATOMICAL FAETURES OF BONES FOR NURSING STUDENTS .pptx
 
Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024Clinical Research Informatics Year-in-Review 2024
Clinical Research Informatics Year-in-Review 2024
 
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
GOUT UPDATE AHMED YEHIA 2024, case based approach with application of the lat...
 
CPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing studentCPR.nursingoutlook.pdf , Bsc nursing student
CPR.nursingoutlook.pdf , Bsc nursing student
 
Female Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before PregnancyFemale Reproductive Physiology Before Pregnancy
Female Reproductive Physiology Before Pregnancy
 
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdfSGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
SGK LEUKEMIA KINH DÒNG BẠCH CÂU HẠT HAY.pdf
 
Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...Rheumatoid arthritis Part 1, case based approach with application of the late...
Rheumatoid arthritis Part 1, case based approach with application of the late...
 
Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.Generative AI in Health Care a scoping review and a persoanl experience.
Generative AI in Health Care a scoping review and a persoanl experience.
 
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
FDMA FLAP - The first dorsal metacarpal artery (FDMA) flap is used mainly for...
 
Basic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptxBasic structure of hair and hair growth cycle.pptx
Basic structure of hair and hair growth cycle.pptx
 
High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)High-Performance Thin-Layer Chromatography (HPTLC)
High-Performance Thin-Layer Chromatography (HPTLC)
 
pA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacologypA2 value, Schild plot and pD2 values- applications in pharmacology
pA2 value, Schild plot and pD2 values- applications in pharmacology
 
EXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung functionEXERCISE PERFORMANCE.pptx, Lung function
EXERCISE PERFORMANCE.pptx, Lung function
 
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D.  Bawankar.pptPharmacokinetic Models by Dr. Ram D.  Bawankar.ppt
Pharmacokinetic Models by Dr. Ram D. Bawankar.ppt
 
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptxDNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
DNA nucleotides Blast in NCBI and Phylogeny using MEGA Xi.pptx
 

osteoporosis epidemiology and diagnosis

  • 1. Endo Bridge 2013 OSTEOPOROSIS: EPIDEMIOLOGY AND DIAGNOSIS Dilek Gogas Yavuz,MD Marmara University School of Medicine Section of Endocrinology and Metabolism Istanbul ,Turkey
  • 2. Silent disease until complicated by fractures
  • 3. Osteoporosis: silent epidemic 385 pts with fragility fractures Have you ever heard of osteoporosis? NO:20% YES:80% Do you think that the fracture you have experienced could be due to fragility of your bones? NO:73 % YES:27 % Chavalley et al. Osteoporosis Int 2002;13:450
  • 4. Definition of osteoporosis NIH Consensus Development Conference, March 2000 A skeletal disorder characterized by  Compromised bone strength  An increased risk of fracture Bone strength =bone density+ bone quality normal osteoporosis Low bone mass and microarchitectural deterioration
  • 5. Osteoporosis Is a Serious Public Health Problem Every 3 second an osteoporotic fracture occcur • Worldwide, osteoporosis causes more than 8.9 million fractures annually • Osteoporosis affects an estimated 75 million people in Europe, USA and Japan, 2.2 million in Australia, 70 million in China only 10 to 20% are diagnosed and treated
  • 6. Prevalance of osteoporosis in men and women by gender-spesific scores Osteoporosis is estimated to affect 200 million women worldwide approximately one-tenth of women aged 60, one-fifth of women aged 70, two-fifths of women aged 80 and two-thirds of women aged 90 Schuit et al. Bone 2004;34:195
  • 7. Prevalance of Osteoporosis  Over 50% of women and 30-45% of men over age 50 have osteopenia/osteoporosis  Men over age 60 has 25% risk osteoporotic fracture  70% over age 80 have osteoporosis At age 50 lifetime risk of fracture is 1:2 women 1:5 men
  • 8. Osteoporotic Fractures in Women: Comparison with Other Diseases 2000 *annual incidence all ages estimate women 29+ ‡annual estimate women 30+ •1996 new cases, all ages Annual incidence x 1000 † annual 1500 1000 1 500 000* 250 000 hip 250 000 forearm 250 000 other sites 513 000† 500 0 750 000 vertebral Osteoporotic Fractures 228 000‡ Heart Attack Risk of osteoporotic fracture in 1 year is greater than combined risk of heart attack, stroke, and breast cancer. 184 300• Stroke Breast Cancer Hip fracture incidence alone exceeds that of breast cancer. Riggs BL, Melton LJ. Bone 1995 Heart and Stroke Facts, 1996, American Heart Association Cancer Facts & Figures, 1996, American Cancer Society
  • 9. Osteoporotic Fractures in Men and Women As with women, hip fractures in men increase dramatically with age Distribution of Fractures Cooper C, Melton LJ. Trends Endocrinol Metab. 1992;3:224–229.
  • 11. Consequences of fractures • Death 10%-20% inrease in mortality with hip fractures • Disability hip fractures 20% of patients require long-term nursing home care 60% of patients fail to return to prefracture level of function vertabral fractures chronic back pain,kyphosis,height loss, impaired pulmonary function • Reduced quality of life • Loss of independence Clinician’s Guide To The Prevention And Treatment Of Osteoporosis US Department Of Health And Human Sciences
  • 12. Diagnosis of Osteoporosis • Based on T score (T Score : standart deviation by which the individual’s BMD differs from the mean value expected in young healthy individuals) • Operational definition of osteoporosis: BMD -2.5 SD or more below the Young female adult mean • Reference technique :DXA • Reference site: femoral neck • Applies to men and to women Osteoporosis international 2013;24:23-57
  • 13. WHO criteria for diagnosis of osteoporosis T-score : Difference expressed as standard deviation compared to young reference population T score normal osteopenia osteoporosis -1.0 and above -1.0 and -2.5 -2.5 and below Severe (established) osteoporosis -2.5 and below ,plus one or more osteoporotic fracture(s) Kanis et al. J Bone Mineral Res 1994;9:1137
  • 14. WHO classification with a T-score cannot be applied to: • premenopausal women • men under age 50 • children Z score Low Z-score (less than -2.0) has been suggested by some to increase likelihood of secondary osteoporosis
  • 15. Who Should Have a Bone Density Test?  Women age 65 and older and men age 70 and older  Younger postmenopausal women and men ages 50–69 with clinical risk factors  Adults who have a fracture after age 50  Adults with a condition (e.g., rheumatoid arthritis) or taking a medication (e.g., glucocorticoids) associated with low bone mass or bone loss 1. Sweet MG, et al. Am Fam Physician. 2009;79(3):193-200. 2. National Osteoporosis Foundation. Clinician’s Guide to Prevention and Treatment of Osteoporosis. www.nof.org. Accessed February 2013.
  • 16. BMD measurements to predict future fracture risk has a high specificity but a low sensitivity Most women with hip fractures do not have a T score < -2.5 Wainwright et al JCEM 2005;90:2787
  • 17. BMD and fracture risk BMD alone is less optimal as an intervantion • The fracture risk varies markedly in different countries ,but T-score varies by a small amount • Any given T-score to fracture risk in women from any one country Depends on age • Fracture risk depends of clinical risk factors For any BMD, fracture risk higher in the elderly than in the young 10 –year probability of hip fracture in women according to age and T-score for femoral neck BMD Osteoporosis int 2013,24:23-57
  • 18. Clinical Risk Factors that Affect Fracture Risk
  • 19. Fractures and weight Compston JE et al. Am J Med 2011;124:1043
  • 20. Fracture risk assessment Risk engines Relative fracture risk BMD 10-year absolute fracture risk Risk Engines • Garvan fracture risk calculator • Q fracture • FRAX
  • 21. FRAX • Computer -based algorithm (http://www.shef.ac.uk/FRAX) • Objective: To estimate fracture risk in order to help with treatment decisions • Rationale: BMD+CRFs predict fracture risk better than either alone • Calculates the 10 year probability of a major fracture (hip, clinical spine,humerus,wrist) and 10-year probability of hip fracture • designed only for postmenopausal women and men over the age of 40 who have not previously received boneprotective therapy
  • 24. Categorization Based on 10-year Fracture Risk Absolute fracture risk in 10 years: low: <10% moderate: 10-20% high: >20%
  • 25. Limitations of FRAX™ WHO Fracture Probability Tool  Not valid in patients on treatment  Only hip BMD is considered  Risk is “yes/no” – there is no consideration of “dose” (e.g., fractures, glucocorticoids, smoking, alcohol)  Not all risk factors are included (e.g., falls)  “Major osteoporotic fracture” is not the same as all osteoporotic fractures  Clinical judgment is required Watts NB, et al. J Bone Miner Res 2009;24:975-979.
  • 27.  Ostoeporosis is a serios health problem  Osteoporotic fractures are expected to rise  Lack of awareness  Risk assesment  Prevenion of fractures