Osteoporosis
Ivan M ü l l e r
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Orthop. Univ. Dept. FN Brno
Systemic metabolic disease
characterized by decreasing of bone
mass and disorder of bone
microarchitecture with pathological
fractures (WHO)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Osteoporosis („silent bone thief“)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Healthy bone Osteoporotic bone
 Every 3rd woman and 6th male (Caucasian, Asian)
above 60 yrs
 Increasing number of femoral neck fractures during 20
years + 33%
 Czech Republic: 10 904 these fractures in 1992
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Occurrence
 genetic (60%, Caucasian and Asian, women)
 Quality of body, tissues (thinness-low BMI, small figure)
 Life style (hypomobility)
 Dysmenorea-disorders of menstruation-emmeniopathy
 Other disorders (GIT, thyroid gland)
 medication - drugs, tobacco, alcohol
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Risk factors
 to 35. yrs prevalence of bone
production
 involution
 menopausa (bone loss of 6% / year)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Skeletal evolution
Bone mass ..increasing.. …Stop bone loss… Elderly …
Treat
 primary - I. type (post menopausal)
II. type (elderly)
juvenile
 secondary - hormonal
drugs - corticosteroids
nutritional disorders
other disorders
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Osteoporosis
 Stress (load) pain of spine and extremities
 Trunk shortening and round back
 Reflex skin, fasciae, muscles changes
 Pathological fractures
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Osteoporosis symptoms
1. medical (anamnesis, physical exam.)
2. Laboratory (blood, urine)
3. Bone density
4. Radiological methods
5. Bone biopsy
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Examination
1. Calcium 1 000 - 1 500 mg per day
2. Vitamin D 800 IU per day
3. Estrogens
4. SERM remedies (Raloxifen)
5. Bisphosphonates (Alendronate, Risendronate –
T-score: -2,5 and less
6. Calcitonin
7. Anabolic hormons (elderly)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Treatment
 Fractures treatment – hip, wrist, proximal
humerus, spine, pelvis, ankle, knee (3R)
 Treatment of posttraumatic deformities
 Vertebral kyfoplasty (bone cement)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Surgical management
Total hip arthroplasty
osteosynthesis
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Physiotherapy and orthotic
management
wrong
wrong
good good
Jewett orthosis
1. Primary (good skeletal evolution)
2. Secondary (osteoporosis treatment)
3. Terciary (technical arrangements against
falls, fall prevention, physiotherapy,
regeneration, “well-ness“ programme -
spas)
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Prevention
 diet
 motion regime (gait, dance)
 struggle against risks
 ergonomic arrangements
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
General arrangements against
osteoporosis
Conclusion
University Hospital Brno, Orthopaedic Dept Brno-Bohunice
Osteoporosis is consequential disease with
predominant women occurrence, including fragility
fractures. Everybody should adhere to regime
approach, healthy life style. Early diagnosis and
treatment are conditions for successful
management of osteoporosis.