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INTRUDUCTIONOSTEOPOROSIS

PREVENTION SOCIETYESTABLISHMENT

Hazem Abdel Azeem

Prof. of Orthopedic Surgery, Cairo University

Cairo April 2005

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As more & more diseases become eradicated

Leading causeof death will

become

Osteoporosis

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Hard Structure should not beleft to fail

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Age-related changes

After age 60, subperiostealarea slowly increases butmedullary cavity enlargesfaster, resulting in netdecrease of corticalthickness and mass

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Underdiagnosed and Undertreated

osteoporosis is commonly notdiagnosed or treated appropriately

Follin SL et al. Pharmacotherapy . 2003;23:190-198 .

large numbers of people withosteoporosis are still not beingdiagnosedare not being treated.

Schnitzer TJ. Diagnosis and Treatment for Osteoporosis:Current Status and Expectations for the New Millennium.Available at: http://www.medscape.com/viewprogram/605.

Women are not aggressively treated for

osteoporosis after hip fractureKiebzak GM et al. Arch Intern Med . 2002;162:2217-2222 .

http://www.medscape.com/viewprogram/605.%20Accessed%20May%2028http://www.medscape.com/viewprogram/605.%20Accessed%20May%2028

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BE AWARE

of The Silent Thief

The Deafening Silent Epidemic

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Over Suspicion

Due to wrong awareness propaganda

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A lifestyle conducive to osteoporosis

Milk intake low

Body image distorted

Exercise non existent

Smoking on the riseSteroid abuse excessive

Health education patchy

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DRUGS RELATED RISKS Smoking

Glucocorticoids and ACTH

Thyroxine

Anticonvulsants

Heparin

Lithium

Cytotoxic

Gonadotrophin-RH agonists

Tamoxifen

Medroxyprogester-one acetate

Aluminium Excess Vitamin D Drugs causing falls Hyperoxia

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MORBIDITY OF OSTEOPOROSIS

Osteoporotic Bone LossOsteoporoticOsteoporotic Bone LossBone Loss

NormalOsteoporosis

Dempster DW, et al. J Bone Min Res . 1986;1:15-21.Reprinted with permission from the American Society for Bone and Mineral Research.

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PAINS

MICROFRACTURES. LONG STANDING

KYPHOSIS. ASSOCIATED

OSTEOMALACIA. OSTEOPOROTIC

FRACTURES. MUSCULAR. FIBROMYOSITIS.

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FRACTURES

FRAGILITYFRACTURES.

MINOR TRAUMA.

COMMON SITES Spine. Proximal end of femur. Distal end of radius. Proximal end of humerus.

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PROGRESSIVE KYPHOSI

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Assessment of osteoporosis (aim)

Diagnosis.

Identification of disorders mimicking osteoporosis. Identification of risk factors.

Methodology for prognosis. Selection of treatment . Baseline for response evaluation.

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Evolution of Diagnostic Facilities for Osteoporosis

X-Ray

Densitometry

Laboratory; New Bone Markers

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Bone Biopsy

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X-Ray Diagnosed Patient

Risk Factors Person

Densitometry diagnosed patient

History of Low-Trauma

(Fragility) Fracture

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Conclusion

Everything about Osteoporosis on the RISE!!

Patient numbers increase as life expectancy rises

Increase risk factors- Early menopause

- Increase smoking

- Increase use of steroids

- Increase sedentary life

Increase in available options for treatment of Osteoporosis

Increase in Research for development of new treatments

Increase in awareness of Osteoporosis

Increase in ways of surgical management (internal fixation,replace tools, bone stimulation)

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Evolution of Medical Treatment Options for Osteoporosis

1986 Calcitonin, HRT

1997 Alendronate, Bisphosphonate daily launch

2001 Risedronate, Bisphosphonate daily launch

2002

Weekly Bisphosphonates launched

Raloxifene, SERM launch WHI study highlights risk of HRT

2003 Parathormone available

And many more to come..

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Evolution of Surgical Treatment Options for Osteoporosis

Leave patient with fracture neck of femur & advise patient to rest

Internal fixation or ways to replace

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High Costs :How Many of Our Patients Have These Facilities?

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Who is picking up the bill inEgypt?

?

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Inaugurated 1999 EOPS

Founders Prof. Samir El Badawi & Prof. Hazem Abdel Azeim

Board Members Prof. Ahmed Rashed, Prof. Omar Hussein, Prof. Ahmed

Mortegy, Prof. Amal El Badawi, Prof. Mohamed Hassan, Mr.

Hatem Sedky, Mrs Nafeesa AbedGeneral Assembly

300 Members

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the correct awareness among the medical & non-medical communitiesresearch work related to osteoporosispublications related to osteoporosisng scientific meetings both National & in conjunction with IOF, PAOS, & Mediterranean Osteoporosis Societywith Pharmaceutical companies & scientific offices interested in the field of Osteoporosis

AIMS

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National Osteoporosis Conferences 2003 PanArab Osteoporosis Society Meeting in

Egypt September 2005 Annual National Osteoporosis

Prevention Society Conference Social events to propagate patient awareness

Activities

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Level of awareness of Osteoporosis Egyptian curve for BMD Steroid Induced Osteoporosis

Discharge Program after fracture Osteoporosis in Males

Research

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New Research Directions

HOW to

PREVENT

DIAGNOSEEARLY

TREAT

PREVENT FRACTURES &SUBSEQUENT SEQUELAE PAIN

& DEFORMITIES

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HOWEVER we are still getting fractures

-Maybe in older age

-Maybe more than once (2ndry fractures)

So we must have

better ways of Management

1. Complete diagnosis (assessment)2. Treatment of fractures

3. Prevention of further fractures

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BoneStrength

BMD

Bone Turnover Bone QualityOsteoporosis is defined as a skeletal disorder characterized by

compromised

bone strength predisposing a person to an increased risk of fracture. NIH Consensus Development Panel, JAMA. 2001;285(6):785-795

Bone Strength Depends on Three Elements

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THANK YOU