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OSTEOPOROSIS
Medical Management
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PRIMARY MEDICAL
MANAGEMENT
Drug Therapy
Surgical Management, Casts,
Moulds(Possibly due toFractures)
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SECONDARY MEDICALMANAGEMENT
The principles of management are :
1. Prevention and control of risk factors. 2. Management of menopause.
3. Musculoskeletal rehabilitation
(Weight Bearing exercises)
4. Lifestyle Modificationhttp://medind.nic.in/jac/t02/i2/jact02i2p128.pdf
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Drug therapy
The drugs used in the treatment can be
classified into two main groups:
Antiresorptive drugs
Formation stimulating drug
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ANTIRESORPTIVE DRUGS These agents act by decreasing bone resorption
Calcium and vitamin D
They act by increasing mineralization of bone, and they are effectiveeven if started very late.
Calcium and vitamin D are more effective if taken in combination.
Calcium alone is effective, but vitamin D is not.
If vitamin D deficiency is due to lack of exposure to sunlight thendietary vitamin D supplementation with ergocalciferol or
cholecalciferol will suffice. But if defect is in the renal synthesis of I-25
dihydroxy vitamin D (calcitrol) then exogenous
calcitrol may be required.
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Calcitonin Osteoclasts have calcitonin receptors.
Calcitonin rapidly inhibits the action of osteoclasts resulting in
decreased bone resorption. It is also effective in steroid induced osteoporosis in men.
Calcitonin is commonly used in post-traumatic situationsbecause of its inherent centrally acting analgesic effect, whichis comparable to NSAIDs
and other strong analgesics. It is less effective in preventing cortical bone
loss than cancellous bone loss
Side effsct are few, such as, flushing of face and nausea
ANTIRESORPTIVE DRUGS
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Bisphosphonate increases cell death and decreases bone resorption
leading to increased BMD and reduced fracture rate. They cause esophagitis and gastrointestinal irritationwhich can be avoided by taking it with large amountof water and remaining upright for at least 30 minutesand usually taken half
an hour before mealtime. The optimal period of therapy is not
known but should be given on long term basis.
ANTIRESORPTIVE DRUGS
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Sodium fluoride
. It acts by stimulating osteoblast proliferation
and function. Gastric irritation and painful extremities are
common side effects.
FDA does not as yet approve them for treatingosteoporosis.
Formation Stimulating Drugs
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Parathyroid hormone (PTH)
It prevents bone loss associated with estrogen
deficient state. PTH has been shown to increase bone formation by
decreasing the apotosis of osteoblast
New onset or worsening of backache was also
reduced. Loss of height was also less with PTH therapy
Formation Stimulating Drugs
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Anabolic steroids
: The androgenic properties of these agents are
responsible for effect on bone formation
Formation Stimulating Drugs
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Management protocolsPain relief and general measures after fracture : The general measures include adequate bed rest, local heat, analgesics,
calcitonin, avoiding constipation, and lumbar support corset.
Once pain subsides, initiate the patient into an exercise programme to
correct postural deformity and increase muscle tone and BMD.
Life-style modification :
It includes identification and elimination/correction of modifiable riskfactors.
Avoid lifting heavy weights and forward bending.
All patients should be given calcium and vitamin D
supplementation and encouraged to join regular exercise
or rehabilitation programme
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KEY POINTS
Type I or post-menopausal Antiresorptive
Drugs
Alternative: Calcitonin, SERMs, andbisphosphonate
Type II or age related calcium and vitamin D
and analogues
Note: Calcitonin can be given for analgesic
effect
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Idiopathic osteoporosis in premenopausal
women Calcium and Vitamin D
Young or middle-aged men
If testosterone is low, give testosterone
enanthate IM at 4 week intervals. Calcium, vitamin D supplementation, and risk
factors modification
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Glucocorticoid-induced osteoporosis Maintain calcium and vitamin D intake, askpatient to do regular exercise, and target risk
modification.
Musculoskeletal and psychological
Rehabilitation : refer to a trained physicaltherapist, psychologist, and
nutritionist for consultation
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End of Slideshow
Primary reference: Osteoporosis Medical
Management by Umesh Kansra