1. Dr santosh kumar Assistant professor Medical unit 2

2. The term “metabolic bone disease” denotes those Conditions producing diffusely decreased bone density And diminished bone strength.

5.  Asymptomatic to severe backache from vertebral fractures.  Spontaneous fractures often discovered incidentally on radiography; loss of height.  Serum PTH, calcium, phosphorus, and alkaline phos- phatase usually normal.  Serum 25-hydroxyvitamin D levels often low as a comorbid condition.  Demineralization, especially of spine, hip, pelvis, and wrist

6. It is defined as low bone mass and micro-architectural destructions of Bone tissue leading fragility and fracture of bone. Bone is normally mineralized but decrease in quantity,quality and Structural Integrity.

7.  Peak bone mass and bone loss are regulated by genetic(80%) and environmental factor (20%),genetic like (ESR1)oestrogen receptor gene,(LRP5)lipoprotein related receptor gene  In normal individual 20-40years bone formation is increased but fall after that.  After menopause is an accelerated phase of bone loss.

8.  Post menopausal osteoporosis  Osteoporosis in men  Steroid induced osteoporosis  Pregnancy associated osteoporosis  Other causes

9.  Hypogonadism  Hyperthyroidism  Hyperparathyroidism  Cushings syndrome  Etc

10.  Inflammatory bowel disease  Ankylosing spondylitis  RA  Etc

11.  Malabsorption syndrome  Chronic liver disease  Others causes

12.  Corticosteroids  Thyroxine over –replacement  Gonadotrophin-releasing hormone agonist  Sedative  Anticonvulsant drugs  Alcohal excess  Heparin  others

13.  Myeloma  Homocystinuria  Anorexia nervousa  High trained athletes  HIV infection  Immobilisation  Poor diet /low birth weight

14.  Asymtomatic until fracture occurs.  Osteoporotic spinal fracture present back pain  or gradual onset of height loss and kyphosis with chronic pain.  in hip fracture affected leg shortened and externally rotated.  Some time on bony pain in old age or menupause  Incidental osteopenia in xrays performed foe other reasons.

16. X rays of bone related limb Routine profile of blood Serum calcium level Alkaline phosphatase level Bone density like radiographs, DXA sccaning

22. Assess risk factors If present, proceed to DXA (may not be necessary In all patients with fragility fractures). Exclude secondary causes in patients with osteoporosis

24. Offer lifestyle advice (e.g. exercise, diet, smoking cessation) Offer treatment: First-line option alendronate or risedronate Also-raloxifene in woman with vertebral osteoporosis -Teriparatide in woman with very severe osteoporosis, or if intolerant to other therapies Give calcium and vitamin D supplements where appropriate

26. Assess need for treatment based on age and other independent risk factors Offer lifestyle advice Offer treatment as above, if appropriate

27. Offer lifestyle advice Fall risk assessment and advice where appropriate Give calcium and vitamin D supplements Hip protectors for individuals in nursing homes