1. Hanna Przepiera-Będzak Klinika Reumatologii PAM, Szczecin

2. OSTEOPOROSIS metabolic bone diseases - characterized by decreased density (mass/unit volume) of normally mineralized bone. The bone becomes abnormally porous and thin. The reduced mass weakens the mechanical strength of the bone, thus making it much more likely to break, often with little or no trauma.  1.5 million fractures a year caused by postmenopausal osteoporosis  affect more than 25 million American women  the healthcare costs of osteoporosis, $18 billion annually

3. OSTEOPOROSIS Living bone is never metabolically at rest. Its matrix and mineral stores are constantly being remodelled along lines of mechanical stress. Under normal remodelling conditions, bone formation and resorption in the adult skeleton are exquisitely coupled so that net bone formation equals net bone resorption.

4. OSTEOPOROSIS Age-related bone loss begins in both men and women at about age 40. Women lose about 35% to 40% of their cortical bone and 55% to 60% of their trabecular bone, whereas men lose about two-thirds of these amounts throughout life. Bone loss occurs in both cortical and trabecular bone in a biphasic pattern. A slow phase of cortical thinning (0.3%-0.5%/yr) begins at about age 40, increasing with aging until it slows or ceases late in life. In addition to age-related bone loss, women also lose cortical bone at a rate of 2% to 3% per year after menopause. This accelerated rate of cortical bone loss reverts to baseline levels 8 to 10 years after menopause. By age 75, skeletal mass may be reduced to half of what it was at age 30.

7. RISK FACTORS ASSOCIATED WITH BONE LOSS AND OSTEOPOROSIS

8. SECONDARY OSTEOPOROSIS (MAIN CAUSES)

9. CAUSES OF GENERALISED OSTEOPOROSIS IN PATIENTS WITH RHEUMATOID ARTHRITIS disease duration activity of the disease menopause physical activity treatment: corticosteroids cyklosporine methotrexate cytokines: PGE 2, IL-1, TNF- ,  -INF

10. OSTEOPOROSIS AND OTHER RHEUMATIC DISEASES ANKYLOSING SPONDYLITIS primary sign of the disease immobility of spine SYSTEMIC LUPUS ERYTHEMATOSUS activity of the disease treatment SCLERODERMA activity of the disease osteopenia at forearm

11. CORTICOSTEROID - INDUCED OSTEOPOROSIS 1) Calcium homeostasis decreased intestinal absorbtiom increased renal sercretion secondary hyperparathyroidism 2) sex hormon secretion decreased indirect decreased gonad syntesis

12. CORTICOSTEROID - INDUCED OSTEOPOROSIS 3) decreased bone formation decreased osteoblasts proliferation decreased collagen I syntesis 4) other mecanisms corticosteroid induced myopaty muscule weckness

22. OSTEOPOROSIS – PREVENTION AND TREATMENT

23. MANAGEMENT OF RHEUMATOID ARTHRITIS OSTEOPOROSIS pain relief increased physical activity low doses of corticosteroids – prednisone < 5 mg/dz Calcium and vit.D suplementation assessement of BMD assessement of bone remodeling Bisphosphonates, Calcitonin,