1. 1 Tuesday 28 Oct 2008 Hall I Session I: 8:00- 10:00 Symposium... 1 Tuesday 28 Oct 2008 Hall I Session I: 8:00- 10:00 Symposium... www.iranoa.org/congress/16_complete.pdf File Format: PDF/Adobe Acrobat - Quick View A.Shahla, MD (Iran). 9:14-9:22. Treatment of femoral shaft fractures a comparative study between open intramedullary nail and plate & screw (paper)...Quick View

2. Evaluation of osteoporosis in patients with a hip fracture A,SHAHLA.MD Urmia university of medical sciences

3. “…a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to enhanced bone fragility and a consequent increase in fracture risk.” Definition of osteoporosis World Health Organization (WHO), 1994

4. normal osteoporotic Trabecular bone Bone quality is not the only factor …

7. Osteoporosis major public healt treat 55% people 50yr and older

8. Bone loss starts slow decline 3 rd decade 0.5-1% pr/yr 6 rd decade 2-3% pr/yr

11. The life risk of sustaining an osteoporotic fracture has been estimated at50%,compared with9% for breast cancer and 31% for coronary artery disease Arch intern med1989;149:2445-8.

12. Osteoporosis evaluation Bone mineral density (BMD)

15. World Health Organization (WHO) guidelines for osteoporosis OsteoporosisOsteopenia Normal Peak Bone Mass -2.5-210 T-Score

16. Definitions: BMD Results Status T-score T-score= # of SDs below or above mean value of BMD for young (20-29yo) adults Normal +2.5 to −1.0, inclusive Osteopenia Between −1.0 and −2.5 Osteoporosis −2.5 Severe osteoporosis −2.5 + fragility fracture Z-score= # of SDs below the mean value for people of the same age Kanis JA. J Bone Miner Res 1994;9:1137-1141.

17. Osteoporotic fractures 1.5 million in USA 250.000 fx/yr 300.000 hip 250.000 wrist 700.000 spine 300.000 other sites National osteoporosis foundaton.2005

19. Hip fracture is serious consequence of hip fracture even small increase in lifespan will lead to large increase in the rate of hip fractures

21. Hip fractures worldwidewas1.7million in1990 and projected to 6.3 million in2050 Curr osteoporos.2003;1:66-70

23. Consequences of hip fracture 20%mortality within 6months 50%loss ability to walk 20%sever impaired mobility after 12 months requiring nursing care Increased risk of furher fracture5.2%first yr- 10.3% 3 yr

24. Optimal fracture treatment – a prerequisite for maintaining quality of life

25. Care gap Few patients are offered investigation or treatment for osteoporosis

26. Interventions to improve osteoporosis treatment following hip fracture Gardner MJ. JBJS(American).2005;87:3-7

27. Barriers and solution to osteoporosis care in patients with a hip fracture Kaufman JD. JBJS(American).2003;85:1837-43

28. Orthopedic surgeon should identify and initiate the assessment of osteoporosis in patients with fragility fractures Intrnational osteoporosis foundation(IOF) osteoporosis int.2005;16 suppl:44-53

29. BMD,T score is suggested for evaluation of osteoporotic fractures USA National osteoporosis risk assessment(NORA) Osteoporos int.2006;17:565-74

30. Evaluation of osteoporosis in patients with a hip fracture in Urmia Shahid motahhari hospital September2004-january2006

31. Contra lateral hip BMD were detected

32. Excluding criteria Previous hip fracture Precedent osteoporosis treatment Acute medical complications requiring intense care Long term steroid therapy Paralytic patients bedridden

33. 76 hip fracture patients 50yr and older Low energy trauma(fall)

34. Men 44(57.9%) Women 32(42.1%0) Age 50-90 mean 66yr Trochantric 55(77.4%) Femoral neck 21(27.6%).

35. Fixation 58(76.3%) Hemiathroplasty 12(15.8%) Traction 3(3.95) Conservative 3(3.9%).

36. 55(72%) osteoprosis 17(23%) osteopenia 4(5%) normal.

37. There were not significance men and women Neck and trochantric fractures age

38. Urmia 76 patients Female 42% Male 58% Mean age 66yr Femural neck 27.6% Intertrochantric 77.4% Subtrochantric – Osteporosis 72% Florida Kamel H. Clin Rheumatol 2005;11:68-71. 95 patients Female 71% Male29% Mean age 81yr Femural neck 51% Intertrochantric 46% Subtrochantric 3% Osteoporosis 17%

39. Definition vs Treatment Defination T score > _1.0 normal T score = _1 to_2.5 osteopenia T score <_2.5 osteoporosis Treat for osteoporosis WHO T score<_2.0 NOF T score<_1.5 with additional risk factors

40. Alendronate 10mg /day_70mg /week Vit D 800-1000 iu/day Calcium 500-1000 mg/day

41. bisphosphonates Mechanism: blind to hydroxappetite at site of active bone resorption inhibiting osteoclast function Alendronate 10mg /day_70mg /week

42. Advantages of bisphosphonates Increased BMD 1-4% Decrease fracture risk 41-44% No increased risk of breast,uterine thromboembolic events Weekly dosing