1. Post Menopausal Osteoporosis
Prof G S Patnaik
Prof and Head,
Dept Of Orthopedics
NMCH Bihar

2. Osteoporosis: The Silent Killer
A well planned program of treatment for osteoporosis depends on correction of all underlying nutritional and physiologic abnormalities there needs to have a strategic balance between bone resorption and bone formation

3. Postmenopausal Osteoporosis
Systemic skeletal disease characterized by:
low bone mass
Micro architectural deterioration of bone tissue
increased bone fragility and susceptibility to fracture

4. Pathophysiology of PMO: Overview
Bone remodeling occurs throughout an individual’s lifetime
In normal adults, the activity of osteoclasts (bone resorption) is balanced by that of osteoblasts (bone formation)
With the onset of menopause (mid-forties or fifties), diminishing estrogen levels lead to excessive bone resorption that is not fully compensated by an increase in bone formation

5. Osteoporotic Fractures
Aging
Menopause
Increased bone loss
Propensity
to fall
High bone turnover
FRACTURES
Low peak
bone mass

6. Biochemical Assessment: Excluding Secondary Causes of Osteoporosis
First Level (Routine Tests)
Complete blood cell count
Serum chemistries:
calcium
phosphorus
creatinine
alkaline phosphatase
albumin
liver enzymes
thyroid-stimulating hormone (TSH)

7. WHO Criteria for Diagnosis of Bone Status
Diagnostic criteria* Classification
T is above or equal to Normal
T is between -1 and Osteopenia (low bon mass)
T is -2.5 or lower Osteoporosis
T is -2.5 or lower + fragility fracture(s) Severe or established osteoporosis
*Measured in "T scores." T score indicates the number of standard deviations below or above the average peak bone mass in young adults.

8. Diagnosis of PMO: Bone Density Assessment
Technique
Sites measured
Advantages
Disadvantages
Dual-energy X-ray
absorptiometry
(DXA)
Lumbar spine
Proximal femur
Total body
Forearm
Calcaneus
Phalanges
Diagnostic test of choice
High accuracy,
precision, resolution
Measures all areas
Short scan time,
low radiation dose
AP spine measurement influenced by
degenerative sclerosis,
other artifacts
Combined trabecular
and cortical measure-
ment
2-dimensional

9. Biochemical Assessment: Excluding Secondary Causes of Osteoporosis (cont’d)
Second Level (Nonroutine Tests)
Urinary calcium excretion
Markers of bone remodeling
Urinary free cortisol
Erythrocyte sedimentation rate (ESR)
Parathyroid hormone (PTH)
25-hydroxyvitamin D
Protein electrophoresis
Bone biopsy

10. Diagnosis of PMO: Clinical Evaluation
Medical history
Risk factor assessment
Signs and symptoms
Bone mineral density (BMD) testing
Physical examination
Laboratory tests, as appropriate
Height assessment

11. Management of PMO: Goals of Therapy
Prevent first fragility fracture or future fractures if one has already occurred
Stabilize/increase bone mass
Relieve symptoms of fractures and/or skeletal deformities
Improve mobility and functional status
Initiate lifestyle changes to enhance prevention of fractures

12. Management of PMO: Goals of Therapy
Prevent first fragility fracture or future fractures if one has already occurred
Stabilize/increase bone mass
Relieve symptoms of fractures and/or skeletal deformities
Improve mobility and functional status
Initiate lifestyle changes to enhance prevention of fractures

13. Thank you