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Osteoporosis Jiří Slíva, M.D.
Osteoporosis §a bone disease that is characterized by progressive loss of bone density and thinning of bone tissue §higher risk of fractures
§25 yr – balance between bone resorption & formation - PBM (peak bone mass) §duration approx. 5 yr §exaggerated resorption (0,5% /year) §climacterium Sceletal status by age
Risk factors for osteoporosis I §genetic factors §elderly §females §early climacterium (before 45. yr)
§time after climacterium §late menarche §race differences – Caucasians, etc. §drugs – antiepileptics, etc. §diseases – malabsorption, Cushing sy Risk factors for osteoporosis II
Concomitant factors §unhealthy lifestyle §low of calcium intake §lack of vitamin D §excessive alcohol intake §stress, smoking
Primary prevention §Increase of body performance – stimulation of osteoblasts §Sufficient intake of calcium – at least 1 g/d, people in higher risk up to 2 g/d §vitamin D - food, sun
Regulatory mechanisms of bone metabolism §parathormone §calcitonine §sexual hormones - estrogens & gestagens
Epidemiology §7-8% population in CZ §1/3 women after climacterium
Diagnosis §Anamnesis, clinical examination §Densitometry §Markers of resorption – pyridinoline in urine
§nonspecific…according to risk factors §specific Treatment
Calcium §stimulation of calcitonine x inhibition of parathormone §1 000 mg/d
Vitamin D §at least 400 IU, in elderly up to 800 IU §formulations containing ergocalciferole, cholecalciferole §risk of overdosage
Antiresorptive treatment - HRT §Estrogens support bone synthesis & inhibit resorption §Proliferaratory effects are inhibited by gestagens §Referral from EMEA
SERM §selective modulators of estrogen receptors §non-steroidal structure §protection of endometrium §raloxifen, tamoxifen, droloxifen
Calcitonine §inhibition of osteoclasts, increase of tubular reabsorption of calcium, analgesic eff., stimulatuon of bone formation §calcitoninum salmonis or humanum (200 IU)
Bisphosphonates §Influence on calcium metabolism §Inhibition of resorption (via cytotoxicity on osteoclasts?) §Accumulation in bones §Elimination via kidneys
§1st generation - etidronate, clodronate §2nd generation - pamidronate, alendronate §3rd generation - risedronate, ibandronate §CI – disease of oesophagus, stomach or kidneys, pregnancy, lactation Bisphosphonates
Thiazide diuretics §diminished renal excretion of calcium; ??? increase of BMD ??? §good for patients with hypertension
Drugs stimulating bone formation §fluoride -? MÚ, 14ti měsíční cykly (12+2) §vitamin K §magnesium §STH – increased activity of osteoblasts §Parathormone ??? §promethazine
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