Autres ressources de médicine

Centre hospitalier du Kirchberg - 9, rue Edward Steichen, L-2540 Luxembourg

Organon belge - Site d'information et d'actualités médicales pour le grand public. En français et néerlandais.

SLAM - Société Luxembourgeoise d'Andropause et de Menopause a.s.b.l.

BMS - Belgian Menopause Society 

Fondation Pescatore - Maison de retraite au centre ville

• Osteoporosis
• Definition of osteoporosis
• Osteoporosis diagnosis Dual Energy X-ray Absorptiometry or DEXA
  
  • Measures X-ray absorption
  • Bone mass per projected area (g/cm2)
  • BMD correlates with whole bone strength
• BMD T-score = number of SD vs. mean BMD of healthy young female population (at peak bone mass)
• DEXA as BMD-measurement method
• WHO criteria for osteoporosis in women
• Diagnosis of Osteoporosis
  
  • BMD T-score <= -2.5 <- DEXA
    and / or
  • presence (history) of osteoporotic fracture <- RX
• Post-menopausal Osteoporosis
• Pathophysiology of osteoporosis:bone remodelling
• Postmenopausal bone loss: role of estrogen deficiency
• Age-related bone lossoccurs in men and women
• Bone Remodelling throughout Life
  Bone turnover = a coupled process
  always : bone resorption → bone formation
  • Childhood & adolescence: resorption < formation
  • As from the age of 40: resorption > formation
    
    • always negative balance per bone remodelling cycle
    • slow bone loss
  • Postmenopausal period: accelerated bone loss
    • estrogens inhibit bone turnover
    • E-deficiency → higher bone turnover rate
• Bone Turnover
• Consequences of Postmenopausal Osteoporosis
• Incidence of osteoporotic fractures in women
• Lifetime fracture risk of people at 50 years of age
• All fractures are associated with morbidity
• Morbidity after vertebral fractures
  • Back pain
  • Loss of height
  • Deformity (kyphosis, protuberant abdomen)
  • Reduced pulmonary function
  • Diminished quality of life: loss of self-esteem, distorted body image, dependence on narcotic analgesics, sleep disorder, depression, loss of autonomy, social dependence
  • Increased mortality
• Mortality after major types of osteoporotic fracture in men and women
• Economic Impact
• Risk factors for Osteoporosis
  ‘Case-finding’
• Risk factors that provide indications for the diagnostic use of bone densitometry
  • Presence of strong risk factors
  • Previous fragility fracture
  • Radiographic evidence of osteopenia or vertebral deformity or both
  • Loss of height, thoracic kyphosis(after radiographic confirmation of vertebral deformities)
• Risk Factors that identify people who should be assessed* for Osteoporosis
• Who to test (BMD-measurement) for Postmenopausal Osteoporosis ?
  • post-menopausal, >= 65 y
  • post-menopausal, < 65 y
    • with additional risk factors, or
    • with fragility fracture, or
    • with loss of height or deformity of the spine (kyphosis)
  • pre- or post-menopausal
    • with disease or receiving a treatment, known that they can cause a ‘secondary’ form of osteoporosis
• Preventing osteoporosis TREATMENT of OSTEOPOROSISin order to prevent (new) fractures
• Drugs used in osteoporosis treatment

• Osteoporosis
• Definition of osteoporosis
• Osteoporosis diagnosis Dual Energy X-ray Absorptiometry or DEXA
  
  • Measures X-ray absorption
  • Bone mass per projected area (g/cm2)
  • BMD correlates with whole bone strength
• BMD T-score = number of SD vs. mean BMD of healthy young female population (at peak bone mass)
• DEXA as BMD-measurement method
• WHO criteria for osteoporosis in women
• Diagnosis of Osteoporosis
  
  • BMD T-score <= -2.5 <- DEXA
    and / or
  • presence (history) of osteoporotic fracture <- RX
• Post-menopausal Osteoporosis
• Pathophysiology of osteoporosis:bone remodelling
• Postmenopausal bone loss: role of estrogen deficiency
• Age-related bone lossoccurs in men and women
• Bone Remodelling throughout Life
  Bone turnover = a coupled process
  always : bone resorption → bone formation
  • Childhood & adolescence: resorption < formation
  • As from the age of 40: resorption > formation
    
    • always negative balance per bone remodelling cycle
    • slow bone loss
  • Postmenopausal period: accelerated bone loss
    • estrogens inhibit bone turnover
    • E-deficiency → higher bone turnover rate
• Bone Turnover
• Consequences of Postmenopausal Osteoporosis
• Incidence of osteoporotic fractures in women
• Lifetime fracture risk of people at 50 years of age
• All fractures are associated with morbidity
• Morbidity after vertebral fractures
  • Back pain
  • Loss of height
  • Deformity (kyphosis, protuberant abdomen)
  • Reduced pulmonary function
  • Diminished quality of life: loss of self-esteem, distorted body image, dependence on narcotic analgesics, sleep disorder, depression, loss of autonomy, social dependence
  • Increased mortality
• Mortality after major types of osteoporotic fracture in men and women
• Economic Impact
• Risk factors for Osteoporosis
  ‘Case-finding’
• Risk factors that provide indications for the diagnostic use of bone densitometry
  • Presence of strong risk factors
  • Previous fragility fracture
  • Radiographic evidence of osteopenia or vertebral deformity or both
  • Loss of height, thoracic kyphosis(after radiographic confirmation of vertebral deformities)
• Risk Factors that identify people who should be assessed* for Osteoporosis
• Who to test (BMD-measurement) for Postmenopausal Osteoporosis ?
  • post-menopausal, >= 65 y
  • post-menopausal, < 65 y
    • with additional risk factors, or
    • with fragility fracture, or
    • with loss of height or deformity of the spine (kyphosis)
  • pre- or post-menopausal
    • with disease or receiving a treatment, known that they can cause a ‘secondary’ form of osteoporosis
• Preventing osteoporosis TREATMENT of OSTEOPOROSISin order to prevent (new) fractures
• Drugs used in osteoporosis treatment