Klasifikasi Osteoporosis

OSTEOPORO
SIS

PRIMER SEKUNDER

- PENYAKIT
AGE- SPESIFIK /
IDIOPATHIC OBAT-
RELATED OBATAN.

- PADA USIA - -PADA

LANJUT REMAJA
- PALING - JARANG
SERING DITEMUKAN
 OSTEOPROSIS
fragilit
Progressive
y
Unnoticed fractur
No symptoms or discomfort e
Fracture
Chronic pain during
Disability activity that
Reduced qol would not
normally
injure
young
healthy bone
(i.e., fall
from
standing
height or
 Insidensi

1 diantara 2 1 diantara 4
 Faktor demografis
Laki-laki vs wanita
Wanita
Premenopause vs post menopause
Laki-laki
> 65 tahun vs < 65 tahun
Etnik
Kaukasian atau asia vs kulit hitam
Hip fracture

Require:
1. Hospitalizati
on
2. Major
surgery

Impair ability
to walk
Prolonged or
permanent
disability
Death
Hip fracture
 Vertebral fracture
Back pain
Loss of height
Deformity
Reduced pulmonary function
Diminished qol:
Loss of self esteem
Sleep disorder dependence of sleeping tablet
Depression
Loss of independence
Risk Factor
osteoporosis Fragile fracture
Prior fragility fracture
Increased age
Ageing Low bone mineral
Heredity density
Nutrition and life style Low body weight
Medications and other Family history of
illness osteoporotic fracture
Glucocorticoid use
Smoking
Diagnosed
 X-ray
Thorax atau lumbal 2 posisi
diindikasikan pada pasien:
Nyeri punggung/ back pain
Kifosis progresif
Tinggi << sebanyak > 4 cm
-2.5 < BMD < -1.0
Kriteria WHO
BONE STRENGTH
FRACTURE RISK
 Oosteoporosis sekunder
Severe chronic liver or kidney disease
Steroid (> 7,5 mg selama > 6 bulan)
Malabsorbsi (chrons)
RA
Systemic inflammatory disorder
Hyperthyroidism
Primary hyperparathyroidism
Antiepileptic med
 PREVENTIF FRAKTUR
Evaluasi penyakit yang mendasari
BMD/ bone mineral density
Menyingkirkan penyebab osteoporosis
sekunder
Terapi osteoporosis sesuai indikasi
Pencegahan jatuh
Menginformasikan kepada pasien dan
dokter mengenai kemungkinan terjadinya
fraktur patologis dan osteoporosis
Followup
 Intervensi
Non-medikamentosa
Nutrisi, olahraga, stategi pencegahan
jatuh
Modifikasi faktor resiko
(merokok,alkohol)
Mengobati kondisi komorbid (kelainan
endokrin)
Medikamentosa
 Rekomendasi umum
Aktivitas fisik reguler:
Menjaga keamanan status ambulatori, dan ADL yang
mandiri
Aktivitas fisik reguler dan aktivitas outdoor harian
(setidaknya 30 menit)
Kecukupan intake kalsium dan vitamin d
1000-1500 mg calcium (harian), 400-800 IU vitamin D
(harian)
Melalui makanan atau kombinasi makanan dan
suplement
Nutrisi yang adequat
Hindari merokok dan konsumsi alkohol
 Medikamentosa
Terapi yang efektif dapat menurunkan
fraktur vertebrae dan panggul dan
fraktur lainnya dari 30% hingga 65%
bahkan pada pasien yang telah
mengalami fraktur sebelumnya
 Agen farmakologi
Inhibitor of bone turnover:
Bifosfonat, calcitonin, estrogen dan
SERMs
Stimulators of bone formation
Fluoride salts, androgens, growth
hormone, parathyroid hormone,
strontium renelate
Pharmacological agents shown to reduce fracture risk
 Current FDA-Approved
Bisphosphonate
Salmon calcitonin
Estrogen therapy
Raloxifene
Conjugated Estrogen
Recombinant Human PTH
Denosumab
 Denosumab: introduction
Human monoclonal IgG2 antibody
High afinity and specificity for human RANKL
(Receptor Activator of Nuclear Kappa-B Ligand)
RANKL regulator of osteoclastic bone
resorption.
Denosumab binds to RANKL preventing
RANKL to RANK on osteoclasts and their
precursors inhibition of osteoclast formation,
function, and survival decreasing bone
resoprtion
Denosumab: Safety, tolerability,
and clinical monitoring

Recommendation of calcium 1000 mg

daily and 400 IU of vitamin D daily to
avoid hypocalcemia.
Monitoring Calcium, Magnesium,
Phosphorous in CKD.
Contraidicated in those with
concurrent hypocalcemia, during
pregnancy (cat. X), and allergy
denosumab.
 Denosumab: conclusion
Denosumab is the first and so far the only
RANKL inhibitor approved for treatment of
osteoporosis.
Extremely effective at decreasing bone
turnover, has reversible effects on
discontinuation.
Since approval (8 years): sustained efficacy in
increasing BMD and decreasing fracture risk.
Post-marketing data: showing good tolerability
and safety compared to placebo and
bisphosphonates.
 Acknowledgement
Maalouf, G., Dreuinhofer, K.,Fragility
fractures, clinical pathway. Slide
Osteoporosis and fractures: an
orthopaedic perspective.
Orthopaedic surgeons initiative. Slide
Terimakasih