LB 1 Osteoporosis Dan Osteoarthritis

Osteoporosis
dr. Arief Indra Perdana Prasetya, Sp OT
FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN AGUNG

SEMARANG
Learning Objectives
• Students understand the definition of osteoporosis,
classification, and its pathogenesis
• Student’s able to do history taking and recognize the risk
factors of osteoporosis
• Student’s able to ask and interpret proper supporting
investigation to rule out osteoporosis
• Student’s able to explain management of osteoporosis
OSTEOPOROSIS
• systemic skeletal disorder
characterized by low bone
mass, micro-architectural
deterioration of bone
tissue leading to bone
fragility, and consequent
increase in fracture risk.
OSTEOPOROSIS
• Osteoporosis is a metabolic bone disease that, on a
cellular level, results from osteoclastic bone
resorption not compensated by osteoblastic bone
formation. This causes bones to become weak and
fragile, thus increasing the risk of fractures
• TRIVIAL INJURY  Fracture
EPIDEMIOLOG
Y Approximately 10 million Americans
over the age of 50 have osteoporosis,
with a further 34 million at risk of the
disease. Osteoporotic fractures in the
USA are extremely common, with an
estimated 1.5 million suffering fragility
fractures each year
In Indonesia, 19.7% of elderly

population (3.6 million people)
suffered from osteoporosis.
SYMPTOMPS
• Pain especially back pain

• Height loss
• Crooked position
• Fragility fracture  TRIVIAL Injury
RISK FACTORS
RISK FACTORS
RISK FACTORS
1. Anthropometric Consideration : Female gender, Caucasian or Asian
race, thin and small body frames, and a family history of osteoporosis.
2. Dietary / Habit : Cigarette smoking, excessive alcohol and caffeine
consumption, lack of exercise, and a diet low in calcium.
3. Poor nutrition and poor general health.
4. Malabsorption (nutrients are not properly absorbed from the
gastrointestinal system) from conditions such as Celiac Sprue.
5. Low estrogen levels such as occur in menopause or with early surgical
removal of both ovaries. Another cause of low estrogen level is
chemotherapy, such as for breast cancer. Chemotherapy can cause
early menopause due to its toxic effects on the ovaries.
6. Amenorrhea (loss of the menstrual period) in young women also causes
low estrogen and osteoporosis. Amenorrhea can occur in women who
undergo extremely vigorous training and in women with very low body
fat (example: anorexia nervosa).
7. Chronic diseases such as rheumatoid arthritis and chronic hepatitis C,
an infection of the liver.
RISK FACTORS
8. Immobility, such as after a stroke, or from any condition that
interferes with walking.
9. Hyperthyroidism, a condition wherein too much thyroid hormone is
produced by the thyroid gland (as in Grave's disease) or is caused by
taking too much thyroid hormone medication.
10. Hyperparathyroidism. Normally, the parathyroid hormone maintains
blood calcium levels by removing calcium from the bone. In untreated
hyperparathyroidism, excessive parathyroid hormone causes too much
calcium to be removed from the bone, which can lead to osteoporosis.
11. Vitamin D deficiency. Vitamin D helps the body absorb calcium. When
vitamin D is lacking, the body cannot absorb adequate amounts of
calcium to prevent osteoporosis. Vitamin D deficiency can result from
lack of intestinal absorption of the vitamin such as occurs in celiac
sprue and primary biliary cirrhosis.
12. Certain medications can cause osteoporosis. These include heparin (a
blood thinner), anti-seizure medications phenytoin (Dilantin) and
phenobarbital, and long term use of corticosteroids (such as
Prednisone).
TYPE
• Type I / Primary : post menopausal

• Type II / Secondary : Senile osteoporosis, or
correlated with other pathology
OSTEOPOROTIC FRACTURE PREDILECTION
PLAIN X-RAY
Proximal Femur Trabeculae

SINGH’s INDEX
Bone MINERAl densitometry
• T- Score : Compared with young-adult (30 y.o), same
ethnic and gender
• Z- Score : Compared with same age, ethnic, and
gender
PREVENTIO
N
Treatment
Treatment
Treatment
Treatment
Algorhytm
Osteoarthritis
dr. Arief Indra Perdana Prasetya, Sp OT
FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN AGUNG

SEMARANG
Learning Objectives
• Students understand the definition of osteoarthritis,
classification, and its pathogenesis
• Student’s able to do history taking and recognize the risk
factors of osteoarthritis
• Student’s able to ask and interpret proper supporting
investigation to rule out osteoarthritis
• Student’s able to explain management of osteoarthritis
OSTEOARTHRITIS
A degenerative disease of joint
cartilage and underlying bone that
worsens over time (progressive),
often resulting in chronic pain.
Joint pain and stiffness can become

severe enough to make daily tasks
difficult. Depression and sleep
disturbances can result from the
pain and disability of osteoarthritis.
OSTEOARTHRITIS
OSTEOARTHRITIS
Primary Osteoarthritis  idiopathic
Secondary Osteoarthritis  underlying

disease :
 Trauma
 Infection
 Avascular Necrosis
 Congenital Anomaly
 Metabolic disorder
 etc
RISK FACTORS
OSTEOARTHRITIS
• OA joint exhibits different clinical and biochemical
phenotypes, including : breakdown of cartilage,
thickening of the subchondral bone, osteophyte and
corpus liberum formation.
• variable degrees of synovial inflammation, narrowed
joint space, thickened and fibrotic ligaments,
hypertrophy of the joint capsule and, in the knee,
damaged menisci.
• In particular, the number of chondrocytes within
cartilage decreases due to increased apoptosis.
• During OA progression, chondrocytes may undergo
dedifferentiation and convert to the hypertrophic and
senescent phenotypes.
• OA chondrocytes also synthesize and secrete SASP,
creating a detrimental environment within the joint.
• Intracellular changes in OA chondrocytes include
mitochondrial dysfunction, loss of structure and
function of endoplasmic reticulum and Golgi,
decreased protein synthesis capacity
ECM: Extracellular matrix;
SASP: Senescence-associated secretory phenotype.
OSTEOARTHRITIS
SYMPTOMPS
The main symptoms of osteoarthritis are pain
and stiffness in your joints, which can make it
difficult to move the affected joints and do
certain activities.
Other symptoms you or your doctor may
notice include:
• joint tenderness
• increased pain and stiffness when you have
not moved your joints for a while
• joints appearing slightly larger or more
"knobbly" than usual
• a grating or crackling sound or sensation in
your joints
• limited range of movement in your joints
• weakness and muscle wasting (loss of
muscle bulk)
OSTEOARTHRITIS PREDILECTION
Osteoarthritis – Plain X-Ray
Cardinal Sign :
• Narrowing joint space
• Osteophyte
• Loose bodies
• Irregular joint line
• Subchondral sclerosis
• Subchondral cyst
• Joint malalignment
Plain X Ray
Kellgren Lawrence
Classification
Ahlback Classification
Therapy
Therapy
Non Operative
- Non Therapeutic : education, life-style modification, physiotherapy, loss
body weight, daily activity modification, brace/external support
- Therapeutic : analgaetic, intrarticular injection (NSAIDs, Hyaluronic Acid)
Operative
- Arthroscopy
- Osteotomy : high tibial osteotomy (HTO), distal femoral osteotomy (DFO)
- Arthroplasty : unicompartement/resurfacing, total arthroplasty
- Arthrodesis
THANK YOU

LB 1 Osteoporosis Dan Osteoarthritis

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Osteoporosis

dr. Arief Indra Perdana Prasetya, Sp OT

FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN AGUNG

In Indonesia, 19.7% of elderly

• Pain especially back pain

• Type I / Primary : post menopausal

Proximal Femur Trabeculae

FAKULTAS KEDOKTERAN UNIVERSITAS ISLAM SULTAN AGUNG

Joint pain and stiffness can become

Secondary Osteoarthritis  underlying

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