Metabolic bone disease

Osteoporosis

-                    Bone Modeling and Remodeling

• Remodeling : osteoclast, osteoblast
• remodeling cycle: cement line
• Control of remodeling cycle
  • RANKL/RANK
  • cytokine eg. osteoprotegerin (OPG)

-                    Bone VS age

• Infant
  • endochondral ossification at epiphyseal growth plate
• Child to adult 30 years old
  • harversian canal ,intertrabecular space
  • peak bone mass
• Adult more than 30 years old
  • Decrease bone mass
• Post menoposal
  • Loss trabecular bone mass

-                    Bone density evaluation

• X-ray
  • Rickets,
  • Osteomalacia
  • metastatic bone
• quantitative CT scan
• bone mass density test
  • dual-energy x-ray absorptiometry (DXA)

-                    biochemical test

• serum calcium, phosphorus, alkaline phosphatase
• Osteocalcin (Gla protein)
• B-cross lap
• P1NP (Procollagen type I)

-                    Type

• Primary Osteoporosis
  • Type I: Post menopausal osteoporosis
  • Type II: Senile (Involutional) osteoporosis

• Secondary Osteoporosis
  • steroid induce
  • immobilization
  • chronic disease

-                    Post-menopausal osteoporosis

• Risk Factor
  • White, asian
  • Family history
  • Miss mense
  • Excessive exercise
  • Anorexia
  • Low BMI
  • Oopholectomy
  • Smoking
  • Drinking
• Symptom
  • Back pain
  • Kyphosis
  • Decrease height
  • Low energy fracture
• Diagnosis
  • BMD
  • Bio-marker
• Treatment
  • Life style modification
  • Ca, vitamin D
  • Hormonal replacement therapy (HRT)
  • Bisphosphonate
  • Parathyoid hormore