Dr. Prakash SigedarConsulting Orthopedic Surgeon

Jalna.

visit us at -www.sigedarhospital.com

About Myself.•Ex- member of I.O.A Presidential Theme Committee.•E.C. Member – Maharashtra orthopaedic Association.•I.P.P- Jalna Orthopaedic Association.

•Past President - I.M.A. Jalna.•Fellow – Poona Orthopaedic Society.

•Recipient of Dr. Suresh Nadkarni Award of I.M.A.•Charter member & Editor of Bulletin Rotary Club.

•Tel. : 91-02482-237210.•Cell. : 9423457010, 9422226012.

•Email. : psigedar@rediffmail.com.•Fax. : 02482-235773.

Dr. Prakash. Sigedar.

What is Fragility Fragility of bones is a disease characterized by low

bone mass and structural deterioration of bone tissue , which leads to bone fragility and an increased susceptibility to fractures.

Common types-primary &secondary Senile & Post menopausal

Normal Bone Fragile Bone

PROBLEM OVERVIEW Fragility is a major public health concern, and the

single most common bone disease. World Health Organization (WHO), postulates fragility as a global health problem second to cardiovascular heart disease. Worldwide, lifetime risk for fragility fractures in women is 30-50% while in men it is 15-30%. Fractures due to fragility are more common than heart attacks, strokes, and breast cancer combined. Therefore it is important for orthopedicians to be at frontline in the screening, diagnosis and management of fragility.

Seen in both poor and rich people In poor reason is nutritional deficiency and in rich

lack of proper diet information

Fragility and fragility fractures are significant public health issue that grows in importance as the population ages.

More than 200 million people worldwide have fragility of bones

Bone strength reflects the integration of bone density and bone quality

It is called as silent killer disease as no symptoms are seen and fracture is the first seen most of the times .

Every post menopausal women is osteoporotic unless proved otherwise

Alarming

Projections

about

osteoporosis

Fragility fractures Fractures contribute to pain, deformity, loss of height,

and disability Who defines fragility (osteoporosis) as a BMD (bone

mineral density) at the hip or spine less than or equal to 2.5 standard deviations below the young normal mean reference population.

It is very alarming problem in rural India and needs to be addressed properly

Concept of strong bone Trabecular pattern of bone decides how strong bone

is? It can be compared with building having strong

structural design. Strong bones, strong nation

Factors Responsible for Osteoporosis. Obesity Lack of exercise Nutritional deficiency Hormonal imbalance Addictions – Smoking,

Alcohol Over diet consciousness Drugs White/Thin women Aging Nulliparity (never having

had children)

Genetic Preponderance Diseases like cushing

syndrome, multiple myeloma

Early menopause in women

Small body build Hereditary factors Surgeries (Hysterectomy)

1. Prolonged glucocorticoid therapy2. Conditions associated with excess glucocorticoid

secretion3. Amenorrhoea lasting more than 6 months before the

age of 45 years.4. Primary hyperparathyroidism5. Chronic liver disease6. Chronic renal disease7. Malabsorption (eg. Coeliac disease)8. Rheumatoid arthritis and other inflammatory

arthropathies (eg. Ankylosing spondylitis)9. Conditions associated with thyroxine excess

Medical conditions associated with increased risk of osteoporosis

Common sites of fragility fractures Wrist, hip and spine are the commonest sites of

fragility fractures However It may occur to any bone . Fragility of bones is the main hurdle in treatment of

patients with fractures in old age

Risk factors in rural India Poverty Illiteracy Misbelieves Addictions (in male, predominantly alcohol and

smoking) Population explosion Lack of facilities to check BMD(DEXA which is gold

standard is only available in metros

Hurdles in rural India Socio- economical problems Lack of awareness about fragility fractures poor hygiene Influence of quacks and bone setters Poor implant holding(purchase) Other co morbid conditions like diabetes,

hypertension, COPD etc Anesthesia fitness problems Other age related problems like senile dementia etc Financial dependence on children

Clinical presentation Fragility is mostly a silent killer disease Fracture at hip, wrist or spine (wedge compression) Recurrent fractures Chronic back pain (MPK) Cervical lordosis and dorsal kyphosis i. e. “dowager,s

hump” in older women Fractures due to trivial trauma, fall Loss of more than 2 inches in height Low BMD done either routinely or for screening purposes Fractures of ICNF, TROCHANTRIC,OR CEVICAL

INJURIES AFTER TRIVIAL TRAUMA Compression fractures of vertebrae with trivial trauma

Diagnosis of fragility* Personal and family health history * Detailed evaluation of risk factors for osteoporosis. * Physical / Clinical examination * Age of the patient* DEXA scan or quantitative CT scan*Blood investigationshormonal assays and bone markersDEXA SCAN is gold standardNOW AVAILABLE IN JALNA

Management of fragility fractures Diet Exercise Drugs Patient education Counseling Positive thinking Surgical treatment Rehabilitation Psychological Evaluation Prevention of early PMO Hormonal Replacement Therapy

Managing fragility&reducing fracture risk Bone mass attained in early life is perhaps the most

important determinant for future development of fragility and fractures

Along with genetic factors environmental and modifiable lifestyle factors have significant role

Prevention is much better than cure Primary as secondary prevention is of at most

importance

Diet and fragility Calcium and vitamin D SATVIK,

SANTULIT(balanced), and SAKAS AAHAR(DIET)

Milk and milk products Soya proteins and soya

isoflavens Sea food Diet rich in calcium Sun bath Zinc and other vitamins

Fragility and exercise Exercise is of at most importance in

preventing fragility and fractures due to it Weight bearing exercises which increase

bone density Regular weight bearing and muscle

strengthening exercise reduce the risk of falls and risk of fractures

Weight bearing exercises includes walking, jogging and similar activities

Muscle- strengthening exercises include weight training and other resistive exercises

Exercises should be part of our routine since adolescent age group to restore bone mass

Medications in Fragility Role of Soya isoflavens (Soya milk, soya

powder) Role of nandrolene decanoate Role of calcitonin nosal spray Role of cholecalciferol sachets Role of Zolandronic acid injection Role of subcutaneus / intradermal

injections Teriparatide, r DNA origin. (Forteo)

Bone and Joint Decade(2000-2010) WHO’s special drive for osteoporosis awareness and

musculoskeletal disorders. Many activities like lectures, camps, propaganda by

electronic and print media for awareness of osteoporosis.20th oct. is world osteoporosis day

Many countries of world are involved in this programme.

Has got extension 2010 to 2020. 20th oct. is observed as “world osteoporosis day every

year

Concept of menopause clinic This is very important step to tackle PMO. This clinic includes gynecologist, orthopedic

surgeon, dietician, physiotherapist and psychologist.

This is the need of time to take care of PMO.

Our Contribution Conducted almost more than 60 camps for free BMD

check up in last 15 years More than 10000 patients screened for fragility Ultrasound based calcaneal method was used most of

the times More stress on health education and public awareness

along with treatment Display of DVDS on fragility awareness in out door

waiting hall for patient education

Our Contribution Councelling, reassurance, Publication of pamplets, articles in newspapers, books

in local language regarding fragility prevention and treatment

Comprehensive approach of treatment like diet, exercise, drugs

Team effort is important(dietician, physiotherapist, psychologist, counselor, social worker, orthopedic surgeon etc

Our Contribution Health education should start from school level

because early age bone mass is important determinant

Lectures at school, college level on health education and awareness of fragility of bones is important

De addiction movement- at least ask your every patient about any addiction in history taking and ask them to quit it

Recommendations Every district hospital should have facility of DEXA scan Team of experts in treating fragility fractures and all

concerned facilities should be available at district govt. hospital

Fragility and fragility fractures should be taken by govt. on Priority as national problem

Sufficient funds should be given to manage this problem Awareness programs should be started by govt. in this

regard Involvement of NGO’S should be encouraged

Take home mesage Fragility fractures is an important issue It should be addressed in proper way to get expected

results Comprehensive treatment approach is must Health education and public awareness is must Prevention is much better than cure Better patient care through education and research

We are sure the change is possible with comprehensive approach

THANK YOU !

Thank You foryour kindAttention.