OSTEOPOROSIS
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OSTEOPOROSISA. PENGENALAN* Satu keadaan & bukan penyakit• Kejadian @ wanita umur• Jumlah jisim tulang/kalsium
badan wanita dpd lelaki• Sepanjang hayat wanita hilang
40% kalsium @ rangka tulang• Boleh dikawal TETAPI tiada
rawatan
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B. DEFINISI• Kegangguan metabolik tulang –
konten kalsium tulang > rapuh & mudah patah
( Abram W.R. et al 1995)
C. INSIDEN* Wanita > lelaki (>65 tahun)* Wanita @ Postmenopausal
( Kessenich, 1997)
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D. KLASIFIKASI (2)1. PRIMER• Berkaitan dgn hormon Estrogen• 2 jenis
1.1. Jenis 1• Postmenopausal Osteoporosis• Wanita 6X lebih dpd lelaki• Berlaku # vertebral (crush) &
Colles
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1.2. Jenis 2* Senile Osteoporosis* Kehilangan tulang secara beransur-ansur* Wanita 2x lebih dpd lelaki* Fraktur femoral & vertebra
2. SEKUNDER* < 5% kejadian kes postmenopausal osteoporosis
* Peratusan tinggi @ wanita & lelaki muda
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* Berkaitan dgn faktor:i. Kekurangan Vitamin Dii. Calcitoniniii. Parathyroid hormoniv. Thyroxinev. Cortisolvi. Alkoholismevi. Immobilisasivii. COADviii. Chronic renal failureix. DMx. Hepatic disease
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xi. Malabsorption syndromxii. Osteomalaciaxiii. Rheumatoid arthritisxiv. Scurvyxv. Systemic mastocytosisxvi. Hiperparathyroidismxvii. Neoplasma – multiple
myeloma/carcinomaxviii. Terafi dgn Corticosteroidxix. Kekurangan Estrogen
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xx. Hypercortisonismxxi. Hypogonadismxxii. Hyperprolactinemia
( Abram W.R. et al, 1995)
E. FAKTOR PENGDISPOS• Kekurangan / kehilangan Ca,
Potasium, protin & Vit D• Immobilisasi & kekurangan latihan
(latihan melambat kehilangan tulang & bantu membuat densiti tulang)
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• Kekurangan Estrogen - kehilangan Ca @ matrik tulang
• Kegangguan Endokrine spt:i. Excess glucortocoidii. Male hypogonadismiii. Hiperparathyroidism
• Penyakit spt:i. Malignancyii. Hepatic insufficiency & terafi
dgn heparin iii. Gastrectomy & Histerektomi
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iv. Rheumatoid arthritisv. Acromegalyvi. COADvii. Chronic renal failureviii. Infeksiix. Kecederaan & sinovitis
• Ubat-ubatan:i. Steroidii. Thyroxiniii. Heparin
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iv. Frusemidev. Tetracyclinevi. Anticonvulsionvii. Aluminium containing
antacid.• Merokok• Alkohol• Premature menopausal &
menopausal berpanjangan
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F. TANDA & SIMPTOM
* Kehilangan ketinggian* Dowager’s hump back- Kyphosis* Sakit belakang* # vertebra, wrist, hip, rib & leher femur* Kesakitan @ kawasan fraktur* Kompresi @ turus vertebra
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* Kehilangan berat* Spasme otot* Benjol abdomen &* Konstipasi
G. DIAGNOSAi. Radiographic measurement of bone density ii. Laboratory biochemical markeriii. Bone Biopsy
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H. KOMPLIKASI
i. Frakturii. kualiti kehidupan (Bed ridden)iii. Kemurunganv. Aktiviti sosial vi. Implikasi kewanganvii. Kematian (Komplikasi)
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I. PENCEGAHAN* Strategi terbaik* Bermula dari zaman kanak- kanak melalui:
i. Pemakanan berzat & seimbangii. Latihan & aktiviti fizikal –
- mengekal & mencegah kehilangan jisim
tulangiii. Vitamin D – bentuk Caiv. Gaya hidup sihat
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* Terafi dgn Estrogen – kurang insiden & perkembangan
osteoporosis.* Berhenti merokok & minuman alkohol – cegah kehilangan kalsium dlm tulang
J. RAWATANi. UMUM
* Matlamat – berhenti kehilangan matrik
tulang utk cegah #
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• Tiada rawatan – hanya memelihara, tingkat densiti tulang & kekal kualiti tulang
• Berhenti merokok & kurang mengambil alkohol
• Kalsium 1500 mgm OD• Sodium Fluoride 60 – 80 mgm• Vitamin D 400 iu• Rawat penyakit penyebab
osteoporosis sekunder
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• Ganti hormon Estrogen, Calcitonin, Alendronate sodium & Raloxifene hydrochloride – melambat menopause.
ii. RAWATAN SETEMPAT* Sokongan belakang – brace* Latihan & aktiviti fizikal* Pengurusan fraktur – ORIF