OSTEOPOROSIS IN INDONESIA

Transcription

1 OSTEOPOROSIS IN INDONESIA Hana Ratnawati Faculty of Medicine Maranatha Christian University Bandung - Indonesia 5th SBA Conference

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3 INTRODUCTION Indonesia is an archipelago comprising approximately 17,508 islands, about 6,000 of which are inhabited Indonesia as the world's fourth most populous nation, with estimated more than 239 million (2012) and 18.1% (43 million) aged over 50 years. 5th SBA Conference

4 Introduction (Cont d) Osteoporosis, a systemic skeletal disease characterized by a low bone mass a major public health problem in Indonesia High incidence of osteoporotic fractures (200/ in women & men > 40 yrs) 5th SBA Conference

5 EPIDEMIOLOGY INCIDENCE OF OSTEOPOROSIS IN INDONESIA??? rarely available UNDERDIAGNOSED -limited availability of densitometers -restrictions in personnel permitted to perform scans -low awareness of usefulness of BMD testing -Expensive and no reimbursement 5th SBA Conference

6 Epidemiology... DXA technology is relatively expensive and is not widely available in Indonesia, especially in rural areas. In 2008 Indonesia had a total of only 34 DXA machines (50% in Jakarta), for a population of 237 million (0.001 per 10,000 population) far below the recommended number for Europe, of 0.11 per 10,000. 5th SBA Conference

7 Epidemiology (cont d)... Indonesian health department stated that the prevalence of osteoporosis in Indonesia about 19.7% of the total population and the prevalence of osteopenia 47.1% (Indonesian Nutrition research and development center in 2005) Two of five Indonesian population has a risk of suffering from osteoporosis. 5th SBA Conference

8 Epidemiology (cont d)... The increasing of life expectancy from 69.3 years (2007) becomes 71.1 years (2012) changed the composition of elderly and led to the higher risk of osteoporosis. Approximately 40% of women years of age will experience a fracture due to osteoporosis, 35% of which related to the spine, with the most frequent complications were vertebral fractures. The high incidence of osteoporosis in Indonesia due to the high incidence of the risk factors. 5th SBA Conference

9 RISK FACTORS SMOKING DIETARY LOW BMI ALCOHOL AGE OSTEOPOROSIS SEDENTARY LIFESTYLE 5th SBA Conference

10 Risk Factors... Indonesia as the third number of smokers in the world (28% = 67 million). One study showed up to age 55 years, men have higher incidence of osteoporosis (relates to the smoking habit in men) and over 55 years the incidence is higher in women, related to menopause and decreased of Calcium intake. 5th SBA Conference

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12 Risk Factors... Dietary calcium and vitamin D deficiencies are important factors in the risk for osteoporosis. AGE NOF Recommended Indonesian people Calcium < 50 yrs 1,000 mg/day 270 mg/day (27%) > 50 yrs 1,200 mg/day ( mg/day) Vitamin D < 50 yrs IU/day > 50 yrs 800-1,000 IU/day 5th SBA Conference

13 Risk Factors % Indonesian children have vit D deficiency 16.7% Indonesian children have Ca deficiency 63% Ind women deficiency vit D (Green, 2008) 5th SBA Conference

14 Physical inactivity and a sedentary lifestyle as well as impaired neuromuscular function (e.g., reduced muscle strength, impaired gait and balance) are risk factors for developing fragility fractures 5th SBA Conference

15 Study to find out the differences of bone density between hormonal contraceptive users (depo medroxyprogesterone acetate) and non hormonal contraceptives (Dermawan M, 2012): The risk of getting low bone mineral density was significantly higher among DMPA contraceptive users. Types of contraception and BMI correlated to bone mineral density and statistically significantly 5th SBA Conference

16 DIAGNOSIS There are a number of methods for diagnosing osteoporosis that have been used in Indonesia, such as: Densitometer (DXA) laboratory examination for osteocalcin, CTx (Ctelopeptide) and parathyroid hormon concentration. 5th SBA Conference

17 TREATMENT Bisphosphonates are the main drugs used for prevention and treatment. Alendronate Risedronate Raloxifene Calcitonin undertreated even in the most high risk patients who have already fractured. Particularly in rural areas, fractures are often treated conservatively at home instead of by surgical treatment in hospitals 5th SBA Conference

18 PREVENTION Osteoporosis is a burden, not only for patients but also for their families. Therefore prevention needs to be a concern early on. Efforts by the Indonesian government is by: increasing public knowledge about osteoporosis risk factors Increasing public awareness in preventing osteoporosis by a healthy diet to keep the composition of protein, calcium and vitamin D, weight-bearing exercises, exposure to sunlight, avoid smoking and alcohol. 5th SBA Conference

19 Risk Factors... Gymnastic instructure training weight-bearing exercise and resistance exercises (such as walking or strength training). 5th SBA Conference

20 Prevention... In order to prevent and predict the incidence of fractures, Indonesian Osteoporosis Association (Perosi) in collaboration with WHO, has made a Fracture Risk Assessment Tool (FRAX) for Indonesia, which has been officially operate in April th SBA Conference

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