SOELARTO REKSOPRODJODivision of Orthopaedic & TraumatologyFaculty of Medicine, Univ. of IndonesiaDr. Cipto Mangunkusumo JakartaSimposium SehariPenanganan Nyeri Tulang Belakang TerkiniGraha Sindang Reret, Garut, 29 Mei 2004

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISINTRODUCTIONDeclaration of Bone and Joint Decade

2000 2010 by the WHO was positively

respons by professional as well social

association by nearly all developed and

developing countries including Indonesia

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISWhat is the Bone and Joint Decade ? It is a worldwide effort to advance under- standing and treatment of muscuolskeletal conditions and to promote research

Patients, physicians, medical specialty societies, allied health professionals and health organizations are urging their nations worldwide to focus attention on the disorders which affect millions of people

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISIRA (Indonesian Rheumatology Association)

was the first professional association in

Indonesia, at their meeting in Jakarta,

May 2000 responded the declaration, which

was announced by the Minister of Health RI

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISIn the same year :

The Woman Association founded YATUSI (Yayasan Tulang Sehat Indonesia) June 2000

The study group of osteoporosis FKUI RSCM founded the PEROSI (Perhimpunan Osteoporosis Indonesia), 28 Oktober 2000

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISThe President of the Republic of Indonesia

declared the participation of Indonesia,

read by the Minister of Health at the Golden

anniversary of RSO Prof. DR. R. Soeharso

in Solo, August 2001

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISGoals of the Bone and Joint Decade1. To raise awareness of the growing burden of musculoskeletal disorders on society

2. To empower patients to participate in their own care

3. To promote cost effective prevention and treatment

4. To improve prevention and treatment of muskulo- skeletal disorders through medical research

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISBONE AND JOINTBone and Joint is part of the musculo-

skeletal system, function as a locomotor

apparatus; disorders and diseases may

disturb the ADL

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISDisorders or diseases of musculoskeletalsystem is classified as follows :

Congenital anomalies Inflammation / infection Trauma Tumor / cancer Degenerative disease Metabolic disease Miscellaneous

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISDisorders or diseases of bone and jointwill widely affect socio-economic and ADL

(example : - USA in 1995 : 36 million people the cost of treatment for musculoskeletal disorders was USD $ 210 billion)

- Musculoskeletal impairment are the number 1 (one) reported category of impairment and the number 1 (one) reason people visit the doctor

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISNatural history of musculoskeletaldiseases through 3 stages of functionaldisorders :

1. Impairment

2. Disability

3. Handicap

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISNot all disorders and diseases of musculo-

skeletal either congenital or acquired

will recover 100%

It needs rehabilitation especially to

improve function

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISThe goal is maximum rehabilitation

of patient as a whole

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISAlthough there are many disease ordisorders of the musculoskeletal, butit seems the topics of the Bone & Jointdecade is more on the process of aging such as (degenerative disease) :

Osteoporosis

Osteoarthritis

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISDegenerative process :

All tissue or organs will reduce

their function 1% per year after

the 3rd decade

(the 1% rule of Andreas & Tobin)

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISAs a whole there is slowly affection of the tissues / organs :

The eye : Vision : cataract, hypermetrop The ear : Deafness The skin : Dry and wrinkled The urinary tract : - Incontinent - hypertrophy prostate in men The GI tract : - Incontinent, resorption The genital : Frigidity, impotency The mental : Depression, dementia The nerve : Reflex Bone & Joint : osteoporosis / osteoarthritis

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISOSTEOPOROSIS PEROSI is a group of doctor in multidiscipline medical sciences interested in problem of osteoporosis

It is now a associate member of IOF (International Osteoporosis Foundation)

The patron of IOF is : Queen Rania of Jordan

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISStrong bones build strong lives, and

strong lives build strong future .,

we must do all we can to make that

strength a reality for allQueen Rania, Lisbon 10 14 May 2002

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISResearch in Indonesia :

Prof. DR. Djoko Roeshadi, dr. Sp.B., Sp.BO

DR. Ichramsyah A.R., Sp.OG, KER

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSIS Osteoporosis is a silent disease meaning no significant clinical symptoms unless a minor trauma produces fracture

A good observation of mild dull aching of the back, reduce in height and kyphotic deformity are the early signs of osteoporotic especially in post menopausal women

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISWHO definition (1991) :Osteoporosis is a disease characterized

by low bone mass and microarchitectural

deterioration of bone tissue, leading to

enhanced bone fragility and a consequent

increase in fracture risk

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISGold standard to detect osteoporosis :

- Densitometry

- WHO criteria :

Normal : 1SD from TScore

Osteopenia : -1SD to 2,5SD from TScore

Osteoporosis : less than 2,5SD from TScore

(severe osteoporosis : associated a fracture)

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISThe Interpretation of DEXAT Score Bone Loss Fracture Risk

0 to 1 None None

-1 to 2 Moderate Small

-2 to 3 Severe Moderate

Less than 3 Very severe SevereOrthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSIS4 Sets of factors as the cause of osteoporosis1. Genetic / familial Nutritional Physical activity Life style Health / disease history with the use of drugs

2. Bone loss post menopause

3. Bone loss with aging

4. Risk

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISWOD and NOD 20 October

2002 : Theme : Seberapa jauh anda peduli terhadap tulang anda

2003 : Tulang kuat mulai dari sekarang

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISBMD / BMC will reach maximum at

the end of the 3rd decade :

(Peak Bone Mass)

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISPrevention is divided into :Primary : Before osteoporosis, to reach maximum PBM

Secondary : - After detected as osteoporosis/ osteopenia (avoid external factor) - If already fractured

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISOSTEOARTRHITISIs a degenerative process non inflammatory

disease of the joint characterized by degradation

of articular cartilage and spur formation at the edge of the articular surface

(a lay man will call = Pengapuran)

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISThere are a lot of terminologies for disorders or diseases of the joint

RA : Rheumatology Arthritis (encok)

Infective arthritis : - Staphylococcus - Tb, etc

Gouty arthritis, etc

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISMostly affected the elderly people

(more than 50 years of age, obese,

and weight bearing joint), stiffness

and pain after a rest following a long

period of activities

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISA multi factoral etiology which cause degradation of articular cartilage such as :

Instability of joint as a biomechanical process : wear and tear (use abuse)

Immunology and inflammation reaction

Stress oxydatives cause destruction of cartilage, etc

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISDIAGNOSIS History

Physical Examination (PE)

Imaging

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISMANAGEMENT PT : - Strengthening exercise - ROM - Non weight bearing exercise / hydrotherapy

Bracing

Operative : - Arthroscopy - Arthrodesis - Joint Replacement

PERAN BONE AND JOINT DECADE 2000 2010PADA KASUS OSTEOPOROSISINCONCLUSION Bone and joint decade 2000 2010 has been declared

Important of awareness concerning the problem of sosio-economic by empowering patient to participate in their own care

Participation of professional association to raise quality of life by : prevention, treatment base on research (Evidence Base Medicine)