SOELARTO REKSOPRODJOSOELARTO REKSOPRODJO

Division of Orthopaedic & TraumatologyDivision of Orthopaedic & TraumatologyFaculty of Medicine, Univ. of IndonesiaFaculty of Medicine, Univ. of Indonesia

Dr. Cipto Mangunkusumo – JakartaDr. Cipto Mangunkusumo – Jakarta

Simposium SehariSimposium Sehari““Penanganan Nyeri Tulang Belakang Terkini”Penanganan Nyeri Tulang Belakang Terkini”

Graha Sindang Reret, Garut, 29 Mei 2004Graha Sindang Reret, Garut, 29 Mei 2004

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

INTRODUCTIONINTRODUCTION

Declaration of Bone and Joint Decade Declaration of Bone and Joint Decade

2000 – 2010 by the WHO was positively2000 – 2010 by the WHO was positively

respons by professional as well social respons by professional as well social

association by nearly all developed and association by nearly all developed and

developing countries including Indonesiadeveloping countries including Indonesia

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

What is the Bone and Joint Decade ?What is the Bone and Joint Decade ?

It is a worldwide effort to advance under-It is a worldwide effort to advance under- standing and treatment of muscuolskeletalstanding and treatment of muscuolskeletal conditions and to promote researchconditions and to promote research

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

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

IRA (Indonesian Rheumatology Association)IRA (Indonesian Rheumatology Association)

was the first professional association inwas the first professional association in

Indonesia, at their meeting in Jakarta,Indonesia, at their meeting in Jakarta,

May 2000 responded the declaration, whichMay 2000 responded the declaration, which

was announced by the Minister of Health RIwas announced by the Minister of Health RI

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In the same year :In the same year :

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

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

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

The President of the Republic of IndonesiaThe President of the Republic of Indonesia

declared the participation of Indonesia,declared the participation of Indonesia,

read by the Minister of Health at the Goldenread by the Minister of Health at the Golden

anniversary of RSO Prof. DR. R. Soeharsoanniversary of RSO Prof. DR. R. Soeharso

in Solo, August 2001in Solo, August 2001

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Goals of the Bone and Joint DecadeGoals of the Bone and Joint Decade

1. 1. To To raise awarenessraise awareness of the growing burden of of the growing burden of musculoskeletal disorders on societymusculoskeletal disorders on society

2. 2. To To empower patientsempower patients to participate in their to participate in their own careown care

3. 3. To To promote cost – effective prevention and promote cost – effective prevention and treatmenttreatment

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

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

BONE AND JOINTBONE AND JOINT

Bone and Joint is part of the musculo-Bone and Joint is part of the musculo-

skeletal system, function as a locomotorskeletal system, function as a locomotor

apparatus; disorders and diseases may apparatus; disorders and diseases may

disturb the ADLdisturb the ADL

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Disorders or diseases of musculoskeletalDisorders or diseases of musculoskeletalsystem is classified as follows :system is classified as follows :

Congenital anomaliesCongenital anomalies Inflammation / infection Inflammation / infection TraumaTrauma Tumor / cancerTumor / cancer Degenerative diseaseDegenerative disease Metabolic diseaseMetabolic disease Miscellaneous Miscellaneous

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

Disorders or diseases of bone and jointDisorders or diseases of bone and jointwill widely affect socio-economic and ADLwill widely affect socio-economic and ADL

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

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

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Natural history of musculoskeletalNatural history of musculoskeletaldiseases through 3 stages of functionaldiseases through 3 stages of functionaldisorders :disorders :

1. 1. ImpairmentImpairment

2. 2. DisabilityDisability

3. 3. HandicapHandicap

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Not all disorders and diseases of musculo-Not all disorders and diseases of musculo-

skeletal either congenital or acquiredskeletal either congenital or acquired

will recover 100%will recover 100%

It needs rehabilitation especially to It needs rehabilitation especially to

improve functionimprove function

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The goal is maximum rehabilitation The goal is maximum rehabilitation

of patient as a wholeof patient as a whole

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Although there are many disease orAlthough there are many disease ordisorders of the musculoskeletal, butdisorders of the musculoskeletal, butit seems the topics of the Bone & Jointit seems the topics of the Bone & Jointdecade is more on the process of decade is more on the process of aging such as (degenerative disease) :aging such as (degenerative disease) :

OsteoporosisOsteoporosis

OsteoarthritisOsteoarthritis

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Degenerative process :Degenerative process :

All tissue or organs will reduceAll tissue or organs will reduce

their function 1% per year after their function 1% per year after

the 3the 3rdrd decade decade

(the 1% rule of Andreas & Tobin)(the 1% rule of Andreas & Tobin)

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As a whole there is slowly affection of As a whole there is slowly affection of the tissues / organs :the tissues / organs :

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

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OSTEOPOROSISOSTEOPOROSIS

PEROSI is a group of doctor in multidisciplinePEROSI is a group of doctor in multidiscipline medical sciences interested in problem of medical sciences interested in problem of osteoporosisosteoporosis

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

The patron of IOF is : Queen Rania of JordanThe patron of IOF is : Queen Rania of Jordan

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““Strong bones build strong lives, andStrong bones build strong lives, and

strong lives build strong future ………., strong lives build strong future ……….,

we must do all we can to make thatwe must do all we can to make that

strength a reality for all”strength a reality for all”

Queen Rania, Lisbon 10 –14 May 2002Queen Rania, Lisbon 10 –14 May 2002

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Research in Indonesia :Research in Indonesia :

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

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

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Osteoporosis is a “silent disease” Osteoporosis is a “silent disease” meaning no significant clinical symptomsmeaning no significant clinical symptoms unless a minor trauma produces fractureunless a minor trauma produces fracture

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

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WHO definition (1991) :WHO definition (1991) :

““Osteoporosis is a disease characterizedOsteoporosis is a disease characterized

by low bone mass and microarchitecturalby low bone mass and microarchitectural

deterioration of bone tissue, leading todeterioration of bone tissue, leading to

enhanced bone fragility and a consequentenhanced bone fragility and a consequent

increase in fracture risk”increase in fracture risk”

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Gold standard to detect osteoporosis :Gold standard to detect osteoporosis :

- Densitometry- Densitometry

- WHO criteria :- WHO criteria :

Normal : 1SD from TScoreNormal : 1SD from TScore

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

Osteoporosis : less than –2,5SD from TScoreOsteoporosis : less than –2,5SD from TScore

(severe osteoporosis : associated a fracture)(severe osteoporosis : associated a fracture)

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The Interpretation of DEXAThe Interpretation of DEXA

T Score Bone Loss Fracture RiskT Score Bone Loss Fracture Risk

0 to –1 None None0 to –1 None None

-1 to –2-1 to –2 Moderate Small Moderate Small

-2 to –3-2 to –3 Severe Moderate Severe Moderate

Less than –3 Very severe SevereLess than –3 Very severe Severe

Orthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889Orthopaedic A Study Guide, Metabolic Bone Disease, 1999, p.885-889

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4 Sets of factors as the cause of osteoporosis4 Sets of factors as the cause of osteoporosis

1.1. Genetic / familial Genetic / familial NutritionalNutritional Physical activityPhysical activity Life styleLife style Health / disease history with the use of drugsHealth / disease history with the use of drugs

2.2. Bone loss post menopause Bone loss post menopause

3.3. Bone loss with aging Bone loss with aging

4.4. Risk Risk

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WOD and NOD 20 October WOD and NOD 20 October

2002 : 2002 : Theme :Theme : “ “ Seberapa jauh anda peduli Seberapa jauh anda peduli terhadap tulang andaterhadap tulang anda “ “

2003 : “ 2003 : “ Tulang kuat mulai dari sekarang Tulang kuat mulai dari sekarang ” ”

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BMD / BMC will reach maximum atBMD / BMC will reach maximum at

the end of the 3the end of the 3rdrd decade : decade :

(Peak Bone Mass)(Peak Bone Mass)

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Prevention is divided into :Prevention is divided into :

Primary : Primary : Before osteoporosis, to reachBefore osteoporosis, to reach maximum PBMmaximum PBM

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

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OSTEOARTRHITISOSTEOARTRHITIS

Is a degenerative process non inflammatory Is a degenerative process non inflammatory

disease of the joint characterized by degradationdisease of the joint characterized by degradation

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

of the articular surfaceof the articular surface

(a lay man will call = (a lay man will call = PengapuranPengapuran))

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There are a lot of terminologies for There are a lot of terminologies for disorders or diseases of the jointdisorders or diseases of the joint

RA : Rheumatology Arthritis (RA : Rheumatology Arthritis (encokencok))

Infective arthritis : - StaphylococcusInfective arthritis : - Staphylococcus - Tb, etc- Tb, etc

Gouty arthritis, etcGouty arthritis, etc

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Mostly affected the elderly peopleMostly affected the elderly people

(more than 50 years of age, obese, (more than 50 years of age, obese,

and weight bearing joint), stiffness and weight bearing joint), stiffness

and pain after a rest following a long and pain after a rest following a long

period of activitiesperiod of activities

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A multi factoral etiology which cause A multi factoral etiology which cause degradation of articular cartilage degradation of articular cartilage such as : such as :

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

Immunology and inflammation reactionImmunology and inflammation reaction

Stress oxydatives cause destruction Stress oxydatives cause destruction of cartilage, etcof cartilage, etc

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DIAGNOSISDIAGNOSIS

HistoryHistory

Physical Examination (PE)Physical Examination (PE)

ImagingImaging

PERAN BONE AND JOINT DECADE 2000 – 2010PERAN BONE AND JOINT DECADE 2000 – 2010PADA KASUS OSTEOPOROSISPADA KASUS OSTEOPOROSIS

MANAGEMENTMANAGEMENT

PT : - Strengthening exercisePT : - Strengthening exercise - ROM- ROM - Non weight bearing exercise /- Non weight bearing exercise / hydrotherapyhydrotherapy

BracingBracing

Operative : - ArthroscopyOperative : - Arthroscopy - Arthrodesis- Arthrodesis - Joint Replacement- Joint Replacement

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INCONCLUSIONINCONCLUSION

Bone and joint decade 2000 – 2010 has beenBone and joint decade 2000 – 2010 has been declareddeclared

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

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