Osteoporosis
Title
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Osteoporosis
Definition
A disorder characterised by:
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Loss of bone mass per unit
volume
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Deterioration of bone
micro-architecture
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Increased fragility of bone and
increased risk of fracture
Pathogenesis
Risk Factors
The risk factors for osteoporosis are:
Internal Factors
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Increasing age
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Female gender
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Caucasian or Asian race
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Family history of osteoporosis
Systemic Factors
Conditions affecting the:
RAG
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Secondary amenorrhoea
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Primary hypogonadism
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Premature menopause
E&M
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Acromegaly
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Hyperthyroidism
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Hyperparathyroidism
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Cushing’s syndrome
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Diabetes mellitus
KUS
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Chronic renal failure
LMS
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Rheumatoid arthritis
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Prolonged immobilisation
GIT
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Low calcium intake
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Nutritional failure
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Inflammatory bowel disease
Drugs
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Steroid therapy
Toxins
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Cigarettes
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Alcohol
Surgery
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Organ transplantation
Pathological Process
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Bone mass is gained in early
life and peak bone mass is attained between 20-30 years
After the age of 40 years:
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Age related bone loss occurs
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Slowing of osteoblatic function
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Increased osteoclastic function
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The risk factors listed above
accelerate bone loss and cause osteoporosis
This results in bone with:
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Thinning of the cortex and the
trabeculae
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Widened haversian systems
Clinical Features:
In osteoporosis symptoms are caused by
fracture. The usual sites involved are:
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Spine
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Wrist:
Colles’ fracture
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Femur:
Fracture neck
History:
LMS
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Pain
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Deformity
Examination
GIT
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Abdominal protuberance
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Decreased distance between the
lower costal cartilages and the iliac crest
LMS
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Spine:
Loss of height
Kyphosis
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Wrist:
Dinner fork deformity in Colles’ fracture
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Lower limb:
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Fracture neck of femur:
Shortening of the lower limb
External rotation and decreased movement of the
hip
Investigations
Imaging
Plain X- Ray
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Decreased bone density
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Reduced cortical thickness
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Wedge collapse of vertebrae
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“Codfish” vertebrae
DEXA
(dual x- ray absorptiometry):
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Provides a T score, which
reflects fracture risk
Management
Control
Drugs
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Bisphosphonates:
Inhibit osteoclasts
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Hormone replacement therapy
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SERM (selective oestrogen
receptor modulator):
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Activates oestrogen receptors in
bone:
Raloxifene
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Recombinant human parathyroid
hormone peptide:
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Anabolic, stimulates bone formation:
Teriparatide
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Strontium ranelate:
Anti-resorptive and anabolic effects
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Androgens:
Hypogonadal men
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Calcium and vitamin D
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Calcitonin
Lifestyle Adjustments
Diet
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Increase calcium and vitamin D
intake
Exercise
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Increase physical activity
Smoking
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Cessation
Prevention
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The same methods as used in
treatment
