B Y :
OSTEOPOROSIS
It is a disease characterized by low bone mass and
DEFINITION
WHO defines osteoporosis as a
Bone density more than 2.5 standard deviation (SDs) below the young adult mean value (T-score < -2.5).
values between 1 and 2.5 SDs below the young adult
INCIDENCE
Fractures related to osteoporosis effect around
matched controls.
Pathophysiology
There is disruption of balance between bone formation
Inc bone loss. Peak bone mass is attained around 30 yrs of age. Gradual decline in men and in women accelerated bone
loss occurs 10 yrs following menopause. the rate of loss later in life.
Polygenic.
- Female gender - Increasing age - Early Menopause - Caucasians and Asians - Slender habitus - Lack of Exercise/immobility - Smoking - Family History - Excess alcohol - Nutrition(low calcium diet,high protein intake for a long time)
Drug Therapy:
- Corticosteroids - Heparin - Ciclosporin - Cytotoxics - Gonadotrophin releasing Hormone agonists - Thyroxine over replacement - Sedatives - Anticonvulsants
Others: - Chronic Renal failure - Chronic liver disease - Mastocytosis - Anorexia Nervosa - IBD - Celiac Disease
- Rheumatoid Arthritis
Clinical Features
Fractureusually the first symptom.
Investigations
If Fracture suspected: Plain Radiographs
Bone Density
DXA (Dual energy X- Ray absorptiometry):
- Measures the areal bone density(mineral per surface area) usually of lumbar spine and proximal femur.
- It is precise and accurate.
- Uses low dose radiation.
Others
Quantitaive CT scanning:
Drug Therapies
Bisphosphonates Hormone replacement therapy
Raloxifene(SERM)
Androgens Combination of Calcium and Vitamin D
Management
IF previous Fracture: Bisphosphonates
If NO previos fracture: Premenopausal women or Men: Identify and treat cause or contributory factors Bisphosphanates(with caution in women of child bearing
age)
Amenorrheic women or postmenopausal: If menopausal symptomsHRT If HRT not tolerated/used for >10 yrs/no menopausal