OSTEOPOROSIS

Question 1

What is osteoporosis?

Answer 1

Decreased bone mass resulting in bone weakness and susceptibility to minimal trauma fractures.

Question 2

What are the risk factors for osteoporosis?

Answer 2

Being over age 50, being female, post-menopause, steroid use, alcohol and smoking, hyperthyroid or parathyroid, having BMI

Question 3

How is osteoporosis diagnosed?

Answer 3

DEXA (dual energy x-ray absorptiometry) is the gold standard for diagnosis. Osteoporosis is diagnosed when the bone mineral density is less than or equal to 2.5 standard deviations below that of a young (30–40-year-old) healthy adult women reference population.

X-rays may also confirm the presence of a fracture which may lead to further investigation for osteoporosis. Bloods can also be done to differentiate from other bone disorders eg in osteoporosis, calcium and phosphate levels are normal but not in osteomalacia.

Question 4

What are the signs and symptoms of osteoporosis?

Answer 4

Fracture. Especially fragility fracture.

Question 5

How is osteoporosis treated?

Answer 5

Lifestyle modifications:
- Weight bearing and aerobic exercise.
- Limit alcohol intake and stop smoking.
- Adequate dietary intake of calcium and vitamin D; no clear evidence that it can prevent fractures, but adequate intake is important for bone density.
Medications:
- Bisphosphonates (eg Alendronate), for reducing the risk of future fractures.
- Strontium ranelate: alternative to bisphosphonates; same periodic group as calcium and reduces reabsorption and may promote new bone formation.
- HRT: can prevent, not treat, osteoporosis in post-menopausal women. Can increase risk of breast cancer.
- Testosterone in men; can promote trabecular connectivity.
- Denosumab: Human monoclonal antibody for the treatment of osteoporosis. RANK-L inhibitor; reduces the activity of osteoclasts.