osteoporosis

Question 1

what is it?

Answer 1

metabolic disease with decrease in bone density and changes in the micro-architecture (increased risk of fractures)

WHO def: bone marrow density of adult CT- score below or equal to -2.5 SD; osteopenia is between -1 and -2,4

Age related or associated with conditions or drugs

Question 2

pathogenesis

Answer 2

● Negative turnover of bone – imbalance between bone formation & resorption.
● Maximum bone stock is achieved at the age 30.
● From 35y, resorption is more active.
● Menopause / adrenopause (activates bone resorption).
● In increasing age – slow down of bone production.

Question 3

etiology

Answer 3

● Primary osteoporosis (Unknown etiology).

● Secondary osteoporosis (Caused by a known disease / condition
⇨ Endocrine – hypogonadism, amenorrhea, hyperprolactinemia
⇨ GIT- lactate def, hepatopathy, malabsorption sy
⇨ Renal- chronic renal insufficiency
⇨ Rheumatic – immobility, chronic infl disorders
⇨ Neurologic – immobilizing disorders
⇨ Orthopedic – scoliosis, bone fractures
⇨ Drugs – CS, thyroid hormones, heparin, cyclosporins

Question 4

clinical presentation

Answer 4

● “Silent robber of bone”.
● Vertebral, proximal femur, wrist & proximal humerus fractures.
● Non specific pain of the spine.
● Progression of thoracic kyphosis & decrease of height.

Question 5

diagnosis

Answer 5

● History.
● Physical examination.
● X-ray (Densitometry) - DEXA is gold standard
● Markers of bone metabolism (ALP, calcium, phosphorus, parathyroid hormone, calcitonin).

Question 6

prevention

Answer 6

● Diet – higher intake of calcium, vit D, proteins.
● Physical activity.
● Exclusion of known risk factors.

Question 7

treatment

Answer 7

●	Inhibitors of bone resorption:
●	Estrogen & its analogs.
●	Calcium.
●	Calcitonin.
●	Bisphosphonates.
●	Vit D.
●	Parathormon (PTH).