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Osteoporosis

Osteoporosis is where there's a reduction in bone density, therefore making the bone weaker and more prone to fractures. A pre-condition of this is Osteopenia. It's characterised by the presence of Fragility fractures.

“This is a depiction of a woman suffering from Osteoporosis. The loss of bone mass has been shown, in comparison to Osteopenia (a milder condition) and a normal bone.” © https://www.myupchar.com/en CC BY-SA 4.0 (https://creativecommons.org/licenses/by-sa/4.0/)

Risk factors:

  • Elderly

  • Female

  • Anorexia (BMI < 19)

  • Long-term steroids

  • Menopause (Oestrogen promotes bone formation)

  • Prolonged immobility, Alcohol, Smoking

  • RA


FRAX Tool

This is a tool to assess risk of fragility fracture over next 10 yrs. To make the tool more accurate, the bone mineral density should be taken into account, and this can be measured with a DEXA scan.


Bone Mineral Density/BMD

Measured with a DEXA scan. The hip is the best part of the body to do this. This scan gives 2 scores:

  • Z score - No. of standard deviations of bone density below mean for their age

  • T score - No. of standard deviations of bone density below mean for a healthy, young adult

    • The T score is the more important measurement!


T score indications:

  • -1 to -2.5 - Osteopenia

  • < -2.5 - Osteoporosis


N.B. Bone profile will be normal in these patients.

Management

Lifestyle:

  • Reduce risk factors - e.g. smoking cessation, reduce alcohol, better diabetic control

  • Diet - adequate vit D, calcium, protein

  • Exercise


Medical:

  • Bisphosphonates e.g. Alendronate, Zoledronic acid

    • This works by reducing osteoclast activity, therefore preventing bone reabsorption

    • Side-effects - Reflux, Oesophageal ulcers, Jaw osteonecrosis

  • Calcium and Vit D supplements may be given to those that are deficient


2nd line medical options include;

  • HRT in menopausal women

  • Denosumab - matures osteoclasts

  • Raloxifene - has oestrogenic effects

  • Teriparatide (a parathyroid hormone) - stimulates bone growth




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