“A systemic skeletal disease characterised by a reduction in bone mass and microarchitectural deterioration of bone tissue leading to enhanced bone fragility and a consequent increase in fracture risk

Risk Factors
  • Modifiable:
    • Reduced mobility and activity
    • Low BMI (<18.5kg/m2)
    • Alcohol
    • Smoking
    • Long term corticosteroid use
    • Medications (SSRIs, PPIs, anti-epileptics, anti-oestrogens)
  • Non-Modifiable:
    • Increasing Age
    • Sex (female, especially post-menopausal)
    • Rheumatoid arthritis
    • Family history of osteoporosis
    • Hyperthyroidism
    • Cushing’s syndrome
    • Hyperparathyroidism
Aetiology
  • Primary:
    • Post-menopausal osteoporosis (due to oestrogen deficiency), age-associated osteoporosis (due to an ageing skeleton and calcium deficiency)
  • Secondary:
    • Due to genetic/congenital disorders, hypogonadal states, endocrine disorders, deficiency states, inflammatory diseases, haematologic and neoplastic disorders, medications (anti-epileptics, anti-psychotics, anti-retroviral, furosemide, heparin, SSRIs)
Pathophysiology
  • Risk factors → Shortening lifespan of osteoblasts & prolongation of lifespan of osteoclasts → Increased rate of bone turnover → Continuous, progressive bone lossn
Clinical Presentation
  • Bones that break more easily than expected
  • Back pain (caused by a fractured or collapsed vertebra)
  • Loss of height over time
  • Stooped posture
Investigations
  • Fracture risk prediction (FRAX assessment) – in women >65, men >75 and younger patients with risk factors
    • Low risk = lifestyle advice and reassurance
    • Medium risk = measure the bone mineral density
    • High risk = treat for osteoporosis
  • Dual-energy x-ray absorptiometry (DEXA) scan – gives an indication of bone mineral density
    • T score at the hip of less than -2.5 indicates osteoporosis
    • T score at the hip of less than -2.5 plus a fracture indicates severe osteoporosis
Management
  • Conservative:
    • Activity and exercise
    • Maintaining a healthy weight
    • Adequate calcium intake
    • Adequate vitamin D
    • Avoiding falls
    • Smoking cessation
    • Reduce alcohol consumption
  • Medical:
    • Calcium supplementation with vitamin D
    • Bisphosphonates (alendronate, risedronate, zoledronic acid)
    • Selective oestrogen receptor modulators (raloxifene)
    • Parathyroid hormone (teriparatide)
  • Surgical: n/a
Complications
  • Bone fractures – particularly in the spine or hip

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