Osteoporosis

Exam Cram

• Osteoporosis describes age related thinning of the bone, resulting in fracture

• Diagnosis: low impact fragility fracture or low mineral bone density of DXA scan, T > 2.5

• Management: PO calcium, vitamin D and consideration of bisphosphonates

• Osteopenia: DXA scan T score 1.5-2.5

Outline

Background 

• Significant cause of morbidity and mortality in the elderly

• Caused by ageing, steroids & poor calcium intake or absorption 

Assessment

Presentation:

• Asymptomatic

• Low impact fracture

Investigations

• Calcium: low/ normal

• Phosphate: normal

• Alk P: normal

• DXA Scan T score > 2.5

Diagnosis

Diagnostic Criteria (1 of 2)

• DEXA scan T score > 2.5

• Fragility Fracture

Fragility fracture definition: low impact fracture. This is any fracture that was sustained with a smaller force than would have been expected to result in a fracture. For example, femur fracture from a fall from standing height. 

Differentials

• Osteomalacia: low vitamin D myopathy

• Paget's: presents monoarthritis

Management

1. PO calcium and vitamin D (depending upon dietary intake and serum levels)

2. Bisphosphonates

3. Denosumab

4. Teriparatide 

Osteopenia

• Mid point between healthy and osteoporosis

• DXA Scan 1.5-2.5

• Management: consider vitamin D & calcium supplements if low dietary intake

Med Reg Notes

Bisphosphonates

Used to be given for all fragility fracture however wasn't associated a good benefit (reduction in fractures): side effect ratio. Bisphosphonates  side effects:

• Osteonecrosis of the jaw

• GI reflux

Common Fragility Fractures

• NOF- neck of femur

• Vertebral compression fractures

Causes of Osteoporosis

Primary/ idiopathic- age, diet and immobility related

Secondary

• Steroids- exogenous, iatrogenic, Cushing's Syndrome 

• Lack of HRT/ low oestrogen

References