Osteoporosis

• Osteoporosis is a complex, progressive skeletal disease that leads to an increased risk of fragility fractures. It can be characterised by a reduced bone mineral density and defects in bone tissue micro-architecture.
• Forms of primary osteoporosis:

  • Type I - postmenopausal
  • Type II - age-related
• Causes of secondary osteoporosis:

  • Hyperthyroidism
  • Hyperparathyroidism
  • Alcohol abuse
  • Immobilisation
• Risk factors for osteoporosis:

  • Age - between 40 and 90 years
  • Female gender
  • Previous fracture
  • Parent fractured hip
  • Smoking
  • Glucocorticoids
  • Rheumatoid arthritis
  • Secondary osteoporosis
  • Alcohol
  • Low bone mineral density
• Osteoporosis pathophysiology:

  • Gradual reduction in bone density due to increased osteoclast activity and reduced osteoblast activity
  • Oestrogen sensitive process - women are at greater risk
  • Dependent on dietary calcium and vitamin D
• Clinical features of osteoporosis:

  • Often presents with a fragility fracture
  • Vertebral compression fracture - sudden episode of acute back pain when bending or lifting
  • Appendicular fracture - can happen in proximal femur or distal radius
• Investigations for osteoporosis:

  • DEXA scan - looking for T-score <2.5
  • Plain radiographs - look for fractures
• The FRAX tool can be used to evaluate fracture risk of patients and guide clinical treatment.
• Differential diagnosis of osteoporosis:

  • Osteomalacia
  • Paget disease of bone
  • Cancer
• Osteoporosis management:

  • Lifestyle modifications - falls risk assessment, exercise, Vitamin D and calcium intake,
  • Pharmacological - Bisphosphonates (e.g. alendronate and risendronate) or Denosumab in severe cases
  • Hormone replacement therapy in postmenopausal women
• Osteoporosis complications:

  • Immobility
  • Depression
  • Pain