Progressive skeletal disorder characterised by low bone mass and deterioration of bone tissue.
Becoming a major public health problem due to high predisposition to fractures
Bone mass is below normal for an individuals age, gender and ethnicity.
1 in 3 females and 1 in 12 males will have an osteoporotic fracture (most commonly the spine, hip and forearm).
Family history, fair skin, early menopause, sedentary lifestyle, low calcium intake, smoking; high caffeine and alcohol consumption, corticosteroids (inhibit bone formation and increase PTH mediated bone resorption); untreated hypogonadism; chronic diseases (eg hyperthyroidism); prolonged immobility; Caucasian
Usually asymptomatic until fracture occurs.
Back pain and fractures are common presentations.
Height loss is sign of vertebral osteoporosis.
Usually inadequate to quantify bone mass
Dual-energy x-ray absorptiometry (DEXA) – good accuracy to quantify extent; high specificity for predicting future fracture risk (low sensitivity);
Bone mass report has 3 values:
absolute bone mass
T-score – number of standard deviations that the patients value is away from mean value for population of young adults
between –1 and –2.5 osteopenia
below –2.5 osteoporosis
Z-score – number of standard deviation that the patients value is away from an age matched population
Management of fractures.
Oestrogen; exercise; calcium supplements
Calcium; Vitamin D; thiazides; oestrogen; bisphosphonates; calcitonin; alendronate; hormone replacement therapy