Osteoporosis

Osteoporosis:

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).

Risk factors:
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

Clinical Features:
Usually asymptomatic until fracture occurs.
Back pain and fractures are common presentations.
Height loss is sign of vertebral osteoporosis.

Radiographs:
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

Treatment:
Management of fractures.

Prevention:
Oestrogen; exercise; calcium supplements

Medical:
Calcium; Vitamin D; thiazides; oestrogen; bisphosphonates; calcitonin; alendronate; hormone replacement therapy

Hip protectors

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