Disease - Osteoporosis

From CambridgeNotes

  • Definition: reduced bone density. Prevalance is 5%

History and Examination

  • Back pain; loss of height, kyphosis, scoliosis
  • Atraumatic fractures - make sure you don't miss bone deformities (suggests Paget’s disease) or blue sclerae (suggests osteogenesis imperfecta)

Investigations

  • FBC, ESR, bone function tests
    • Osteoporosis: Ca, PO, alk phos are all normal
    • Paget’s: ↔Ca, ↔PO, ↑alk phos
    • Osteomalacia: ↓Ca, ↓PO, ↑alk phos
  • Consider calcitonin, TSH, testosterone levels in men
  • Plain films
  • Bone densitometry or DEXA (WHO define osteopenia between –1 and –2.5 SD; osteoporosis below –2.5 SD)

Treatment

  • Analgesia
  • Exercise (regular and weight bearing), calcium rich diet, avoid smoking and alcohol
  • Medication: if previous osteoporotic fracture (especially if aged 60 years or over) or crush fracture, chronic steroid use (>7.5mg for >6mo), early menopause (at <45yrs)
    • Bisphosphonates e.g. Alendronate: good for elderly patients (patients aged >75 years do not need DEXA scan)
    • Raloxifene (selective oestrogen receptor blocker) and Teriparatide (PTH) are alternatives if contraindications e.g. oesophageal ulcers, erosions or lower GI symptoms
    • HRT e.g. Prempak: good for early menopause; contraindications include deep vein thrombosis (DVT), pulmonary embolism (PE), or raised breast cancer risk
    • Calcitriol rarely used because of side effects
  • Elderly: consider Vitamin D and calcium

References

  1. NICE guidelines
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