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Osteoporosis

Osteoporosis. Definition : Reduced bone mass May be primary (age-related) Or Secondary (another condition or drugs) T Score ≤ - 2.5 Prevalence: > 50 yrs ♀18%♂6% Women lose trabeculae with age but men do not – hence less lifetime fracture risk. Pathogenesis

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Osteoporosis

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  1. Osteoporosis

  2. Definition: Reduced bone mass • May be primary (age-related) • Or Secondary (another condition or drugs) • T Score ≤ - 2.5 Prevalence: • > 50 yrs ♀18%♂6% • Women lose trabeculae with age but men do not – hence less lifetime fracture risk

  3. Pathogenesis • OP results from ↑ bone breakdown by osteoclasts & ↓ bone formation by osteoblasts • BM ↓ with age but will depend on peak mass obtained during life • Genetic factors are single most significant influence

  4. BMD dependent Risk Factors: • Female sex • Caucasian/Asian • GI disease • Immobilization • CLD/CRD • Low dietary calcium intake • Vit D insufficiency • COPD • Endocrine Disease (thyroid, Cushings) • Other disease (DM, myeloma) • Drugs *

  5. Drugs* • Main ones we need to know; • Heparin • Calcineurin inhibitors • Ciclosporin • PPI’s • SSRI’s • Glucocorticoids

  6. BMD-independent Risk Factors; • Age • Previous fragility fracture • Family H(x) • Low BMI • Smoking • Alcohol • Glucocorticoid therapy • RA

  7. Risk Factors: • SHATTERED • Steroid use > 5mg/day of prednisalone • Hyperthyroidism • Alcohol & Tobacco use • Thin (BMI ≤ 22) • Testosterone ↓ • Early menopause • Renal or liver failure • Erosive bone disease (RA or myeloma) • Dietary Ca2+ ↓(malabsorption T1DM)

  8. Clinical Presentation; • Fractures are the only cause of symptoms • Sudden onset of severe pain in spine, radiating to front – VCF • Pain from mechanical derangement • Increasing kyphosis • Height loss • Colles fractures • Fractures of proximal femur etc

  9. Investigations • X-ray • DEXA scan • Bloods – CA, PO4, & alk phos • Consider specific investigations for secondary causes • Biopsy is unreliable and not often used

  10. Management • Treat known risk factors if possible (drugs etc) Lifestyle measures; Smoking & alcohol cessation WB exercise & balance training Calcium and vit D dietary intake Home based fall prevention program

  11. Pharmacological T(x) • Bisphosphonates 1st line • Calicum and Vit D • Strontium ranelate (2nd line after BisP) • Hormone replacement therapy (prevention) • Raloxifene • Teriparatide • Calcitonin • Testosterone ( in men)

  12. Quiz • What is the most common presentation of OP? • What does SHATTERED stand for in terms of OP risk factors? • What investigations would you do on a patient with suspected OP?

  13. Quiz • Mrs X has a T score of -2.3. Is she osteoporotic? • List 5 lifestyle modifications for treatment of OP: • List 5 pharmacological mangements for OP; • What is the 1st line treatment?

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