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B Y :


It is a disease characterized by low bone mass and

microarchitectural deterioration of bone tissue,

leading to enhanced bone fragility and an increase in

fracture risk.

WHO defines osteoporosis as a

Bone density more than 2.5 standard deviation (SDs) below the young adult mean value (T-score < -2.5).
values between 1 and 2.5 SDs below the young adult

mean are termed OSTEOPENIA.

Fractures related to osteoporosis effect around

- 30% women - 12% men at some point.

Immediate mortality after fracture is 12%.
Cont increase in mortality when compared to age

matched controls.

There is disruption of balance between bone formation

and bone loss.

Inc bone loss. Peak bone mass is attained around 30 yrs of age. Gradual decline in men and in women accelerated bone

loss occurs 10 yrs following menopause. the rate of loss later in life.

Bone mass depends on the peak mass attained and on

Role of Genetic Factors

Genetic factors has the influence on peak bone mass.


Polymorphism in the genes for the collagen type IA1,

vitamin D receptors and estrogen rec

Risk Factors/ Causes

Risk factors:

- Female gender - Increasing age - Early Menopause - Caucasians and Asians - Slender habitus - Lack of Exercise/immobility - Smoking - Family History - Excess alcohol - Nutrition(low calcium diet,high protein intake for a long time)

Drug Therapy:

- Corticosteroids - Heparin - Ciclosporin - Cytotoxics - Gonadotrophin releasing Hormone agonists - Thyroxine over replacement - Sedatives - Anticonvulsants

Diseases Associated With Osteoporosis


- Cushings syndrome - Hyperparathyroidism - Hypogonadism - Acromegaly - Type 1 diabetes


Others: - Chronic Renal failure - Chronic liver disease - Mastocytosis - Anorexia Nervosa - IBD - Celiac Disease

- Rheumatoid Arthritis

Clinical Features
Fractureusually the first symptom.

- low trauma fracture

Common sites of fracture:

- Forearm (Colles fracture) - Spine (vertebral Fracture) - Hip joint

Backache Loss of height

If Fracture suspected: Plain Radiographs

If plain films normal Then

Bone scintigrahy

(Especially for pelvic and vertebral hairline fractures)

Bone Density
DXA (Dual energy X- Ray absorptiometry):

- Measures the areal bone density(mineral per surface area) usually of lumbar spine and proximal femur.
- It is precise and accurate.
- Uses low dose radiation.

- Gold standard for diagnosis of osteoporosis.

- Provides the T- Score reflecting fracture risk which may

influence the treatment decisions.

Indications for DXA Scan

Low Trauma fracture Clinical Features of Osteoporosis Osteopenia on plain X-Ray. Previous fragility fracture Corticosteroid Therapy(>7.5mg daily for>3 months) Family history of Osteoporotic fracture Body mass index <19kg/m2 Diseases associated with Osteoporosis

Assessing response of osteoporosis to treatment


Quantitaive CT scanning:

- True volumetric assessment. - More expensive. - Higher radiation - No clinical advantage.

Associated disease and risk factors :

- Exclude other diseases - Identify contributory factors

Prevention and Treatment

Address the predisposing lifestyle factors

Identify high risk patients with DXA scan.


- Ca1000 mg daily. - Vit D 400-800 mg daily

Exercise:30 min wt bearing exercise 3 times/week. Smoking cessation Reduce falls Physiotherapy

Those on long term steroids(6 months or more)

- Assess for co existing risks - Start preventive treatment with Bisphosphanates

Secondary prevention:

(Reducing fracture risk in those with Osteoporosis) - Bisphonates (Alendronate,Risedronate)

- Raloxifene (selective estrogen receptor modulator)

- Combined calcium and Vitamin D.

Drug Therapies
Bisphosphonates Hormone replacement therapy

Androgens Combination of Calcium and Vitamin D

Strategies less commonly used

Combination Therapies

- HRT or SERM and a Bisphosphonate

Calcitriol (1,25-(OH)2D3) Calcitonin Flouride Parathroid hormone therapy

IF previous Fracture: Bisphosphonates

If NO previos fracture: Premenopausal women or Men: Identify and treat cause or contributory factors Bisphosphanates(with caution in women of child bearing


Amenorrheic women or postmenopausal: If menopausal symptomsHRT If HRT not tolerated/used for >10 yrs/no menopausal

symptoms SERM or Bisphonates

If no menopausal symptoms Bisphonates (SERM or

calcitriol if poorly tolerated)

Older Men or women(70 +) Vitamin D and calcium. Consider Hip Protectors