Osteoporosis

Nota:

• Reduced bone mass per unit

1. Associated with
   1. Low BMI Inc Age Periods of Immobility High dose po or inh corticosteroids untx thyrotoxicosis early menopause postive fam hx
2. WOMEN

   Nota:

   • postmenopause - low estrogen so lose calcium from bones alot quicker than before Within 5–10 years of the menopause, women can be seen to suffer from osteoporosis and by the age of 65 the rate of fractures in women has increased to 3–5 times that of men.
3. Rule Out
   1. MM
4. TYPES
   1. PRIMARY
      1. TYPE 1 Postmenopausal

         Nota:

         • SIx times more common in women than men Due to Inc osteoclast activity vertebral or distal forearm. Age 51 - 75. 
      2. TYPE 2 Involutional or Senile

         Nota:

         • proximl femur >60 y/o Twice as common in women than men
      3. Idiopathic OP

         Nota:

         • in children and young adults of either sex with normal gonadal function
   2. Secondary
      1. Eating Disorders

         Nota:

         • anorexia nervosa
      2. Malabsorption

         Nota:

         • coeliacs
      3. Endocrine Disorders

         Nota:

         • Cushing's DM Hyperparathyroidism, Thyrotoxicosis, hypogonadism, acromegaly
      4. C.T Dis

         Nota:

         • RA
      5. Chronic organ Failure
      6. Drugs

         Nota:

         • Corticosteroids, antiepileptics, thiazolidinediones (DM), long term heparin, excessive thyroid hormone, prostate cancer hormone therapy, breast cancer hormone therapy
5. RISK FACTORS
   1. NON MODIFIABLE
      1. Female Ageing Thin Build BMI < 18 Asian Caucasian Family Hx Premenopausal estrogen deficiency Late menarche Early menopause (natural and surgical)
   2. MODIFIABLE LIFESTYLE FACTORS
      1. cigarette smoking high caffeine intake > 4 cups/day High etoh intake > 2 sd/day Low calcium intake Lack of Vit D Physical inactivity
6. INVESTIGATIONS
   1. XRAY - will only show once >40% of bone density is lost
   2. Vit D
      1. 25-hydroxy vitamin D normal range 75–250 nmol/L.
   3. DEXA

      Nota:

      • dual energy xray absorptiometry spine and femoral neck GOLD STANDARD Tscore is the standard deviation of the mean BMD of a 30 y/o adult
      1. >1 Normal -1 to -2.5 Osteopenia <-2.5 Osteoporosis <-2.5 with fracture Severe Osteoporosis
      2. Recommended for all women who:
         1. > 50 y/o Postmenopausal, > 40 with a minimal trauma #, Fam Hx of OP, smoking hx or BMI< 18
7. TREATMENT

   Nota:

   • to reduce further loss
   1. Prevention
      1. Regular exercise Dietary Calcium
         1. 1000mg /day 50 to 70 y/o 1300 if > 70 y/o
         2. Premenopause 1000mg /day Postmenopause 1300mg/day
   2. ELIMINATE RISK FACTORS
      1. cigarette smoking high caffeine intake > 4 cups/day High etoh intake > 2 sd/day Low calcium intake Lack of Vit D Physical inactivity
   3. OPTIMISE LIFESTYLE MEASURES
      1. A combination of high intensity, weight-bearing and muscle-strengthening exercises
   4. MEDS
      1. ?HRT
      2. Biphosphonates

         Nota:

         • Decrease bone absorption, alone or in combination with things that protect from s/e 
         1. upper gi, jaw osteonecrosis

            Nota:

            • esophagitis, gastritis
            1. oral bisphosphonates in the morning prior to foodf and remain upright for at least 30 minutes afterwards
         2. jaw necrosis
            1. maintain good po hygeine
               1. IV > PO
      3. Raloxifene SERM
         1. DVT, PE, STROKE
      4. Strontium ranelate
         1. MI, Venous Thromboembolism
8. RESOURCES MURTAGH / NPS