3+ Osteoporosis Flashcards
What is osteoporosis?
An age related skeletal disease characterised by low bone density and micro-architectural defects in bone tissue, resulting in increased bone fragility and susceptibility to fracture
What is the epidemiology of osteoporosis?
Post-menopausal white women
Age of onset: 50-70
What is the aetiology of osteoporosis?
- Post-menopausal
- Trabecular bone loss
- Oestrogen stimulates osteoblast activity and inhibits osteoclast activity - Age-related
- Cortical and trabecular bone loss - Secondary
- Drug-induced: corticosteroids long-term
- Endocrine: hyperparathyroidism, hypogonadism, hypercortisolism, hyperthyroidism
- Metabolic: DM
- CKD
What are some risk factors for osteoporosis?
Advancing age
Female sex
History of corticosteroid use
Rheumatoid arthritis
Alcohol excess
Smoking
Endocrine disorders
Multiple myeloma, lymphoma
CKD
What is the pathophysiology of osteoporosis?
Imbalance in bone formation and development = resorption > formation
- Gradual reduction in bone mass
- Progressive discontinuity in bone microarchitecture –> structural failure or fracture
What are the pathological features of osteoporosis?
- Porous bone
- Reduced supporting struts
- Bone morphology: trabecular and cortical thinning
- Bone marrow: cellularity, osteoid seam
What is the clinical presentation of osteoporosis?
History:
- Mostly asymptomatic
- May present with minimal fracture/spontaneous fracture
- Vertebral (compression) > NOF > Colle’s fracture > long bones
Examination:
- Fracture
- Possibly thoracic hyper kyphosis and stooped posture
What are the overall investigations you do with suspected osteoporosis?
Biochemical/Laboratory tests:
- Increased ALP = ?osteomalacia
- Ca: hypo= ?osteomalacia, hyper = ?hyperparathyroidism
- Phosphate= low ?osteomalacia
- Creatinine for CKD
- Serum PTH
- TFTs
- Serum testosterone in young men with OP
- Serum electrophoresis (MM)
X-Rays:
- May reveal osteopenia and/or fractures
DEXA:
- Bone density scan
- -1 to -2.5 = osteopenia
- <-2.5 = osteoporosis
What is the DDx for osteoporosis?
Osteomalacia
Secondary causes
Metastases
Multiple myeloma
What is the management of osteoporosis?
- Lifestyle: reduce alcohol, stop smoking, strength and balance training
- Avoid/minimise glucocorticoids
- Calcium and Vit D!!!
Pharmacological:
- 1st: bisphosphonate
- 2nd: denosumab (RANK-L inhibitor)
- 3rd line: teriparatide (synthetic PTH that increases bone formation)
Post-menopausal women: oestrogen and raloxifene (SERM)
Men with hypogonadism: testosterone
