Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Osteoporosis is trabecular (spongy) and cortical bone lose mass and interconnections despite normal bone mineralization and lab values.

Question 2

What is the most common cause of osteoporosis?

Answer 2

Osteoporosis is most commonly caused by increased bone resorption related to decrease in estrogen levels and old age.

Question 3

What are secondary causes of osteoporosis?

Answer 3

1. Drugs: steroids, alcohol, aniconvulsants, anticoagulants, thyroid replacement therapy
2. hyperparathyroidism
3. hyperthyroidism
4. multiple myeloma
5. malabsorptive syndromes

Question 4

How is osteoporosis diagnosed?

Answer 4

Osteoporosis is diagnosed by a bone mineral density scan (dual energy x-ray absorptiometry –> DEXA) with a T-score of less than or equal to -2.5 or by a fragility fracture of the hip/vertebra.

Question 5

What can be done prophylactically to prevent osteoporosis?

Answer 5

1. weight bearing exercises

2. adequate calcium and vitamin D intake throughout adulthood

Question 6

What are treatment options for osteoporosis?

Answer 6

1. bisphosphonates
2. teriparatide
3. SERMs
4. Rarely calcitonin
5. Denosumab –> monoclonal antibody against RANKL

Question 7

What are complications of osteoporosis?

Answer 7

Vertebral compression fractures –> present with acute back pain, loss of height, kyphosis

Also can present with femoral neck or distal radius (Colles fracture)