osteoporosis Flashcards
what is it?
metabolic disease with decrease in bone density and changes in the micro-architecture (increased risk of fractures)
WHO def: bone marrow density of adult CT- score below or equal to -2.5 SD; osteopenia is between -1 and -2,4
Age related or associated with conditions or drugs
pathogenesis
● Negative turnover of bone – imbalance between bone formation & resorption.
● Maximum bone stock is achieved at the age 30.
● From 35y, resorption is more active.
● Menopause / adrenopause (activates bone resorption).
● In increasing age – slow down of bone production.
etiology
● Primary osteoporosis (Unknown etiology).
● Secondary osteoporosis (Caused by a known disease / condition
⇨ Endocrine – hypogonadism, amenorrhea, hyperprolactinemia
⇨ GIT- lactate def, hepatopathy, malabsorption sy
⇨ Renal- chronic renal insufficiency
⇨ Rheumatic – immobility, chronic infl disorders
⇨ Neurologic – immobilizing disorders
⇨ Orthopedic – scoliosis, bone fractures
⇨ Drugs – CS, thyroid hormones, heparin, cyclosporins
clinical presentation
● “Silent robber of bone”.
● Vertebral, proximal femur, wrist & proximal humerus fractures.
● Non specific pain of the spine.
● Progression of thoracic kyphosis & decrease of height.
diagnosis
● History.
● Physical examination.
● X-ray (Densitometry) - DEXA is gold standard
● Markers of bone metabolism (ALP, calcium, phosphorus, parathyroid hormone, calcitonin).
prevention
● Diet – higher intake of calcium, vit D, proteins.
● Physical activity.
● Exclusion of known risk factors.
treatment
● Inhibitors of bone resorption: ● Estrogen & its analogs. ● Calcium. ● Calcitonin. ● Bisphosphonates. ● Vit D. ● Parathormon (PTH).