Rheumatology: Osteoporosis

Question 1

What is osteoporosis?

Answer 1

Low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture

Question 2

What are the risk factors for osteoporosis?

Answer 2

Non-modifiable

• Advanced age (>65 years)
• Female gender
• Caucasian or south Asians
• Family history of osteoporosis-genetic
• History of low trauma fracture (fall from standing height or less, at walking speed or less.

Modifiable

• Low body weight (58 kg or body mass index [BMI] <21)
• Premature menopause (age<45)
• Calcium/vitamin D deficiency
• Inadequate physical activity
• Cigarette smoking
• Excessive alcohol intake (>3 drinks/day)
• Iatrogenic: e.g. corticosteroids, aromatase inhibitors

Question 3

How is a Dx of osteoporosis made?

Answer 3

Dual energy x-ray absorptiometry (DEXA) of the lumbar spine and hip is considered the gold standard for the diagnosis of osteoporosis.

T-score is the number of SDs from the mean bone density of persons of same gender at age of peak density (25 years)

• T-score minus 2.5 or less = osteoporosis
• Normal BMD = T-score ≥ −1
• Osteopenia = T-score between −1 and −2.5

Question 4

Outline how osteoporosis is managed?

Answer 4

Osteopenia

• Weight-bearing exercise
• Vitamin D3 supplementation (800-2000 IU/day)
• Limiting alcohol, and smoking cessation
• Dietary advice regarding calcium intake; supplements if needed.

Osteoporosis

• Vitamin D ± calcium supplementation plus:
• 1st line: Oral bisphosphonates (inhib osteoclasts), or IV if oral not tolerated
• 2nd line: Denosumab or teriparatide