Osteoporosis
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Osteoporosis is a disease characterised by low bone mass and structural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.
Osteoporosis is the result of osteoclastic bone resorption not compensated by osteoblastic bone formation
Osteoporosis is asymptomatic until fracture occurs.
Osteoporosis is defined by the World Health Organization as a bone mineral density (BMD) of 2.5 standard deviations below the mean peak mass (average of young healthy adults) as measured by dual-energy X-ray absorptiometry (DXA) applied to the femoral neck and reported as a T-score.
Reduced bone density is a major risk factor for fragility fracture. Risk factors for fragility fractures therefore include:
Fragility fractures occur most commonly in the vertebrae, proximal femur (hip) and distal radius but may occur in the humerus, pelvis, ribs and other bones.
Osteoporosis is the result of osteoclastic bone resorption not compensated by osteoblastic bone formation
Osteoporosis is asymptomatic until fracture occurs.
Diagnosis
Diagnosis is confirmed with DXA T-score ≤-2.5
Osteoporosis is defined by the World Health Organization as a bone mineral density (BMD) of 2.5 standard deviations below the mean peak mass (average of young healthy adults) as measured by dual-energy X-ray absorptiometry (DXA) applied to the femoral neck and reported as a T-score.
Fragility fractures
Fragility fractures are fractures that result from mechanical forces that would not ordinarily result in fracture, known as low-level (or 'low-energy') trauma. Low-level force is considered equivalent to that from a fall from a standing height or less.Reduced bone density is a major risk factor for fragility fracture. Risk factors for fragility fractures therefore include:
- Glucocorticoid use
- Advancing age
- Female sex (post menopause)
- Previous fractures
- Family history of osteoporosis
- Smoking
- Alcohol excess
- Endocrine disease including diabetes mellitus, Hyperthyroidism, and hyperparathyroidism
- Chronic disease e.g. CKD, COPD and chronic liver disease
- BMI < 18.5 kg/m2
- Factors that increase falls risk e.g. impaired vision
Fragility fractures occur most commonly in the vertebrae, proximal femur (hip) and distal radius but may occur in the humerus, pelvis, ribs and other bones.
Management
- Lifestyle advice (exercise, diet, reduce alcohol and stop smoking)
- Bisphosphonates (inhibit osteoclast resorption & decrease the risk of hip and non vertebral fractures)
- Raloxifene has established efficacy in decreasing the risk of vertebral fractures.
- Calcium and vitamin D supplementation