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Osteoporosis

Osteoporosis is a common metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures. It is most prevalent in postmenopausal women and older adults. Risk factors include low peak bone mass in youth, advanced age, loss of sex hormones, nutritional deficiencies, smoking, excess alcohol, and family history of fractures. The condition results from an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Diagnosis is made through DEXA scans to measure bone mineral density, with treatment focusing on lifestyle changes, calcium and vitamin D supplementation, medications to reduce bone resorption like bisphosphonates, and

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169 views16 pages

Osteoporosis

Osteoporosis is a common metabolic bone disease characterized by low bone mass and structural deterioration of bone tissue, leading to bone fragility and an increased risk of fractures. It is most prevalent in postmenopausal women and older adults. Risk factors include low peak bone mass in youth, advanced age, loss of sex hormones, nutritional deficiencies, smoking, excess alcohol, and family history of fractures. The condition results from an imbalance between bone resorption by osteoclasts and bone formation by osteoblasts. Diagnosis is made through DEXA scans to measure bone mineral density, with treatment focusing on lifestyle changes, calcium and vitamin D supplementation, medications to reduce bone resorption like bisphosphonates, and

Uploaded by

ldw627
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Osteoporosis

Overview
Introduction
Epidemiology
Definitions
Risk Factors
Pathophysiology
Differential Diagnosis
Workup
Treatment
Case Presentation
Introduction
Most common metabolic abnormality of bone
Important health issue because fractures can lead to:
Chronic pain
Loss of independence
Loss of function
Mortality
Peak bone mass achieved by 30 years of age
Lose 1% of bone mass every year
Peak Bone Mass
Epidemiology
Affects 10 million people in the US
8 million women
2 million men
1.5 million fractures per year due to osteoporosis
34 million people in the US with osteopenia
Higher prevalence in Asians
Lower prevalence in African Americans
85% of nursing home women over age 80
Definitions
Osteoporosis
Compromised bone strength predisposing to an increased risk of
fractures
WHO: Bone mineral density (BMD) > 2.5 standard deviations (SD)
below mean of young healthy adults
Osteoporosis Is NOT synonymous w/ decreased BMD.
Small bone size, unfavorable macro-architecture, cortical porosity
Osteopenia
WHO: BMD between 1-2.5 SD below the mean
Risk Factors
Low peak skeletal density in young adulthood
Advanced age
Loss of steroid hormone production
Menopause, hypogonadism, long-term glucocorticoid therapy
Nutritional deficiencies
Low body weight
Family history of hip fracture
Smoking
Excess alcohol intake
Pathophysiology
Imbalance between bone resorption and bone formation
Genetic (80 genetic loci that influence BMD)
RANKL osteoclast formation
WNT osteoblast formation
Estrogen
Promotes osteoblast differentiation
Inhibits osteoclast differentiation
Calcium and Vitamin D deficiencies increase PTH
Glucocorticoid excess
Inhibits osteoblast differentiation
Differential Diagnosis
Postmenopausal osteoporosis
Hyperparathyroidism
Senile osteoporosis (>70 yo)
Calcium/Vit D insufficiency
Immobilization
Hypercortisolism
Malignancy



Workup
Labs
Calcium
Phosphorus
Alkaline phosphatase
PTH
Estrogen levels

Workup
Imaging
Dual-energy x-ray absorptiometry (DEXA) scan
Hip, spine or forearm
United States Preventative Services Task Force (USPTF)
Women > 65 yo or <65 yo w/ risk factors
National Osteoporosis Foundation
Men >70 yo or 50-69 yo w/ risk factors
T score compared BMD to young adult in same range
More useful for predicting fracture risk
Every 1 SD decrease DOUBLES risk of fracture risk
Z score compares BMD in same age

Treatment
Medications
Calcium (1000-1200 mg/day for premenopausal women and
adult men)
Vitamin D (400-800 IU/Day) for postmenopausal women
Calcium (1000-1200 mg/day)
Estrogen replacement
Bisphosphonates (osteoclast apoptosis)
Caution for severe esophagitis
Empty stomach, upright for 30 min
SERM
Denosumab
Monoclonal antibody that inhibits osteoclast differentiation
Treatment
Weight bearing physical activity
Decrease bone loss
Improve coordination and muscle strength
Fall Prevention
Vision correction
Home safety evaluation
References
Manolagas, Stavros C. "Pathogenesis of Osteoporosis." UpToDate
(2013): N. pag. Web. 4 Aug. 2013. http://www-uptodate-
com.proxy.westernu.edu/contents/pathogenesis-of-
osteoporosis?detectedLanguage=en&source=search_result&search=
osteoporosis&selectedTitle=10~150&provider=noProvider
Drezner, Marc. "Overview of the management of osteoporosis in
postmenopausal women." UpToDate (2013): N. pag. Web. 4 Aug.
2013. http://www-uptodate-
com.proxy.westernu.edu/contents/overview-of-the-management-
of-osteoporosis-in-postmenopausal-
women?detectedLanguage=en&source=search_result&search=oste
oporosis&selectedTitle=1~150&provider=noProvider


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