Osteoporosis definition

 “Porous bone”
 According to the National Osteoporosis Foundation:
o “Osteoporosis is a bone disease that occurs when the body loses too much bone,
makes too little bone, or both. As a result, bones become weak and may break from
a fall or, in serious cases, from sneezing or minor bumps.”

Osteoporosis across the nation

According to the AAFP:

o Osteoporosis related fractures will affect 1 in 2 white women and 1 in 5 white males
in their lifetime
 African American men and women are less likely to get osteoporosis-
however if they develop it, their fracture risk is the same
o Osteoporosis related fractures have significant impact:
 Loss of function
 Significant cost: $19 Billion dollars annually
 Increased mortality

Diagnosis

 Osteoporosis is a SILENT disease

o You don’t know you have it until you break something, lose height or notice spine
curving forward
 It is diagnosed with a DEXA SCAN:
o Dual energy x-ray absorptiometry
 Screening Guidelines: Women at age 65, Men at age 70
 However, if you are a post-menopausal women over the age of 50 with a fracture, you should
asked to be screened!
 Often blood work may be drawn to rule in/out medical causes of osteoporosis

Risk factors for osteoporosis

 Age
 Female
 Caucasian/Asian
 Weight < 125 lbs
 Family History
 Post-menopausal
 Smoker
 Steroid Use
  Rheumatoid Arthritis
 COPD
 Kidney Disease
 Weight loss (Surgical)
 Cancer
 Stroke
 Hyperparathyroidism
 Thyroid issues
 Eating Disorders
 Premature Menopause
 Low Testosterone
 Liver Disease
 Organ Transplants
 Autoimmune disorders
 Polio
 Non weight bearing status
 Inflammatory Bowel Disease
 MS
 Blood and Bone Marrow Disorders
 Frequent Falls
 Alcohol Abuse
 Hormone Deficiency

What is a fragility fracture?

 Any fracture (broken bone) that has happened due to a state of low bone density or
osteoporosis
o Any women over the age of 50 with a fracture that is not a finger, toe or skull should be
screened
o Men should be screened if there are other risk factors medically or especially a severe
non-traumatic fracture
 REMEMBER: Typically, you don’t fall and break your hip. Your hip breaks and you fall
o Typically, the worse type are vertebral spine fractures and hip fractures

So now you have your DEXA, what’s next?

 DEXA Scan Scores: T- score

o Osteopenia (Stage Prior to Osteoporosis: T-score -1.0 to -2.4
o Osteoporosis: T-score anything less than -2.5
o If you have a fracture and Osteoporosis on DEXA, that is considered SEVERE
Osteoporosis
 o It is very important you see your Primary Care Physician or an Osteoporosis specialist to
discuss treatment
 DEXA scan only needs to be completed every 2 years
o Once treated- you may not need another unless monitoring treatment effect or
treatment had been stopped

Nonpharmacological treatment

 Healthy weight bearing exercise with resistance training

 Balance training
 Stop Smoking
 Vitamin D and Calcium supplements
 Fall prevention at home
 Nutrition
 Decrease alcohol intake
 Prevention starts in Childhood:
o We reach out peak bone mass by our late teens and early 20s
o “Exercise is medicine"

Pharmacological treatment

 Bisphosphonates: Antiresorptive agents- inhibit osteoclastic activity (cells that break down
bone)
o Oral forms: Alendronate Sodium (Fosamax), Ibandronate (Boniva), Risedronate (Actonel)
 Taken once weekly or monthly
 Can cause GI upset
o IV once a year: Zolendronic Acid (Reclast)
 There are new recommendations to take a “Holiday” from treatment after 5 years
 Important to have dental check-ups: very RARE- osteonecrosis of the jaw
 Atypical femur fractures very rare: more common with long term and IV use

Hormone replacement

 Raloxifene: Selective Estrogen Receptor Modulator

 Decreases risk of vertebral fractures only
 Generally, not recommended due to increased risk of blood clot, breast/ovarian cancer

Teriparatide (Forteo)

 Teriparatide. Teriparatide is a recombinant human parathyroid hormone with bone anabolic

activity.
  Decreases vertebral and nonvertebral fractures
 Teriparatide is approved for the treatment of postmenopausal women with severe bone loss,
men with osteoporosis who have high risk of fracture, and individuals whose condition has not
improved with bisphosphonate therapy.
 Daily injection under the skin for 2 years!
o $1,500 a month
 Newer analog on the market: Abaloparatide (Tymlos)

Denosumab (Prolia)

 Denosumab is a human monoclonal antibody that inhibits the formation and activity of
osteoclasts by blocking receptor activator of nuclear factor kappa B ligand
 Decreases hip, vertebral, and nonvertebral fractures compared with low doses of calcium
and vitamin D
 Denosumab appears to be safe for patients with chronic kidney disease stages 1 to 3
 Subcutaneous Shot every 6 months: $881
 If you stop taking it, effect wears off

References

 https://www.aafp.org/afp/2015/0815/p261.html#sec-4
 https://www.nof.org/patients/what-is-osteoporosis/