OSTEOPOROSIS

DAVIN PANNAAUSTEN

WHAT IS OSTEOPOROSIS?
Osteoporosis which means porous bone is a
generalized disease of bone characterized by a
combination of decreased osteoblastic formation of
matrix and increased osteoclastic resorption of
bone, with a resultant decrease in the total amount
of bone in the skeleton

ETIOLOGY
Endocrine diseases
Hypogonadism
Hypercortisonism
hyperthyroidism

Disuse
Post-menopausal state
Senility
Alcohol abuse

RISK FACTORS

Gender (female>male) 25% vs 12.5%

Amenorrhea
Insufficient calcium in diet
Eating disorders such as anorexia nervosa
Smoking
Excessive consumption of caffeine or alcohol
Inadequate physical exercise
Race (black Africans somehow less prone to age
related fracture, whites and Asians more at risk)

PATHOLOGY

Involves increased bone resorption

Also involves a decrease in bone formation
Both are surface phenomena
Affects trabecular bone more than cortical bone
due to the larger surface area
Thus, osteoporosis is most severe in vertebral
bodies and metaphyses of long bones
Cortical bone eventually becomes thin and porous
as well

PATHOLOGY
This reduction in bone mass causes the bones to
become fragile, instead of becoming soft as in
osteomalacia
As such, even modest stress or low energy trauma
can cause fractures: pathological fractures

X-RAY IMAGING
Generalized rarefaction of all bones, but most
marked in cancellous bone
Thin cortices
Evidence of deformity particularly in vertebral
bodies
In severe cases a fracture or collapse of the spinal
bones may be seen

RAREFACTION OF BONE

BONE MINERAL DENSITOMETRY (BMD)

An imaging technique used to measure bone
density
Expressed in gram per unit area
Method of choice is the dual energy x-ray
absorptionetry (DXA)

INDICATIONS FOR BMD

All women > 65 years
All postmenopausal women< 65 years with other
risk factors
Men with testosterone deficiency
Post-oophorectomy
X-ray features of osteopenia
Patients with hyperparathyroidism,
hyperthyroidism, renal insufficiency, or rheumatoid
arthritis
Patients on long term glucocorticoids, thyroid
hormone replacement, thiazide diuretics
Dietary deficiencies
Checking treatment results

LAB TESTS

Serum calcium and phosphate

Serum bone alkaline phoisphatase
Osteocalcin
Parathyroid hormone activity
Vitamin D activity
Urinary calcium and phosphate
Glucocorticoid levels
Thyroid hormone levels
Estrogen / testosterone levels

PRINCIPLES OF
MANAGEMENT
Osteoporosis cannot be reversed
Therefore treatment is given to slow down or stop
the progression
Any fracture must be managed properly as and
when they happen
Increase mobility to prevent disuse osteoporosis
Avoid prolonged immobilization

MEDICATION
Vitamin D
Calcium
Anti-resorptive medication (biphosphonates,
calcitonin)
Hormone replacement therapy