Osteoporosis


What is osteoporosis?



 Osteoporosis is characterized by reduction in bone mass per unit volume to a level below that required for adequate mechanical support.
 There is no abnormality in ratio of the mineral to organic phase of bone matrix.
 It is also defined as bone density that fall 2.5 standard deviation below the mean for that population.



Causes-





 Nutritional and GIT disorders- malnutrition, malabsorption syndrome, severe liver disease.
 Endocrine disorder- cushing syndrome, thyrotoxicosis.
 Inherited disorder- osteogenesis imperfecta, marfan syndrome, porphyria.
 Drugs-chronic steroid therapy.
 Rheumatoid arthritis, ankylosing spondylitis.



Risk Factors-



 Bone development peaks at the age of 20s to early 30s, after that you start losing bone mass. Women are more likely to get osteoporosis than men because they have less bone mass to begin with and because they lose bone mass after menopause.
Other risk factors include-
➢ Having a small, slender body.
➢ Having a family member with osteoporosis.
➢ Drinking more than two alcoholic drinks per day.
➢ Less intake of calcium and vitamin D.
➢ Taking certain medications, such as steroids, for more than 3 months.
➢ Certain disease conditions such as hyperthyroidism.
➢ Having abnormal menstrual periods or skipped periods, having surgery to remove ovaries before 45 years of age.



Clinical features-





 Fracture is only cause of symptoms in osteoporosis which produce sudden pain.
 Common site of fracture include spine, hip and wrist joint.



Lab Investigations-



 Sarcoplasmic reticulum calcium, alkaline phosphatase, urine calcium.
 Urinary lever of cross linked N-telopeptide of type 1 collagen more than 40nmol/L indicate excessive bone turnover and is feature of osteoporosis.
 Radiograph of spine and pelvis.
 Reduce cortical thickness of bones, increase radiolucency of bone. Vertebra show Codfish appearance.
 Measurement of bone density by CT-scan, ultrasound and DEXA scan.



Treatment-



 Diet should include at least 1 g of calcium and 400-800 IU of vitamin-D.
 Ensure adequate weight bearing exercises.
 Smoking and alcohol should be stopped.
 Reduce fall by taking care of home safety and personal precautions.
 If steroids are required for chronic use, addition of calcium, vitamin D and bisphosphonates.