November 18, 2017
Osteoporosis Minimize

Osteoporosis

Osteoporosis is due to a primary loss of bone matrix with no secondary osteoblastic repair process. Plasma concentrations of calcium, phosphate and alkaline phosphatase are normal.

Risk factors for osteoporotic fracture:

  1. Previous fragility fracture - suggests established, but possibly unrecognised, disease
  2. Liver disease
  3. Alcoholism
  4. Malabsorption
  5. Thyrotoxicosis
  6. Rheumatoid arthritis
  7. Male hypogonadism
  8. Primary hyperparathyroidism
  9. Myeloma
  10. Anorexia nervosa
  11. Prolonged immobilisation
  12. Current or planned long term oral corticosteroid use (>7.5mg prednisolone per day for 3 months or more)
  13. Family history of osteoporosis (especially maternal hip fracture)
  14. Early surgical or natural menopause (before age 45 years)
  15. Pre-menopausal amenorrhoea > 6 months not due to pregnancy
  16. Hysterectomy, with at least one ovary conserved, before age 45 - this may affect ovarian function

A diagnostic DEXA scan should be considered in:

Patients on steroids

Controversy exists about the approach to corticosteroid-induced osteoporosis. The guidelines proposed by the National Osteoporosis Society suggest:

  1. for individuals more than 65 years who take >15 mg Prednisolone daily - treat for osteoporosis
  2. for others, consider risk factors and perform DEXA scan if present
  3. if one, or more, strong risk factors are present or bone mineral density T < -1.5 - treat for osteoporosis
  4. if no risk factors, repeat DEXA after 1 year and treat if bone loss > 4% at spine or > 7% at hip

 

Women with:

oestrogen deficiency (menopause, hysterectomy before 45yrs, prolonged secondary amenorrhoea or primary hypogonadism)

if HRT contraindicated and in those who are uncertain about or do not wish to take HRT

clinical risk factors for osteoporosis (see above) at menopause

to identify future fracture risk only in those who are uncertain about or do not wish to take HRT

 

 

Men and women with:

possible secondary osteoporosis (see risk factors above)

all men, and women not taking or uncertain about HRT

previous low impact fracture

if there is uncertainty about diagnosis

height loss or kyphosis

if there is uncertainty about diagnosis ie no vertebral deformity on plain radiograph

x-ray evidence osteopenia

if there is uncertainty about diagnosis

corticosteroid use (>7.5 mg daily for 3 months or more)

to identify fast bone losers or to monitor therapy

References

  

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