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Osteoporosis (Risk Factors (Thin - BMI<22, Testosterone low, Alcohol +…
Osteoporosis
Risk Factors
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Hyperthyroidism, hyperparathyroidism
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Erosive bone disease - RA, myeloma
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Aetiology
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Untreated menopause - in menopause there is loss of restraining effects of oestrogen on bone turnover
Investigations
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Bloods: calcium, phosphate and alkaline phosphate all normal
DEXA scan to measure bone mineral density.
1 = normal
-1 to -2.5 = osteopenia
<-2.5 = osteoporosis
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Pathophysiology
In ageing, there is decreased trabecular thickness and a decrease in connections between horizontal trabeculae
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There is high bone turnover: resorption > turnover. Inflammatory cytokines and cortisol increase bone resportion
Epidemiology
230,000 osteoporotic fractures in the UK each year
Prevalence in >50 yrs: male = 6%, female = 18%
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Treatment
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Pharmacological
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Denosumab - monoclonal antibody to RANK ligand, reduces risk of fracture
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Hormone replacement therapy - reduces risk of fractures + stops bone loss. Increases risk of breast cancer + stroke
Teriparatide - PTH analogue, good for those who suffer further fractures despite treatment
Definition
Osteoporosis = reduced bone mass that leads to increase in bone fragility and susceptibility to fracture