Definition

A disease characterised by low bone mass and deterioration of bone architecture, which increases the susceptibility to fractures.

The ultimate goal of osteoporosis therapy is to prevent fractures.

Bone Density Measurement

Use the same machine for follow up measurements.

T score
T = 0 value equal to young normal same sex. T = -1 equals one deviation below the mean.
T= - 2.5 or below, osteoporosis!

Investigation of Osteoporosis

X-Ray

To confirm fracture - can be suggestive but is not diagnostic of osteoporosis.

BMD

DEXA - Best technique. Measure hip and spine.

Pathology

* Extensive testing not required.

* Initially measure calcium LFTs (incl Alk Phosph), Creatinine, FBC ESR.

*Further testing according to clinical indicators:

• 25-OH Vitamin D.
• thyroid function.
• sex steroids.
• Intact PTH (ionised calcium may suffice).

Treatment

HRT

Still the gold standard for the menopausal and immediately post menopausal woman because of other benefits e.g. symptoms, effect on lipids, sexual functioning. brain function.

SERMS Raloxifen (Evista) Authority required.

Actions

• Selectively activates E receptors in bone.
• Reduces bone turnover towards premenopausal levels.
• Increases bone density in spine and hip
• Reduction in vertebral fracture risk.

Other Effects

• May increase flushing and other menopause symptoms.
• No effect on endometrium (c.f. tamoxifen which may increase cancer rate).
• No effect on breasts therefore may reduce breast cancer risk.
• Increased risk of thrombo-embolism (same as HRT).
• Favourable effect on lipid profile..reduces LDL.
• Can use calcium Vit D as well.
  

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