Osteoporosis
Pathophysiology/Etiology
-- Type 2 (senile): results from decreased formation of bone and decrease renal production of 1,25(OH)2 D3 occurring late in life
-- This results in loss of cortical and trabecular bone and increased risk for fractures of the hip, long bones, and vertebrae
Signs/Symptoms
Diagnostic Tools
-- Osteopenia: -1.1 to -2.4
-- Osteoporosis: -2.5 or less
Risk Factors
Treatment
Prevention
Differential Diagnosis
- Primary: deterioration of bone mass related to aging
-- Type 2 (senile): results from decreased formation of bone and decrease renal production of 1,25(OH)2 D3 occurring late in life
-- This results in loss of cortical and trabecular bone and increased risk for fractures of the hip, long bones, and vertebrae
- Secondary (Type 3): accompany various endocrine & metabolic disorders
Signs/Symptoms
- Hallmarks: asymptomatic decrease bone loss and bone mineral density
- Fractures: vertebral, hip, wrist
Diagnostic Tools
- Diagnosis determined with bone mineral density (BMD) by dual-energy x-ray absorptiometry (DXA)
-- Osteopenia: -1.1 to -2.4
-- Osteoporosis: -2.5 or less
Risk Factors
- Current age
- Gender
- Low body mass index
- A prior osteoporotic fracture
- Parental history of hip fracture
- Oral glucocorticoids >5 mg/d or prednisone for > 3 months
- Current smoker
- Alcohol intake (3+ drinks per day)
- Rheumatoid arthritis
- Secondary osteoporosis
- Femoral neck BMD
Treatment
- Estrogen therapy
- Medication
- Fall risk reduction
- Hip protectors and other assistive devices
- Psychosocial support
Prevention
- Medication: Alendronate, Ibandronate, Resedronate, Raloxifene
- Diet rich in calcium and vitamin D
- Smoking cessation
- Fall prevention
- Exercise
Differential Diagnosis
- Vitamin D deficiency: 25-hydroxyvitamin D blood level <16 ng/ml
- Hypercalciuria: urinary calcium excretion > 250 mg/24 h
- Hyperparathyroidism: PTH blood levels < 40 pg/ml