Osteoporosis: Treatment, symptoms, advice & help

About Osteoporosis

Osteoporosis is reduced bone density, which leads to an increased risk of fracture.

Osteoporosis: Incidence, age and sex

The prevalence of osteoporosis increases with age, reflecting the fact that bone density declines with age, especially in women. It affects 30% of women and 12% of men at some point in developed countries and is a major public health problem.

Causes and prevention of osteoporosis

Osteoporosis can occur because of a defect in attaining peak bone mass and/or because of accelerated bone loss. Environmental factors such as exercise and calcium intake during growth and adolescence are important in maximizing peak bone mass and in regulating rates of post-menopausal bone loss. Smoking has a detrimental effect on BMD. Heavy alcohol intake is a recognised cause of osteoporosis and fractures. Early menopause (below the age of 45 years) is a particularly important risk factor. Genetic factors are probably important in the 50% of cases. Corticosteroid is an important cause of osteoporosis which relates to dose and duration of corticosteroid therapy.

Signs & symptoms of osteoporosis: Diagnosis

Patients with osteoporosis are asymptomatic until a fracture occurs. Osteoporotic spinal fracture may present with acute back pain or gradual onset of height loss and kyphosis with chronic pain. Peripheral osteoporotic fractures present with local pain, tenderness and deformity, often after an episode of minimal trauma. Many patients present with incidental osteopenia on an X-ray performed for other reasons. The pivotal investigation is a dual energy x-ray absorptiometry (DEXA) at the lumbar spine and hip. The DEXA provides an image of the region studied, a BMD measurement (expressed as grams of hydroxypatite/cm2) and T-score and Z-score values.

Osteoporosis: Complications

The most important complication is fracture particularly involving the hip and vertebrae. In patients with hip fracture, the affected leg is shortened and external rotated and vertebral fracture may cause disabling pain.

Osteoporosis: Treatment

Drug treatment should be considered in patients with BMD T-score values below -2.5 or below -1.5 in corticosteroid induced osteoporosis. Bisphosphonates inhibit bone resorption by binding to hydroxyapatite crystals on the bone surface. Alendronate is the bishosphonate used most frequently. It reduces risk of vertebral fracture by 50% and non-vertebral fractures by about 25% in post-menopausal women with osteoporosis. Resedronate is an alternative with similar efficacy, but may be better tolerated in patients with a history of gastrointestinal upset. Calcium and vitamin D have limited efficacy. PTH is an anabolic agent that works by stimulating new bone formation. PTH is expensive and is usually reserved for patients with severe osteoporosis (BMD T-score of -3.5 to -4.0 or below) and those who have failed to respond adequately to other treatments. Surgery is frequently required to reduce and immobilise osteoporotic fractures.