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Feedback Rheumatology

Osteoporosis (OP)

Osteoporotic fractures seen in forearm (colles), spine, hip

Etiology + Pathogenesis

  • Defect in obtaining peak bone mas or accelerated bone loss.
  • Peak bone mass is normally achieved b/w 20-40y before gradually declining.
  • Estrogen deficiency (menopause) accelerates bone loss
  • Age related – fat accumulation in BM causes decrease in stell cell differentiation into osteoblasts
  • Genetics – RANK and WNT pathways regulate bone turnover
  • Enviro – exercise, lack of calcium diet, smoking, alcohol
  • Males – hypogonandism, corticosteroids (CS), alcohol
  • Corticosteroids – inhibit osteoblasts and decrease Ca intestinal absorption (leading to 2oHPTH)
  • Pregnancy associated w/ back pain/vertebral fractures
  • Endocrine – HPTH, cushings, hyperthyroidism
  • Drugs – CS, GnTH antagonists, sedatives, alcohol, heparin
  • Inflam disease – IBD, ankylosing spondylitis, RA
  • GIT – malabsorption, chronic liver disease
  • Others – MM, homocysteinuria, anorexia, BMI (<18)

Clinical features

  • Pain, tenderness, deformity, height loss, kyphosis

Diagnosis

  • DEXA  – lumbar spine and hip
  • History – menopause, alcohol, smoking, CS, neoplasia
  • Renal function, LFT,

Treatment

  • Non pharmacological
    • Stop alcohol/smoking, Ca diet, hip protection
  • Pharmacological
    • Bisphosphonates – alendronic acid [10mg]/ risedronate [5mg oral], pamidronate (IV)
      • Inhibit bone reabsorption (bind to hydroxyapatite) and osteoclast function
    • Denosumab – monoclonal-antibody inhibit RANK-L
    • Ca/Vit D (500/800) – used as adjuvants
    • Strontium ranelate – inhibit bone reabsorption
    • PTH – stimulate bone formation
      • Effective in CS induced osteoporosis
    • HRT – SERM , raloxifene (increased risk of embolism)
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