Metabolic bone disease

Osteoporosis

Pathology:                   Osteoporosis is a common condition characterized by low bone mass leading to an increased risk of fractures due to an imbalance between the rate of bone resorption and formation.

Aetiology:                    Primary:

• Type I osteoporosis (postmenopausal osteoporosis) typically affects women aged 50-65 years
• Type II osteoporosis (age-associated or senile) occurs in both women and men over the age of 70 years

Secondary:

• Endocrine-related causes, such as Cushing Syndrome, adrenal insufficiency, multiple myeloma, and corticosteroid use
• Renal failure, alcoholism, and reduced physical activity can also contribute to osteoporosis

Symptoms:    Osteoporosis is usually asymptomatic until a fracture occurs.

Signs:                              Fracture.

Investigations:          Bloods: Blood tests to measure calcium, phosphate, and ALP levels are typically returned as normal.

Imaging: A chest X-ray may indicate the presence of wedge fractures in vertebrae, while DEXA Scanning allows for the assessment of bone mineral density by calculating a T Score which compares an individual's bone density to their peers.

• T-Score >-1 indicates normal bone density
• T-Score -1 to -1.5 is suggestive of osteopenia
• T-Score < -2.5 is indicative of osteoporosis

Treatment:                  Conservative:Conservative treatment options include exercise, ceasing smoking, and an improved diet.

Medical: Medical interventions, such as calcium, vitamin D, and bisphosphonates, oestrogen, and calcitonin may also be prescribed.

Complications:          Fractures are the chief complication of osteoporosis.

Prognosis:                    Early detection of osteoporosis is associated with a good prognosis.