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Medical Bulletin

OSTEOPOROSIS

A skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture. Bone strength primarily reflects the integration of bone density and bone quality.

Risk Assessment

After menopause, all women should be evaluated clinically for osteoporosis risk in order to determine the need for BMD testing. In general, the more risk factors a woman has, the greater her risk of fracture.

Major Risk Factors

  • Personal history of fracture as an adult
  • History of fragility fracture in a first degree relative
  • Low body weight (refer to OSTA chart)
  • Current smoker
  • Use of oral corticosteroid therapy for more than 3 months

Additional Risk Factors

  • Sedentary lifestyle
  • Impaired vision
  • Use of medications that can impair balance/proprioception
  • Recent falls
  • Dementia
  • Estrogen deficiency at an early age (<45 yrs)
  • Poor health/frailty
  • Low calcium intake
  • Alcohol in amounts >2 drinks per day

Diagnostic Procedure

  • Bone Mineral Density
  • Quantitative Computed Tomography
  • Biochemical Markers of Bone Turnover

BMD Testing Should Be Performed On

  • All women aged 65 and older
  • Younger postmenopausal women with one or more risk factors
  • Postmenopausal women who present with fractures

Alternative To BMD

  • OSTA (Osteoporosis Screening Tool for Asians) – in conjunction with:
    • Careful assessment of risk factors
    • Lateral spine x-rays

Treatment

  • Treatment f the fracture
    • Non-pharmacologic
    • Pharmacologic
  • Treatment of the osteoporosis
  • Fall Prevention

Monitoring Treatment

  • Patients and physicians should accept treatment of osteoporosis as a life-long commitment
  • It is important to monitor adherence and compliance to therapy and interventions
  • Bone density measurements for monitoring response to therapy should generally be repeated not earlier than 2 years.
  • Biochemical markers can also be used to monitor response to treatment to understand the dynamics of bone turnover.