Osteoporosis

1. 1
Osteoporosis

2. 2
Vertebral column

3. 3
Vertebrae

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Osteoporosis
•A reduction of bone mass or the presence of a
fragility fracture
•WHO osteoporosis: a bone density that fall 2.5 SD
below the mean for young healthy adults of the same
race and gender
•WHO osteopenia : a bone density that fall 1-2.5 SD
below the mean for young healthy adults of the same
race and gender

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Osteoporosis

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Osteoporosis
•PATHOGENESIS
•1. Peak bone mass : about 20 years old
- genetic, hormone, nutrition, life style
•2. Rate of bone loss : after age 30-45, bone
resorption (osteoclast)> formation (osteoblast) and
become exaggerated after menopause
(50 years old)
•3. Bone remodeling : keep balance at 20-30 years
old, after that become negative balance

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Osteoporosis
• Type 1 Type 2 Type 3
Postmenopausal Senile secondary
•Age 55 -70 years 70-90 years all
•Sex(F/M) 6:1 2 :1 1:1
•Fx site vertebrae vertebrae vertebrae
distal forearm hip hip
distal forearm
•The threshold for Fx is reduced for osteoporotic
bone

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Disease associated with
increased risk of osteoporosis
•1. Hypogonadal states : Turner syndrome,
Klinefelter syndrome
•2. Endocrine disorder : Cushing’s syndrome, hyper
PTH, thyrotoxicosis
•3. Nutritional and GI disorder : malnutrition
•4. Rheumatologic disorder : RA
•5. Hematologic disorder/malignancy : MM,
lymphoma, leukemia
•6. Inherited disorder : osteogenesis imperfecta
•7. Other disorder : immobilization, COPD

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Drugs associated with increased
risk of osteoporosis
•- Glucocorticoids
•- Cycosporine
•- Cytotoxic drugs
•- Anticonvulsants
•- Excessive alcohol
•- Excessive thyroxine
•- Heparin
•- Lithium

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Risk factor for osteoporosis
fracture
•Nonmodifiable
1. Hx of Fx in first degree relative
2. Female (lower peak bone mass and
menopause)
3. Advanced age
4. Caucasian , white
5. Dementia

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Risk factor for osteoporosis
fracture
•Potentially modifiable
1. Cigarette smoking
2. Low body weight ( < 58 kg.)
3. Estrogen deficiency : early menopause
(<45 years)
4. Low calcium intake, high salt and protein diet
5. Alcoholism
6. Inadequate physical activity
7. Poor health

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Measurement of bone mass
•1. Dual energy x-ray absorptiometry (DEXA)
- standard for measuring bone density
- hip, spine, wrist
•2. Quantitative computed tomography
- expensive, greater radiation exposure
•3. Ultrasound
- low cost, use as screening procedure
•Plain radiography not noticeable until 30 % of
bone mineral is lost

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Bone mineral density (BMD)
should be measured in
1. Post menopausal women > 65 years old.
2. Post menopausal women < 65 years who
have 1 or more risk factor.
3. Post menopausal women with Fx.
4. Women who considering therapy by using
BMD decision.
5. Women who have been HRT for long time.
6. Men who experience Fx after minor trauma.
7. Evidence of osteopenia/osteoporosis on film.

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Management of osteoporosis
•1. Risk factor reduction
•2. Nutritional recommendations
–Calcium, vitamin D
–Avoid salt, caffeine, excessive protein
intake
•3. Exercise
•4. Protective pads

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Management of osteoporosis
•5. Pharmacologic therapies
A. Estrogens (prevention & Rx)
B. Selective estrogen response modulator
(SERMs) prevention & Rx :Tamoxifen,
Raloxifene
C. Biphosphonates (prevention & Rx) :
Alendronate, Risedronate
D. Calcitonin : Rx, pain relief effect, not
indicated for prevention
E. Parathyroid hormone, fluoride

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Spine compression fracture in
osteoporosis
•Compression Fx may be caused by trauma,
osteoporosis, malignancy, infection
•Found 25 % in women over 50 years old and 40
% in women 80 years old
•Many cases found incidental during CXR
•Causes : - Hx of trauma
- No Hx of increased force on spine
- stepping out bathtub, lifting trivial
object, bending forward, raising window (in
severe osteoporosis)

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Spine compression fracture in
osteoporosis
•Fx site : any where ( in trauma usually at T11,12
and L1)
•Symptoms : - 1/3 are symptomatic, sudden
back pain
- sudden injury – severe pain
- collapse in gradual –
mild pain
- chronic pain – change in spine
alignment, muscle spasm

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Spine compression fracture in
osteoporosis
•Investigation
•1. Plain radiography : may not
differentiate between old and recent
fracture.
•2. MRI can determine
–Old v.s. recent Fx
–Osteoporosis v.s. malignancy

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Spine compression fracture in
osteoporosis
•Investigation
•3. Bone scan :
–help determine acuity of Fx

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Spine compression fracture in
osteoporosis
•Management
•1. Rest
•2. Analgesic, NSAID
•3. Calcitonin
•4. Brace

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Spine compression fracture in
osteoporosis
•Management
•5. Vertebroplasty
•6. Surgical Rx