Diagnosis and Treatment of Osteoporosis

Overview of Osteoporosis

Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue and bone structure, which can lead to increased bone fragility and risk of fracture.

The most common fractures associated with osteoporosis are in the hip, spine, wrist, and shoulder.


Osteoporosis is the major cause of fractures in postmenopausal women and in older men. Fractures can occur in any bone but happen most often in bones of the hip, vertebrae in the spine, and wrist.

Early diagnosis and treatment of osteoporosis is essential to help prevent fragility fractures, which can cause severe pain, long-term disability, and early mortality. The goals of treatment of osteoporosis are to preserve bone mass, prevent fractures, decrease pain, and maintain function.

What are the symptoms & signs of Osteoporosis?

Osteoporosis symptoms can include:

Usually, there are no symptoms of osteoporosis. That is why it is sometimes called a silent disease. However, you should watch out for the following things:

  • Loss of height (getting shorter by an inch or more).
  • Change in posture (stooping or bending forward).
  • Shortness of breath (smaller lung capacity due to compressed disks).
  • Bone fractures.
  • Pain in the lower back.

 

Osteoporosis signs can include:

  • Severe back pain
  • Loss of height over time
  • A stooped posture
  • Bone fractures from minor injury

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Clinical Exams

    • Medical history
    • Physical examination
    • Laboratory tests (Serum 25-hydroxyvitamin-D, calcium, phosphate, magnesium, alkaline phosphatase, creatinine and thyroid-functions test)
  • Dual-Energy X-ray Absorptiometry (DEXA or DXA) for Bone Mineral Density (BMD)

 

The following procedures can be performed to determine bone fractures due to osteoporosis:

  • Bone x-ray
  • CT scan of the spine
  • MRI of the spine

Risk factor modification

·        Proper nutrition.

·        Lifestyle changes.

·        Sunlight exposure.

·        Exercise.

·        Fall prevention to help prevent fractures.

Medications

·        Calcium and vitamin D supplements

·        Bisphosphonates (alendronate, risedronate, ibandronate, zoledronic acid)

·        Raloxifene and bazedoxifene

·        Teriparatide and abaloparatide

·        Denosumab

·        Romosozumab

·        Hormone replacement therapy


For treatment and prevention, ensure adequate intake of calcium and vitamin D, using supplements when necessary, and modify risk factors to help preserve bone mass (eg, with weight-bearing exercise and by minimizing use of caffeine, alcohol, and tobacco). 

The rate of bone loss can be slowed with drugs, but adequate Calcium and Vitamin D supplements and Physical activity are critical to maintaining optimal bone density.

 

Arthritis Organization
Osteoporosis Foundation
PUB Med
American Family Physician Journal
NICE Guidance
This is for informational purposes only. You should consult your clinical textbook for advising your patients.