Osteoporosis

Overview/prevalence

Osteoporosis is an illness where bone mineral density and mass decreases or when the strength of the bone and the structure changes, leading to an increased risk of fractures. 

This is a major cause of fractures in the postmenopausal and older men population.  

Risk Factors

The risk of getting osteoporosis increases as you age. 

Osteoporosis is more common in women than men, specifically non-Hispanic white women and Asian women. 

There are certain medications that may also increase the risk of developing osteoporosis, such as some cancer medications and corticosteroids. 

Women that are slender and thin-boned are at a higher risk of osteoporosis. 

Those with a family history are more prone to getting osteoporosis. 

Symptoms

There are no symptoms of osteoporosis until there is a fracture. The most common type being a vertebral fracture. Also common are hip fractures, which increases in risk as you get older. 

Diagnosis

The diagnosis of osteoporosis is based on getting a fragility fracture or the results of a DEXA scan. A fragility fracture is when forces that would not typically give a fracture, gives a fracture. The largest risk factor for a fragility fracture is low bone density. If there is no fragility fracture then a DEXA scan should be used to diagnose Osteoporosis. If there is a fragility fracture a DEXA scan should still be done to see how severe it is and to also monitor the response to therapy.

The USPTF recommends that all women 65 years old and older be screened for osteoporosis with bone measurement testing. They screening postmenopausal women less than 65 years old if they are at increased risk of getting osteoporosis. 

It is recommended that postmenopausal women with a fragility fracture or DEXA results showing osteoporosis should be further evaluated with labs, specifically vitamin D, CBC and CMP. 

Treatment

Once diagnosed with osteoporosis it is recommended to 

-stop smoking 

-have adequate intake of vitamin D 800 IU and calcium 1200mg
-exercise 

-avoid heavy alcohol intake 

-review fall prevention

Medication management is recommended for those with a diagnosis of osteoporosis. The initial treatment for a postmenopausal woman is bisphosphonates. If someone is allergic or unable to take this type of medication, the next step of medicines would be dependent on the risk of fracture.