Osteoporosis

Risk factors:

Modifiable:
-inadequate exercise
-low body weight
-in adequate nutrition; cavit. D
-Smoking
-Alcohol abuse
-Medications:

Non-modifiable:
Age
Gender(female)
Race(white and Asian)
Early menopause
Family history of
fractures

Causes
Primary osteoporosis:
Secondary causes of osteoporosis

SECONDARY CAUSES OF BONE LOSS

Cushings Disease
Primary hyperparathyroidism
Hyperthyroidism
Hypogonadism
Multiple myeloma
Osteomalacia
Pagets Disease
Primary hyperparathyroidism
Malabsorption syndromes (gastrectomy)

Slide 4

SECONDARY CAUSES OF BONE LOSS:

MEDICATIONS
Glucocorticoids
Excess thyroid supplement
Anticonvulsants
Methotrexate
Cyclosporine
Heparin

Slide 5

DEFINITIONS OF BONE-LOSS
DISORDERS

Normal :T-score at -1.0 and above

Osteopenia: T-score between -1.0 and -2.5
Osteoporosis: T-score at or below -2.5
Severe or Established Osteoporosis:
T-score at or below -2.5 with one or more
fractures

 If T-score at or below -2.5

Comment on Z score
Z score at or below -2 indicates 2ry
osteoporosis

Lines of treatment
Non pharmacological treatment:
Modification of reversible risk factor.
Exercise

Pharmacological treatment:
Treatment of osteoporosis should start
management of secondary causes if present.
Drug therapy:

with

Vitamin D
Is given to improve absorption of calcium

bisphosphonates
alendronate, ibandronate, risedronate and
zoledronic acid
decreasing osteoclastic activity, decreasing
bone resorption.
Side effects include; nausea, abdominal pain,
oseophageal irritation
All bisphosphonates can affect renal function
and are contraindicated in patients with
estimated GFR below 30-35 ml/min

Calcitonin:

anti-osteoclastic activity and anti-prostaglandin effect.

Miacalcic(synthetic salmon calcitonin)
cibacalcin (synthetic human calcitonin).
IM/SC/ nasal spray is available

RANKL Inhibitor: Denosumab

60 mg every six months as a subcutaneous
injection

 Testosterone is only given in case of

deficiency

THANK YOU