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DEFINITION
Bone quality
architecture, turnover, damage accumulation, and
mineralisation of the bone
Epidemiology
2
Estrogen deficiency
Estrogen deficiency accelerates bone loss in
postmenopausal women.
Estrogen deficiency can lead to excessive
bone resorption accompanied by
inadequate bone formation.
Osteoblasts, osteocytes, and osteoclasts all
estrogen receptors.
Aging
In contrast to postmenopausal bone loss,
which is associated with excessive
osteoclast activity, the bone loss that
accompanies aging is associated with a
progressive decline in the supply of
osteoblasts in proportion to the demand.
After the third decade of life, bone
resorption exceeds bone formation
Calcium deficiency
CLASSIFICATION
Primary Osteoporosis
Postmenopausal osteoporosis.
Accelerated bone loss related to oestrogen
deficiency
Secondary osteoporosis
RISK FACTOR
Clinical Presentation
Diagnosis
Investigations
The main aims of investigations are to:
1. Confirm the diagnosis of osteoporosis
2. Assess fracture risk
3. Exclude secondary causes
Specific investigations
Densitometry
BMD measurement gives an accurate reflection of
bone mass and helps in establishing the diagnosis
of osteoporosis
use race-specific reference ranges when available
results are reported as
T-scores (comparison with the young adult mean)
The risk of fracture is increased two fold for each SD
reduction of T-score in BMD
Quantitative computed
tomography (QCT)
an alternative technique for measuring
bone density in the axial skeleton and
vertebral volumetric bone density
The main limitations are the lack of
availability in Malaysia and a higher
radiation dose compared to DXA
Monitoring of Therapy
PREVENTION OF OSTEOPOROSIS
AND FALLS
Nutrition
I. Calcium
II. Vitamin D
>50 years old or older, the Malaysian
Recommended Nutrient Intake
advocates 400 IU of vitamin D per
day, but many experts recommend at
least 800 to 1000 IU per day
Exercise
Regular
The
Prevention of falls
o
MANAGEMENT OF
OSTEOPOROSIS
I. Hormonal therapy (HT)
ii. Bisphosphonates
III. Calcium
In established osteoporosis, calcium
supplementation alone is not adequate for
fracture prevention. However, calcium
supplementation is necessary for optimal
response to other
treatment modalities
V. Calcitonin
Calcitonin has also been shown
to have an analgesic effect for acute pain
in osteoporosis related vertebral fractures
Side effects of calcitonin include nausea,
flushing, vomiting and nasal irritation.
Reference
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