Osteoporosis

Osteoporosis is the loss of bone tissue - both the matrix and the mineral.

On a dexa scan -2.5 below standard deviation is osteoporosis.

Better density - 0 to -2.5 = osteopenia.

Median of Healthy white females at 35 is the reference point.

Bisphosphonates reduce osteoclastic action and are most useful to reduce nonvertebral and vertebral fractures. S/E – GERD, Need to be erect and not eat/drink x 30 min.

Recombinant PTH (Forteo) is a new drug and is also helpful. – max duration 2 years therapy for severe osteoporosis only.

Raloxifene (Evista) – vertebral fx reduction. (Selective estrogen receptor modulator)

Hormone replacement only prevents and does not treat already established osteoporosis.

Salmon Calcitonin (Miacalcin) nasal spray – for those at least 5 yrs past menopause and cannot take oral agents. Only helps vertebral Fractures.

Screening –

more than 65 yrs females

Over 60 for risk factrs.

ETOH

Smoking

Hormonal dysfunction – oophrectomy, post menopausal

F/H

Low body weight

Calcium and Vit. D deficiency

Long term glucocorticoids >3 mo steroid at dose more than 5 mg/day prednisone equivalent – start bisphosphonates regardless of T score.

In osteomalacia, the matrix remains but mineral is lost  it is found in Rickets (Vit D deficiency).