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Osteoporosis



Osteoporosis

Definition

Osteoporosis is a systemic skeletal disorder characterized by low bone mass and micro-architectural deterioration of bone tissue, leading to increased bone fragility and fracture risk.

Etiology

Primary

  • Postmenopausal osteoporosis (estrogen deficiency)

  • Senile osteoporosis (age-related)

Secondary

  • Long-term glucocorticoid therapy

  • Endocrine disorders: hyperthyroidism, hyperparathyroidism, Cushing syndrome

  • Malabsorption, chronic liver or kidney disease

  • Rheumatoid arthritis

  • Prolonged immobilization

Common sites of fracture

  • Vertebrae (compression fractures)

  • Neck of femur

  • Distal radius (Colles fracture)

  • Proximal humerus

Clinical features

  • Often asymptomatic until fracture

  • Back pain due to vertebral collapse

  • Loss of height

  • Kyphosis (dowager’s hump)

  • Fragility fractures after trivial trauma

Diagnosis

Bone Mineral Density (BMD)

Measured by DEXA scan

T-scoreInterpretation
≥ −1Normal
−1 to −2.5Osteopenia
≤ −2.5Osteoporosis

Laboratory findings

  • Usually normal calcium, phosphate, and ALP

  • Helps rule out secondary causes

Radiological features

  • Generalized bone thinning

  • Reduced cortical thickness

  • Vertebral compression fractures (wedge or biconcave vertebrae)

Management

Non-pharmacological

  • Weight-bearing exercises

  • Fall prevention

  • Adequate calcium and vitamin D intake

  • Smoking and alcohol cessation

Pharmacological

  • Calcium + Vitamin D

  • Bisphosphonates (alendronate, risedronate) – first line

  • Denosumab

  • Teriparatide (severe cases)

  • Selective estrogen receptor modulators (raloxifene)

One-line exam point

Osteoporosis causes fragile bones with normal mineralization but reduced bone mass.


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