This document discusses the management of osteoporosis. It defines osteoporosis as a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones. It identifies several risk factors for osteoporosis including age, gender, diet, lifestyle, and family history. The diagnosis involves physical exams, bone mineral density tests, and imaging. Treatment aims to reduce pain, slow bone loss, and prevent fractures through medications, exercise, nutrition, and fall prevention. Pharmacological treatments include hormones, bisphosphonates, and anabolic agents.

2. Management of Osteoporosis
Presented By,
Dr. Sajid Hasan
MBBS
Army Medical College Chattogram

3. What is Osteoporosis?
 Osteoporosis is a systemic skeletal disease characterized by
low bone density and micro architectural deterioration of bone
tissue with a consequent increase in bone fragility.

4. Causes
 Low calcium diet
 Lack of physical activity
 Positive family history
 Gender: More in female
 Ethnicity: Asian & White people are more likely to be affected by
osteoporosis.
 Gastrointestinal surgery
 Estrogen deficiency in post menopausal women
 Hyperthyroidism
 Smoking

5. Risk Factors
 Nonmodifiable:
a) Advance age
b) Female gender
c) White/Asian race
d) Low peak body mass
e) Family history of osteoporosis
f) Personal history of fracture
g) Low body mass index
 Modifiable:
a) Smoking
b) Inadequate Calcium intake
c) Inadequate Vitamin D intake
d) Low body weight (BMI <21)
e) Estrogen deficiency
f) Hypogonadism
g) Chronic Glucocorticoid therapy

6. Symptoms of Osteoporosis
Usually, there are no symptoms of osteoporosis. That is why it is
sometimes called a silent disease. However, some patient may have
following symptoms:
 Loss of height (getting shorter by an inch or more).
 Change in posture (stooping or bending forward).
 Shortness of breath (smaller lung capacity due to compressed disks).
 Bone fractures.
 Pain in the lower back.

7. Diagnosis
Diagnosis can be done by:
 Physical examination
 Bone Mineral Density (BMD)
 Duel-energy X ray Absorptiometry (DEXA)
 Ultrasonic measurement of bone
 MRI
 Radiograph

8. Management of Osteoporosis
Goals of treatment
 Control pain from the disease
 Slow down or Stop bone loss
 Prevent bone fractures with medicines that strengthen bone
 Minimize the risk of falls that might cause fractures.

9. Management of Osteoporosis
Cont..
Osteoporosis management involves both pharmacological & Non
pharmacological measures-
 Non Pharmacological Approach:
 Smoking cessation
 Moderation of alcohol intake
 Adequate dietary calcium intake
 Exercise
 Vitamin D
 Fall Prevention
 Good nutrition
 Minimization of Glucocorticoids

10. Management of Osteoporosis
Cont..
Pharmacological Approach:
 Hormone replacement therapy.
 Selective estrogen receptor modulators.
 Calcitonin
 Bisphosphonate
 Denosumab: It is a human monoclonal antibody that inhibits the formation
and activity of osteoclasts by blocking receptor activator of nuclear factor
kappa B ligand
 Anabolic agents: Teriparatide. It is a recombinant human parathyroid
hormone with bone anabolic activity
 Sclerostin inhibitors: Romosozumab, Blosozumab

11. Management of Osteoporosis
Cont..
There are also some exercises for prevention of osteoporosis
a) Weight bearing exercise – Walking, Jogging, Playing tennis
b) Resistance exercise – Stretch bands, Free Wt lifting, Wt machine
c) Balance exercises – Yoga
d) Riding a stationary bicycle
e) Using rowing machine
f) Postural retraining – Improves core muscle strength at back

12. Prevention of Osteoporosis
From a young age, both men and women can take steps to prevent
osteoporosis by making sure that they –
 Have a healthy and varied diet with plenty of fresh fruit, vegetables and
whole grains.
 Eat calcium-rich foods.
 Absorb enough vitamin D.
 Avoid smoking.
 Limit alcohol consumption.
 Limit caffeine.

13. Take Home Messages
 Osteoporosis is a progressive metabolic bone disease that decreases
bone density with deterioration of bone density.
 Osteoporosis has a major impact on a individual’s quality of life.
 Physical exercise & movements with appropriate sunlight exposure is an
important preventive tools specially in childhood.
 The treatment of osteoporosis consists of life style measures &
pharmacologic therapy.

14. References:
1) https://www.mayoclinic.org/diseases-conditions/osteoporosis/symptoms-
causes/syc-20351968
2) https://www.nhs.uk/conditions/osteoporosis/#:~:text=Osteoporosis%20is%2
0a%20health%20condition,broken%20wrist
3) https://my.clevelandclinic.org/health/diseases/4443-osteoporosis
4) https://www.aafp.org/pubs/afp/issues/2015/0815/p261.html