Osteoporosis is a systemic skeletal disease characterized by low bone mass and deterioration of bone tissue, leading to fragile bones that are prone to fracture. It is primarily caused by age-related bone loss after peak bone mass has been achieved. Diagnosis involves excluding secondary causes, and may include blood tests, imaging like DEXA scans to measure bone mineral density. Management focuses on lifestyle factors like nutrition, exercise, and medications to prevent bone loss and fractures.

1. OSTEOPOROSI
S
& OTHER METABOLIC BONE DISEASES
DSL

2. OSTEOPOROSIS
Greek
(Osteo)(poro)(osis) – (Bone)(Porous)(Condition)

3. Definition
‘Systemic skeletal disease characterized by
1)Low bone mass and;
2)Micro-architectural deterioration of bone
tissues
with a consequent increase in bone fragility and
susceptibility to fracture.’

4. Aetiology
Primary osteoporosis
1) Juvenile
2) Post-menopausal (Type I)
3) Senile (Type II)
Secondary osteoporosis
1) Congenital
2) Hypogonadal states
3) Endocrine disorders
4) Deficiency states
5) Inflammatory diseases
6) Haematologic and
neoplastic disorders
7) Medications
8) Miscellaneous

5. Risk Factors
• Advanced age (>50)
• Female
• White / Asian ethnicity
• Family history
• Small stature (wt.<57kg)
• Amenorrhoea
• Early menarche / late
menopause
• Physical inactivity
• Use of certain drugs
• Alcohol and tobacco use
• Androgen / oestrogen
insufficiency
• Calcium deficiency

6. Age & Bone Mass

7. WHO working group Classification of
Osteoporosis
Normal BMD within 1 SD of young adult reference
range (T score > -1).
Osteopenia BMD more than 1 SD but less than 2.5 SD
below the young adult mean (T score
between -1 and -2.5).
Osteoporosis BMD of 2.5 or more below the young
adult mean (T score ≤ 2.5).
Severe Established Osteoporosis BMD value of 2.5 SD or more below the
young adult mean with the presence of a
or more fragility fractures.
* BMD – Bone Mineral Density
* T score: comparison with young adult mean

8. Complications

9. Diagnosis
1) Clinical Presentation
Mostly asymptomatic; incidentally found after a
fracture
- Increasing dorsal kyphosis (Dowager’s hump)
- Low-trauma fracture
- Loss of height
- Back pain

11. 2) Exclusion of secondary causes
-Careful history
-Physical examination (Low body weight, loss of
height, kyphosis, tenderness over vertebrae)

12. 3) Investigations
(a)General
FBC, ESR, serum calcium, phosphate and
albumin, alkaline phophatase, RFT, plain X-rays
(osteoporosis apparent only >30% of bone loss
has occurred)
(b) Others – as indicated
FT4, TSH, testosterone, FSH, LH, etc.

13. (c) Specific Investigations
- Densitometry

15. Monitoring
• Regular clinical assessments
• DEXA every 1 -2 years
• Dietary counselling

16. Prevention
1) Nutrition
(a) Balanced diet with
adequate calcium
- 1000 mg for men (19-
65) and women (19-50)
- 1300 mg for
adolescents (10-18),
postmenopausal
women (>50) and men
(>65).

17. Prevention
(b) Vitamin D
-Exposure to sunlight >15
min / day
-Otherwise 800IU Vit D
supplement daily.

18. 3) Body weight
- Maintain BMI of not less than 19 kg/m2
4) Exercise
-Regular physical activity
-Weight-bearing exercises
5) Pharmacological agents
-HRT, SERMs, bisphosphonates
Prevention

19. Management
1) Hormone Replacement Therapy (HRT)
- Oestrogen therapy for prevention and treatment.
- Absolute CI: Undiagnosed vaginal bleeding, severe liver
disease, hx of venous thromboembolism in past 12
Type of oestrogen Dose
Conjugated Equine Oestrogen 0.625 mg
Oestradiol Valerate 2.0 mg
Transdermal oestradiol 50 μg to 100 μg
Micronised oestradiol 1.0 mg
Tibolone 2.5 mg

20. Management
2) Selective Oestrogen Receptor Modulator
-Eg. Raloxifene, 60 mg daily
-Improves and preserves bone density of hip and
spine.
-Alternative to HRT.
-Has been demonstrated to reduce vertebrae
fracture.
-Adverse effects: Hot flushes, leg cramps, increased
risk of deep vein thrombosis.

21. Management
3) Bisphosphonates
-Eg. Alendronate, 10 mg daily
Etidronate, 400 mg daily
-Increases bone mineral density and prevents
fractures.
-Adverse effects: Gastrointestinal side effects
(oesophageal / gastric irritation)

22. Management
3) Calcitonin
-Eg. 200IU intranasal daily
-Anti-resorptive agent
-Analgesic effect for acute pain relief in
osteoporotic fractures
-Adverse effects: Nausea, flushing, vomiting,
nasal irritation.

23. • Excessive parathyroid hormone resulting in
abnormal calcium homeostasis
HYPERPARATHYROIDISM

24. Effects on bone
• Osteopenia from chronic
excessive bone resorption
• In severe cases – osteitis
fibrosa cystica
- Subperiosteal resorption
of the distal phalanges
- Tapering of the distal
clavicles
- Salt-and-pepper
appearance of the skull
- Brown tumour of long
bones

25. • Vitamin D is important for calcium
homeostasis
• Increases the efficiency of calcium absorption
from the small intestine
• Enhances absorption of phosphorus from the
distal small bowel
• Both important for proper bone
mineralization
VITAMIN D DEFICIENCY

26. Effects on bone
• Rickets – in children
before growth plate
fuses – leg bowing
• Osteomalacia – in
adults, presents as
poorly mineralized
skeletal matrix –
periosteal bone pain

27. • “Brittle/fragile-bone disease”
• Generalized disease of connective tissue due
to qualitative or quantitative reduction in type
1 collagen
OSTEOGENESIS IMPERFECTA

28. • Localized disorder of bone remodelling
• Begins with excessive bone resorption
followed by an increase in bone formation
• Structurally disorganized bone – susceptible to
fracture
Phases: 1) Lytic
2) Mixed lytic and blastic
3) Sclerotic
PAGET DISEASE

29. Effects on bone
• May be monostotic /
polyostotic
• Axial skeleton – pelvis
and spine
• Mostly asymptomatic,
if not – bone pain,
manifestations of
complications
(deafness, nerve
palsies)

30. • “Marble bone disease”
• Failure of osteoclasts to
resorb bone
• Due to various gene
mutations
• Impaired bone modelling
and remodelling
• Skeletal fragility despite
increased bone mass –
thick, dense, sclerotic
bone
OSTEOPETROSIS