Osteoporosis is the most common metabolic bone disease characterized by low bone mass and increased fragility, leading to a higher susceptibility to fractures, particularly in the dorsal spine. It can be classified into primary and secondary osteoporosis, with various causative factors including aging, hormonal changes, and certain chronic illnesses or medications. Prevention and treatment involve lifestyle modifications, pharmacological interventions like bisphosphonates, and surgical options for advanced cases.

1. Reference literature: G S KULKARNI
Osteoporosis
Neha Sherin,2020 Batch

2. Types of metabolic bone diseases
• OSTEOPENIC DISEASES - decrease in bone matrix.(eg:osteoporosis)
• OSTEOSCLEROTIC DISEASES- increase in bone mass.(eg:fluorosis)
• OSTEOMALACIC DISEASES-diseases characterised by increase in ratio of organic
fraction to mineralised fraction.(eg:osteomalacia)
• MIXED DISEASES-diseases that are a combination of osteopenia and
osteomalacia.(eg:hyperparathyroidism)

3. Osteoporosis
• Commonest metabolic bone disease.
• Definition-Systemic skeletal disease
characterised by low bone mass and
micro architectural deterioration of bone
tissue with a consequent increase in bone
fragility and susceptibility to fractures.
• Diffuse reduction in bone density due to a
decrease in bone mass.
• Rate of bone resorption exceeds rate of
bone formation.

4. Causes
• PRIMARY OSTEOPOROSIS
• SENILITY-commonest cause in males.
• IDIOPATHIC-rare
• POST-MENOPAUSAL
• SECONDARY OSTEOPOROSIS
• PROTEIN DEFICIENCY-old age,illness,malnutrition,protein loss,burns etc.
• ENDOCRINAL-Cushings disease,Cushings syndrome,Hyperthyroid state
• DRUG INDUCED-long term steroid therapy, phenobarbitone therapy
• CHRONIC DISEASES-renal impairment,cirrhosis,rheumatoid arthritis

5. RISK FACTORS

6. Clinical features
• Frequent fractures-DORSOLUMBAR SPINE-most common site
• Increased kyphosis
• Slight loss of height
• Mostly asymptomatic until complications appear.

7. Radiological features
• Loss of vertical height of a vertebra
due to collapse.
• Cod fish appearance:disc bulges
into the adjacent vertebral bodies so
that the disc becomes biconvex.
• Ground glass appearance of bones.
• Singh’s index-grades osteoporosis
into 6 grades based on trabecular
pattern of femoral neck trabeculae.

8. Investigations
• Initial investigations-full blood count,Erythrocyte sedimentation rate,serum
calcium,phosphate,albumin.
• Alkaline phosphatase
• Renal function
• Plain X-rays
• PTH
• Specific investigation-plane radiography,DXA,Quantitative ultrasound,quantitative
computed tomography,MRI,BTM(bone turnover markers)

9. Prevention of osteoporosis
• Exercise
• Nutrition during adolescence
• Drugs at menopause
• Yearly BMD measurement
• Excessive alcohol
• No smoking
• Balanced nutrition -total calcium intake should be increased

10. Pharmacological treatment of osteoporosis
• Bisphosphonates-first line drugs,fracture reduction seen after one year of treatment
• Examples-alendronate(70 mg weekly), Risedronate(35 mg once weekly), Ibandronate(2.5
mg daily)Zoledronic acid(5 mg by IVinfusion over at least 15 min once yearly)
• SERMs- Raloxifene-60 mg daily
• Hormone replacement therapy
• Calcitonin-intranasal dose of 200 IU
• Denosumab
• Strontium ranelate
• Teriparatide

11. Non pharmacological treatment
• Healthy diet,exercise
• Surgical treatment
• Internal fixation
• Total hip replacement
• Percutaneous vertebroplasty and kyphoplasty