Osteoporosis is a medical condition in which the bones become brittle and fragile from loss of tissue, typically as a result of hormonal changes, or deficiency of calcium or vitamin D.
Prevention:
Some life style changes can be done to prevent osteoporosis, including the following:
1.maintain an adequate calcium and vitamin D levels is the first step in preventing osteoporosis.
Post-menopausal females should have a calcium intake of 1200 mg/ day as a total level from both food and calcium supplements. Calcium supplements can be taken as 500-1000 mg daily with meals. Vitamin D supplements may be needed to maintain D3 blood level of 30-60 ng/ml.
2. Limit alcohol intake to less than 2 servings daily
3. Limit caffeine intake
4. Moderate exercise 30 minutes daily
5. Avoid smoking
Screening:
Who should screen for osteoporosis?
1. Female 65 years and older.
2. Younger postmenopausal women with fractures risk factors (Prior low-trauma fracture as an adult, Advanced age, Low bone mineral density Low body weight or low body mass index, Family history of osteoporosis, Use of corticosteroids Cigarette smoking Excessive alcohol consumption Secondary osteoporosis)
Diagnosis:
Osteoporosis is diagnosed using a central dual-energy x-ray absorptiometry (DXA) measurement.
In the absence of fracture, osteoporosis is defined as a T-score of -2.5 or below in the spine, femoral neck, or total hip.
Osteoporosis is defined as the presence of a fracture of the hip or spine.
Pharmacological treatment:
Once patient is diagnosed with osteoporosis (history of a hip or spine fracture, No fractures but with a T-score of -2.5 or lower, Patients with a T-score between -1.0 and -2.5 if FRAX major osteoporotic fracture probability is ≥20% or hip fracture probability is ≥3%)
Bisphosphonates:
Bisphosphonates are first-line therapy for postmenopausal osteoporosis. We prefer oral bisphosphonates as initial therapy because of their efficacy,long term safety data and low cost.
In cases of intolerance to gastrointestinal side effects, we can use IV zaledronic acid, which has been demonstrated to reduce vertebral and hip fractures.
also, denosumab can be used as initial therapy in certain patients at high risk for fracture, such as older patients who have difficulty with the dosing requirements of oral bisphosphonates, patients unresponsive to other therapies and in those with impaired renal function.
Strontium ranelate can be used by women who cannot tolerate or are unable to take oral or intravenous bisphosphonates.
raloxifen is used for patients who cannot tolerate any bisphosphonates or for women with osteoporosis and increased risk of invasive breast cancer.
Other therapies:
Tibolon:
Tibolone, a synthetic steroid whose metabolites have estrogenic, androgenic, and progestagenic properties and can be used for osteoporosis management.
Growth factors:
Only effective in patients with growth hormone deficiency.
Monitoring:
Health care practioners should monitor the patient for the following:
1. Adherence to therapy
2. Calcium and vitamin D levels
3. DXA of hip and spine after two years, and continous monitoring according to response
4. Biochemical markers including fasting urinary N-telopeptide (NTX) or serum carboxy-terminal collagen crosslinks (CTX)