Definition of Osteoporosis
Osteoporosis is characterized by low bone mass, microarchitectural disruption, and skeletal fragility, leading to decreased bone strength and an increased risk of fracture. The decrease in bone strength is related to many factors besides bone mineral density (BMD), including bone formation and resorption rates (turnover), bone geometry (size and shape of the bone), and microarchitecture.
Clinical Manifestations
Low-trauma fractures are the main clinical manifestation of osteoporosis. Fragility fractures are those that occur spontaneously or following trauma that would not normally result in a fracture, such as a fall from a standing height or less. Osteoporosis has no signs or symptoms until a fracture occurs, such as in the ilio-pubic area. Complications of fractures include pain, deformity, disability, and loss of height.
Diagnosis
A clinical diagnosis of osteoporosis can be made in any of the following contexts:
- Fragility fracture – A clinical diagnosis of osteoporosis can be made in the presence of a fragility fracture, particularly in the spine, hip, distal radius, humerus, ribs, and pelvis, regardless of BMD.
- BMD – In the absence of a fragility fracture, BMD assessment by densitometry is the standard test for diagnosing osteoporosis, according to the World Health Organization (WHO) classification. A T-score ≤ -2.5 (i.e., at least 2.5 standard deviations below the mean for a young adult reference population) is consistent with a diagnosis of osteoporosis, whether or not there is a fragility fracture.
- High fracture risk – Patients with low bone mass (osteopenia ; defined as a T-score between -1.0 and -2.5) who do not meet either of the first two criteria, a clinical diagnosis of osteoporosis can also be made based on a high estimated fracture risk. We use the Fracture Risk Assessment Tool (FRAX) to estimate fracture risk. The online FRAX tool provides a country-specific 10-year probability of major osteoporotic fracture, using clinical risk factors and BMD when available. In the United States, for example, a clinical diagnosis of osteoporosis can be made when the 10-year FRAX probability of a major osteoporotic fracture is ≥ 20 percent or the 10-year probability of hip fracture is ≥ 3 percent.
Evaluation of Osteoporosis
All postmenopausal women with osteoporosis should undergo a history, physical examination, and basic laboratory evaluation. Initial laboratory studies should include a complete blood count (CBC), biochemical profile, and 25-hydroxyvitamin D.
The need for further laboratory evaluation depends on the initial assessment and Z-score. Women with abnormalities on initial laboratory tests, suspicious findings on history or physical examination suggesting a secondary cause of osteoporosis, or Z-scores ≤ -2 may require further evaluation for these secondary causes.
Treatment for Osteoporosis
The treatment of osteoporosis primarily aims to prevent fractures, slow bone loss, and increase bone mineral density (BMD). Here are the different therapeutic options available for the treatment of osteoporosis :
- Lifestyle modifications:
- Consume a balanced diet rich in calcium and vitamin D.
- Engage in regular moderate-impact physical activities (walking, swimming, etc.) to strengthen muscles and stimulate bone formation.
- Avoid smoking and limit alcohol consumption.
- Medication treatment
- Surgical treatment
The treatment of osteoporosis should be tailored to each patient's case, based on age, sex, medical history, and disease severity. It is important to consult a specialized doctor to assess your fracture risk and determine the most appropriate treatment for you.
Source: UpToDate