(Endocrine & Metabolic) (Medicine of Elderly) (GP)

Overview

• Skeletal disease characterised by low bone density and micro-architectural defects in bone tissue, leading to increased bone fragility and susceptibility to fractures
• F>M (4:1), age of onset 50-70 yrs old
• Primary Osteoporosis (most common) → postmenopausal osteoporosis (decreased oestrogen leads to increased bone resorption due to increased osteoclast activity), senile osteoporosis (gradual loss of bone mass as patients age), rheumatoid arthritis

(Oestrogen stimulates osteoblasts and inhibits osteoclasts hence has protective role on bone strength)

Osteoporosis in a man ⇒ check testosterone

• Secondary Osteoporosis → drug induced (long term corticosteroid therapy, or anticonvulsants, anticoagulants, PPIs), hypogonadism, hyperthyroidism, cushings syndrome, immobilisation, hyperparathyroidism, thin
• Risk Factors → tobacco smoking, malabsorption, malnutrition (low calcium and vitamin D), low body weight

Making Diagnosis

Clinical Features:

• Usually asymptomatic until fracture occurs
• Fragility Fractures → pathological fractures caused by everyday-activities or minor trauma
• Back Pain → Vertebral fracture is most common

Investigations: