Osteoporosis

Data gathering

  • Red flags – weight loss, night sweats
  • Others – fractures, menopause
  • Examine – BMI

 

Clinical management

  • Investigations
    • FRAX score +- DEXA
    • Bloods – FBC, U+Es, LFTs, TFTs, calcium, phosphate, vitamin D, LH, FSH, testosterone
  • Explanation –
    • DEXA scan looks at how strong your bones are
    • -1 to -2.5 means your bones are slightly less dense and strong than normal
    • less than -2.5 means you have osteoporosis where your bones are less dense and strong, meaning they are easier to break
  • Treatment
    • Lifestyle – increase calcium, reduce alcohol, increase weight bearing exercises, stop smoking
    • Calcium, vitamin D
    • Alendronic acid (if confirmed osteoporosis or if 75+fragility fracture)

NB:

  • Risedronate if alendronic acid not tolerated
  • FRAX, who to consider
    • previous fragility fracture
    • post menopausal women
    • oral steroids (>7.5mg over three months)
    • all women > 65
    • all men > 75
  • If high risk – start alendronic acid + adcal
  • If low risk – DEXA + adcal