Osteoporosis

The World Health Organization (WHO) has established criteria for making the diagnosis of osteoporosis, as well as determining levels which predict higher chances of fractures. These criteria are based on comparing bone mineral density (BMD) in a particular patient with those of a 25-year-old female. BMD values which fall well below the average for the 25-year-old female (stated statistically as 2.5 standard deviations below the average) are diagnosed as 'osteo-porotic'. If a patient has a BMD value less than the normal 25-year-old female, but not 2.5 standard deviations below the average, the bone is said to be 'osteopaenic' (means decreased BMD, but not as severe as osteoporosis).

This disease is secondary to a decrease in the actual skeletal bone mass and is commonest in postmenopausal women, especially those over the age of 65 years. The patho-genesis is thought to be related to oestrogen deficiency but many factors ultimately play a role.

The usual presenting symptoms are back pain, generalized bone and joint pain, fractures secondary to relatively minor trauma and increasing kyphosis of the dorsal spine due to vertebral body collapse. Fractures most commonly involve the distal radius and neck of femur.

Radiological changes include cortical and trabeculae thinning, and vertebral body collapse. The skeleton in general becomes more radiolucent.

Treatment once the condition is established is difficult. Prevention involves encouraging a healthy diet and regular exercise to maintain the normal body bone mass as long as possible. Hormone replacement therapy may maintain skeletal mass if instituted around the time of or within 5 years of the menopause. Other treatments include: diphos-phonates, calcium supplements, fluoride supplements and vitamin D metabolites. In general, no treatment is absolutely satisfactory and the complications of the disease tend to be treated as they arise (i.e. bone pain and pathological fractures).

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