Osteoporosis

Definition

Osteoporosis is the bone disease, characterized by the decrease of bone mass and microstructural deterioration of bone tissue, with the consequent increase in the risk of fractures (1991)

Skeletal disorder characterized by the commitment of bone resistance, predisposing to increased risk of fractures (2000).

Risk factor’s

Not Modifiable

  • Advanced age
  • Woman over 45 years old
  • Postmenopausal women

Modifiable

  • Sedentary
  • Consumption of alcohol
  • Tobacco use
  • Malnutrition (low calcium intake)

How is Osteoporosis classified?

Primary Osteoporosis

  • Youth
  • Postmenopausal
  • Senile

Secondary Osteoporosis

  • Endocrinopathies
  • Gastrointestinal diseases
  • Connective tissue diseases
  • Medicines
  • In-mobilization
  • Bone marrow disease

Classification of the WHO according to BMD. 1994

  • Normal: Greater than Tscore -1
  • Osteopenia: Tscore between -1 and -2.5
  • Osteoporosis: Tscore less than -2.5
  • Severe or established osteoporosis: Tscore less than -2.5 with associated fragility fracture.

Fracture Mechanisms

Lost Bone Speed

  • The faster the bone mass is lost, the more fragile it is made and therefore it is easier to break it.
  • Bone loss can be measured by densitometry.
  • In women, the greatest bone loss occurs after menopause.
  • In men, bone mass is lost constantly throughout adult life.

Falls

  • They are the second factor necessary for a fracture to occur
  • One out of every 100 falls in elderly people produces a major fracture, such as the femur.
  • Factors that predispose falls

Mechanism of fall (reflex mechanisms)

  • Young people tend to fall forward, support with one hand (Wrist Fracture).
  • The older ones fall inertly, without reflex reaction to the fall and hit on the hip (Fracture of Femur)

Amortization Fabrics

  • Obese people, who have an adipose panniculus on the hip, have more protection than thin ones

Bone mass reached in youth

  • Bone mass increases from birth to adulthood.
  • The higher the bone mass is reached, the higher the level from which you start to lose in menopause.

Genetic Factors

  • In recent years the importance of genetic factors has been demonstrated.

Diagnosis

Osteoporosis is difficult to suspect since there are no obvious symptoms until a fracture occurs

The densitometry is currently the Gold Standard

The laboratories that must be requested depend on the possible cause that is suspected, discarding any secondary cause.

What region should be measured to perform the diagnosis?

  • NOF and ISCD recommend measuring hip and lumbar spine, taking the lowest value for diagnosis
  • Consider L1 to L4, avoiding the vertebrae with artifact. It is not valid in artorisi and / or aortic classification
  • BMD of the femur neck is the best predictor of hip fracture.
    The forearm serves in obese

Densitometry (BMD)

It measures density, inferring bone strength, correlates with risk of fracture, being a strong independent predictive factor.

Criteria US Preventive Task Force

  • Menopausal woman over 65 years
  • Menopausal woman under 65 with risk factors
  • Premenopausal man or woman with fragility fracture
  • Treatment that interferes with bone metabolism

Measurement of BMD

  • Central DEXA (hip and spine, can also measure forearm.) Useful for diagnosis and treatment follow-up International guidelines are based on this method.
  • DEXA peripheral (population)
  • pQCT / QCT
  • QUS (Ultrasound)

Use of DEXA for monitoring

  • Older women with normal BMD do not need to repeat DEXA
  • Women with risk factors and normal BMD, repeat at 5-10 years
  • Patients with border and risk values, repeat 2-3 years
  • Patients on treatment repeat at 2 years (Medicar) (Complication?)
  • Patient with corticosteroids, Every 6 months

Treatment

Who should be treated

  • There is no evidence of a Tscore value indicating need for treatment
  • In each patient, the BMD value must be combined with the individual characteristics (fracture risk factors, drug effectiveness, adverse effects and costs)
  • Post-menopausal women (PM) with previous osteoporotic fracture
  • PM women without fracture who have ≥1 risk factors and Tscores ≤-2.0
  • Women PM without fracture and without risk factors with Tscore ≤-2.5
  • Premenopausal women and men with osteoporosis
  • Patients who have chronic treatment with corticosteroids

The first thing that must be done to start an osteoporosis treatment is to make a lifestyle change:

  • Improve nutrition
  • Perform exercise
  • Prevent falls in patients with high risk
  • Use hip protectors
  • Pharmacotherapy

Pharmacotherapy

Antiresorptive

  • Bisphosphonates
  • Estrogens
  • Serms (raloxifene)
  • Calcitonin
  • Denosumab

Anabolic

  • Teriparatide (PTH)
    Strontium ranelate

Bibliography

1. Harrison. (2012).Principios de Medicina Interna(18 ed., Vol. 2).(D. L. Longo, A. S. Fauci, S. L. Hauser, J. L. Jameson, J. Loscalzo, Edits., & H. P. Medicine, Trad.) New York: Mc Graw Hill.

2. Robins y Cotran. (2010). Patología Estructural y funcional(8 ed.). (V. Kumar, A. k. Abbas, N. Fausto, J. C. Aster, Edits., & S. GEA Consultoría Editorial, Trad.) Barcelona, España: Elsevier.

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Osteoporosis
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