osteoporosis
Neck of femur fracture pathways exist to integrate good frailty care with ortho...
| Low bone density | |
|---|---|
| Etiology | - lack of physical stress on bones - lack of vitamin C - postmenopausal ↓ oestrogen - Cushing's syndrome - malnutrition |
| Epidemiology | Risk factors include: previous fragility fracture, current/frequent recent use of oral corticosteroids, history of falls, BMI <18.5 kg/m2, smoker, alcohol >14 units/week, etc |
| Clinical presentation | Have this slightly ominous sentence from BMJ best practice: "Osteoporosis is asymptomatic until fracture occurs." |
| Pathogenesis | ↓ bone mass (i.e. bone matrix) = ↓ osteoblastic activity |
| Diagnostic investigations | DEXA |
| Management | Lifestyle advice: regular exercise, diet, ⛔️ smoking/alcohol Pharm: - Ca, Vit D supplementation - bisphosphonates - first line for post-menopausal osteoporosis and glucocorticoid-associated osteoporosis. If not tolerated: raloxifene, denosumab (RANKL inhibitor) - r/v after 5y of treatment Treat without assessment if: women with previous fragility fracture, OR anyone age>70 on high dose corticosteroids |