Characteristics

• A systemic skeletal disease characterised by low bone mass and microarchitectural deterioration of bone tissue (Am. J. Med., 94 646–650 1993).

• Increased bone fragility and susceptibility to fracture (Am. J. Med., 94 646–650 1993).

• Pathology – increased resorption compared to formation of bone.

• Post-menopausal women most affected.

• Prevalence increases with age – but senile osteoporosis differs from post-menopausal osteoporosis, although this is not fully understood.

• Racial differences likely to relate to higher starting bone density.

• Family history may be positive.

Clinical features

• Usually diagnosed secondary to a fracture.

• Co-morbid medical conditions increase the likelihood of a fracture secondary to osteoporosis. For example, poor balance and falling sideways increases the risk of hip fracture six-fold compared to other directions.

• Exclude eating disorders in the young patient.

• Look for primary and secondary amenorrhoea, adequate calcium uptake and drug treatments, e.g. steroids.

• Common fracture sites are the femoral neck, vertebrae and distal radius.

• Vertebral fractures are often asymptomatic and discovered incidentally.

• Kyphosis and loss of height can occur following vertebral crush fractures.

• See Trauma section for clinical features.

Radiological features

• Bone density is difficult to interpret on plain radiographs, hence the use of the term osteopaenia to describe the relative bony lucency.

• See Trauma section for individual fractures.

• DEXA (dual energy X-ray absorptiometry) is the current investigation of choice for the diagnosis of osteoporosis – measured as the standard deviation from the ‘normal’ range.

Management

• Aimed at prevention, preventing progression and treating complications.

• Prevention should begin early in life with education regarding good nutrition, weight-bearing exercise and limiting alcohol intake.

• Fall prevention is useful in the elderly.

• Group resistance exercise classes in athletic amenorrhoea are useful.

• Supplementary calcium and vitamin D.

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