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  • Age-related decrease in bone mass: Disrupted microarchitecture

  • Male: female ratio is 1:4

  • Can lead to fractures: vertebral body > hip  > wrist fractures

    • wrist fractures occur most commonly at age 50-60 years

    • vertebral fractures occur most commonly at age 60-70 years 

    • hip fractures occur most commonly at age 70-80 years

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Treatment

  • Life style modification : smoking, alcohol, physical acitivty, weight loss

  • Vit D, Calcium.

    • Daily calcium and Vitamin D requirements are as follows: 

      • Age 1-3yrs - 500mg/d

      • Age 4-8yrs - 800mg/d

      • Age 9-18yrs - 1000 to 1500mg/d  

      • Age >50 yrs- 1200 to 1500 mg/d calcium 

      • 800-1,000 IUs Vit. D

  • Biphosphonate

    • Indication

      • T-score <2.5 at the femoral neck or spine (after exclusion of secondary causes)

      • low bone mass (T-score between -1.0 and -2.5) and 

        • 10-year probability of a hip fracture ≥ 3% or greater or 

        • 10-year probability of a major osteoporosis-related fracture ≥ 20% based on WHO algorithm

    • Oral : pamidronate, alendronate (Fosamax), risedronate (Actonel), zolendronate (Reclast), ibandronate (Boniva)

    • IV

    • side effects: Esophagitis, dysphagia, gastric ulcers, Osteonecrosis of the Jaw, atypical hip fracture (Sub-trochanteric) if taken for long time

  • Teriparatide (Forteo)

    • 1-34 amino terminal residues of parathyroid hormone (1-84)  

    • given by daily subcutaneous injections in case of Severe osteoporosis/high fracture risk or vertebral fracture

    • can induce transcient hypercalcemia, dizziness, nausea, headache

    • contre indicated in Paget disease : Sarcoma

    • cumulative dose: 2 years (risk of sarcoma)

  • Denosumab (Prolia) 

    • Monoclonal Ig2 against RANKL (inhibits binding of RANKL to RANK)

    • given 1 injection of 60mg every 6 months

    • For Postmenopausal women at high risk of fracture

    • side effects : nasopharyngitis, back pain, mandubular osteonecrosis ( ask for dental hygiene)

    • contre indicated in severe hypocalcemia ( pay attention in case of renal diffiency)