Osteoporosis: Concept, Classification, and Treatment

Osteoporosis: Concept, Classification, and Treatment

Osteoporosis is a condition characterized by decreased bone density and weakened bone quality. This leads to increased risk of fractures, resulting in serious complications.

# 1. Concept of Osteoporosis:

• Reduced bone density: Bones become thinner and more brittle due to mineral loss.

• Weakened bone quality: Bone structure, turnover, mineralization, accumulated damage, and the properties of bone matrix are all affected.

# 2. Classification of Osteoporosis:

• Primary Osteoporosis:

• Type 1: Postmenopausal osteoporosis, commonly observed in women aged 50-60 years, a few years after menopause.

• Type 2: Senile osteoporosis, seen in both men and women above 70 years of age.

• Secondary Osteoporosis: Caused by other underlying factors, such as medications or diseases.

# 3. Characteristics of Osteoporosis:

• Type 1 Osteoporosis:

• Caused by estrogen deficiency.

• Mineral loss in trabecular bone, manifesting as vertebral compression fractures, spinal fractures, and Colles fractures.

• Type 2 Osteoporosis:

• Affects both men and women over 70 years old.

• Mineral loss occurs in both trabecular and cortical bone, often leading to hip fractures.

• Commonly associated with decreased calcium absorption and reduced osteoblast function.

# 4. Risk Factors for Osteoporosis:

• Age: Bone density naturally declines with age.

• Estrogen Deficiency: Especially in postmenopausal women.

• Nutritional Factors: Inadequate calcium and vitamin D intake.

• Physical Activity: Lack of exercise reduces bone-building stimulation and bone mass.

• Genetics: Family history of osteoporosis.

• Underlying Medical Conditions: Certain diseases can impact bone density, including hypercortisolism (Cushing’s syndrome), hyperparathyroidism, hyperthyroidism, multiple myeloma, and bone metastases.

# 5. OSTA Index:

• Evaluates the risk of postmenopausal osteoporosis based on the intersection of weight and age.

• Significance:

• Moderate to high risk: Bone mineral density (BMD) testing is recommended.

• High risk: Early anti-osteoporosis medications should be considered.

• Low risk: BMD testing is only required if other risk factors are present.

# 6. Causes of Secondary Osteoporosis:

• Medications: Long-term use of corticosteroids, long-term heparin therapy, etc.

• Diseases: Hypercortisolism, hyperparathyroidism, hyperthyroidism, multiple myeloma, bone metastases.

# 7. Clinical Presentation of Osteoporosis:

• Often asymptomatic.

• Symptoms only manifest when complications arise:

• Vertebral compression fractures.

• Spinal deformities.

• Fractures.

# 8. Spinal X-ray Findings in Osteoporosis:

• Early Stages: Increased radiolucency in the vertebrae, with a possible “toothcomb” appearance: Transverse bony trabeculae are absent, while vertical trabeculae remain.

• Late Stages: Vertebral deformities.

# 9. When Is Osteoporosis Clearly Visible on X-ray?

• When bone mass loss exceeds 30%.

# 10. Meunier Index:

• Not a diagnostic tool, but rather an assessment of osteoporosis severity.

• Categorizes the degree of concavity on the upper vertebral surface: Unilateral concavity, bilateral concavity, wedge-shaped, and tongue-shaped collapse.

# 11. Biochemical Characteristics During New Vertebral Compression Fractures:

• Erythrocyte sedimentation rate (ESR) can increase to 30mm, and alkaline phosphatase levels may slightly increase but both usually normalize within a week.

# 12. Significance of Bone Mineral Density Measurement Devices:

• Ultrasound: Primarily for screening purposes.

• Dual-Energy X-ray Absorptiometry (DEXA): Diagnostic value.

# 13. T-score Scale:

• Osteoporosis: T-score < -2.5

• Severe Osteoporosis: T-score < -2.5 with one or more fractures.

• Osteopenia: T-score between -1 and -2.5

# 14. Definitive Diagnosis of Osteoporosis:

• Gold standard: BMD measurement.

• Other methods: Detected in later stages when complications are present, or in postmenopausal women with these symptoms:

• Reduced height compared to adolescence.

• Spinal deformities, kyphosis.

• Vertebral compression fractures or osteoporosis on X-ray.

• Fractures from minimal trauma or no trauma at all.

# 15. Non-pharmacological Treatment Options:

• Exercise, Physical Activity: Strengthens muscles, leading to stronger bones.

• Calcium and Vitamin D-rich Diet: Supports bone formation.

• Fall Prevention: Particularly important for individuals at high risk for osteoporosis.

• Back Brace: When spinal deformities are present.

# 16. Indications for Treatment to Reduce Fracture Risk:

• Postmenopausal women over 65 years of age with >= 2 risk factors.

• Postmenopausal women with fractures.

• Postmenopausal women with T-score <-2 and no risk factors.

• Postmenopausal women with T-score <-1.5 and risk factors.

# 17. Groups of Medications for Osteoporosis:

• Calcium and Vitamin D3 Combination: Provides essential minerals for bone health.

• Bisphosphonates: Inhibit bone resorption and promote programmed osteoclast apoptosis. First-line treatment, most effective in osteoporosis and corticosteroid-induced osteoporosis.

• Alendronate foxamat (10mg/day or 1 tablet 70mg/week)

• Risedronate actonel (5mg/day or 1 tablet 35mg/week)

• Ibandronate drofen 150mg/week; taken 60 minutes before meals

• Zoledronic acid-aclasta: Intravenous injection once per year

• Calcitonin: The only anti-osteoporosis drug that reduces pain.

• Indications: New fractures, mild osteoporosis.

• Miacalcic administered intramuscularly or intranasally.

• Selective Estrogen Receptor Modulators (SERMs): Mimic estrogen action, inhibiting bone resorption similarly to estrogen.

• Raloxifen.

• Parathyroid Hormone:

• Forsteo.

• Possesses bone-building capabilities.

• Contraindicated in osteoporosis with cancer risk.

# 18. Characteristics of Bisphosphonates:

• Inhibit bone resorption and promote programmed osteoclast apoptosis.

• First-line treatment, most effective in osteoporosis and corticosteroid-induced osteoporosis.

# 19. Efficacy and Contraindications of Zoledronic Acid:

• Reduces fracture rates, increases bone mineral density, prevents recurrent fractures, and rapidly alleviates spinal pain from vertebral compression fractures due to osteoporosis.

• Contraindications: Serum creatinine levels > 35ml/p.

# 20. Precautions When Using Zoledronic Acid:

• Infusion duration > 15 minutes.

• Ensure no hypocalcemia prior to infusion.

• Drink plenty of fluids before and after infusion.

• Paracetamol or ibuprofen can be taken before or after administration to minimize flu-like side effects.

# 21. Calcitonin:

• The only anti-osteoporosis drug that reduces pain.

• Indications: New fractures, mild osteoporosis.

• Miacalcic administered intramuscularly or intranasally.

# 22. SERMs:

• Mimic estrogen action, inhibiting bone resorption similarly to estrogen.

• Raloxifen.

# 23. Parathyroid Hormone:

• Forsteo.

• Possesses bone-building capabilities.

• Contraindicated in osteoporosis with cancer risk.

Osteoporosis is a serious condition that can lead to significant complications. Prevention and timely treatment are crucial for protecting bone and joint health.