++
Refers to the increased bone fragility that accompanies ageing and many illnesses. It literally means porous bone and is actually reduced bone mass per unit volume. Densitometry can predict an increased risk of osteoporosis. Osteopenia is low bone density. DEXA, which is the current gold standard, assesses bone mass density (BMD). The BMD ‘T score’ is the number of SDs away from the mean BMD of a 30-year-old adult while the ‘Z score’ is the number of SDs away from the age- and sex-matched BMD.
++
++
Treatment The following medication may be valuable in preventing further bone loss, possibly reversing the osteoporosis process and preventing further fractures.
++
Menopausal hormone therapy (not currently recommended for long-term use) or
Bisphosphonates (decrease bone absorption)
– alendronate* 70 mg (o) once weekly on an empty stomach (take care with potential side-effect of oesophagitis)
– risedronate* 35 mg (o) once weekly or 150 mg (o) once monthly
– zoledronic* acid, single annual IV injection or
Raloxifene—a selective oestrogen receptor modulator 60 mg (o) daily or
Teriparatide (synthetic parathyroid hormone) 2 mcg SC daily
Denosumab* (a monoclonal antibody) 60 mg SC once every 6 mths once Ca intake and vitamin D levels are optimal. Can cause hypocalcaemia, which could lead to heart failure.
++
Anabolic agents such as nandrolone decanoate may reduce further loss but the side effects are problematic.
++
*Recommended by the American College of Physicians who also recommend treatment should last 5 years (oral) or 3 years (annual IV) then usually cease unless recent fracture.
++
Recommendations for prevention—includes regular intake of calcium and vitamin D
++
++
Note: 500 mL calcium-enriched milk contains 1000 mg calcium.
++
Exercise (e.g. brisk walk for 30 mins 4 times/wk)
Lifestyle factors: stop smoking and limit alcohol and caffeine intake
Exposure to sunlight: face, arms and hands (e.g. 5–15 mins/d in warm–hot climate; 25–50 mins/d in winter in temperate climate [check regional recommendations])
Vitamin D supplementation based on s vitamin D (keep ≥75 mmol/L)
Adequate nutrition: keep BMI >19
Attention to falls prevention incl. avoiding sedatives, consider hip protectors