Osteoporosis Recorded Lecture

Osteoporosis Overview

• Osteoporosis is a condition characterized by low bone mass leading to increased fragility and risk of fractures.

• Common fractures occur in:

  • Vertebrae

  • Proximal femur (hip)

  • Distal forearm (wrist)

• Majority of fractures in older adults are due to low bone mass.

• Individuals often remain unaware of their condition until a significant fracture occurs.

Disease Process

• Bone Health: Important for life, necessitating awareness and education for prevention of fractures.

• Osteoporosis results from a decrease in bone mass where the rate of bone resorption exceeds the rate of bone formation.

Bone Remodeling

• Involves two main cell types:

  • Osteoblasts: Build new bone by synthesizing collagen and minerals.

  • Osteoclasts: Break down old bone (bone resorption), releasing calcium into the bloodstream.

• Bone remodeling follows a continuous cycle of resorption and formation, maintaining bone health and mineral balance.

• Normal Bone vs. Osteoporotic Bone: Osteoporotic bone is characterized by thin, weak structures.

Risk Factors

• Majority of osteoporosis risk factors are non-modifiable:

  • Gender (females more prone)

  • Genetics

  • Age

  • Past fracture history

• Modifiable factors include:

  • Diet (calcium and vitamin D intake)

  • Physical activity

  • Smoking and alcohol consumption

• Screening: Many individuals over age 65 have never been screened for osteoporosis.

Diagnosis

• Bone Mineral Density Test (DEXA scan): Most effective method to diagnose osteoporosis.

• T-scores indicate bone density compared to young healthy individuals:

  • Normal: T-score ≥ -1

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

  • Osteoporosis: T-score ≤ -2.5

Treatment Strategies

• Aim to decrease bone resorption and increase bone formation.

• First-Line Treatments:

  • Bisphosphonates:

    • Commonly prescribed to inhibit osteoclast activity.

    • Administered orally, with bioavailability affected by foods such as orange juice and coffee.

    • Side effects: GI issues, hypocalcemia, and contraindications in specific patient populations.

  • Selective Estrogen Receptor Modulators (SERMs):

    • Raloxifene: Mimics estrogen effects on bone without some risks (e.g., blood clots).

    • Indicated primarily for postmenopausal women.

    • Side effects: Hot flashes.

• Calcitonin:

  • Used occasionally, primarily for women at least five years post-menopause.

  • Inhibits osteoclast activity, reducing calcium and phosphate release from bones.

Hormonal Regulation of Bone Health

• Parathyroid Hormone (PTH):

  • Increases osteoclast activity to release calcium into the blood when serum calcium is low.

• Calcitonin:

  • Released when calcium levels are high, reduces osteoclast activity.

• Vitamin D:

  • Enhances calcium absorption from the gut, essential for bone health.

Supplementation and Lifestyle

• Encourage lifelong adequate calcium and vitamin D intake:

  • Calcium supplementation should typically include vitamin D for proper absorption.

• Emphasize weight-bearing exercises to help build bone density.

Patient Education

• Educate patients on dietary sources of calcium and how to read nutrition labels for calcium content.

• Discuss the importance of understanding individual risks and available assessments like the ten-year fracture risk calculator.

• Physical Activity: Stress the significance of activities that add weight to bones—strength training and jumping rather than low-impact exercises like swimming.