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About Osteoporosis

Osteoporosis is a condition of bone thinning with a subsequent increased risk of fracture. It is this increased fracture risk that treatment attempts to reduce.

Common fractures are of the wrist, spine and hip but any low trauma fracture could be secondary to osteoporosis.

Bone thinning is a natural consequence of aging and with our steadily aging population most osteoporotic sufferers will be over the age of 70 years. However there are others who are at increased risk of osteoporosis because of genetic or medical causes. Such groups are summarised in the table. (Table 1) Our indications for DXA scan can be accessed by the link on the LHS. There is no age barrier to referral from DXA scanning but it must be noted that patients require to access the department and to self transfer onto a table. They must be able to lie still for 5 minutes. The total appointment time is around 20 minutes.

The scan report will detail what should be done in terms of treatment and follow up advice. Please note that there is NO automatic follow up for scanning in NHS Grampian-each appointment is a new referral.

Looking for secondary causes of osteoporosis is often suggested in the scan reports. Table 2 details the tests you should consider doing in a patient with unexplained osteoporosis. Your clinical suspicion should indicate which ones you feel are required in individual cases.

Please note that current waiting times for DXA Scan are >30 weeks for a routine referral. (<6 weeks for Dr Grays Hospital, Elgin)

DEXA Scanner

Table1

Secondary Causes of Osteoporosis

Neoplasia

Myeloma

Primary Bone Cancer

Secondary bone Cancer

Endocrine

Thyrotoxicosis

Cushing?s Syndrome

Hypogonadism

Hyper/Hypoparathyroidism

Hypopituitarism

Hyperprolactinaemia

Renal Disease

Chronic Renal Failure

Idiopathic Hypercalcuria

Gastrointestinal Disease

Gastrectomy

Malabsorption

Primary Biliary Cirrhosis/Chronic Active Hepatitis/Cirrhosis

Other Bone Diseases

Osteogenesis Imperfecta

Connective Tissue Diseases

Marfans Syndrome

Ehlers-Danlos

Homocystinuria

Medications

Heparin

Corticosteroids

Depo-Provera

Arimidex/ other antiestrogen therapies

Miscellaneous

Anorexia nervosa

Chronic Alcoholism

Immobilisation

Rheumatoid Arthritis

Table 2

Routine Laboratory Tests to Exclude/Identify Secondary Causes of Osteoporosis

Biochemical

Urea and Electrolytes

Bone Biochemistry

Liver Function Tests

25 hydroxyvitamin D levels

Immunoglobulins and Electrophoresis

Haematological

Full Blood Count

Erythrocyte Sedimentation Rate

Endocrine

Thyroid Function Tests

Testosterone

Sex Hormone Binding Globulin

Estradiol

Follicle Stimulating Hormone and Leutinising Hormone

Prolactin

Endomyseal Antibodies

The world health organisation have specific definitions for osteoporosis based on Standard deviation comparison with young adult mean figures.(Table 3) Whilst these are valuable definitions the overall fracture risk of the individual is the most important assessment when considering who and at what time point therapy is required for fracture prevention. (www.shef.ac.uk/FRAX)

 

Table 3

WHO Criteria for Diagnosis of Osteoporosis in Postmenopausal Women

T-score

Osteoporosis Definition

T -1

Normal BMD

-1 T < -2.5

Borderline osteopenia

T< -2.5

Osteoporosis

T< -2.5 + fragility fracture

Established Osteoporosis