CLINICAL SERVICES

Osteoporosis

OSTEOPOROSIS

Osteoporosis is a progressive condition in which bones become weak and more likely to fracture. Bone loss increases dramatically during and after menopause. Men also lose bone mass as they age. 40% of women and 25% of men over age 50 will have an osteoporosis-related fracture in their remaining lifetime. Bones in the hip, spine, and wrist are especially prone to these fractures. Exercise and sufficient calcium and vitamin D help maintain bone strength and prevent fractures. Medical treatment may also be necessary.

INTERNAL MEDICINE

DIABETES

ENDOCRINOLOGY

Hormones and bone disease

Estrogen helps protect bone. Production by the ovaries falls during and after menopause. Estrogen loss may also occur with surgical removal of the ovaries or because of excessive dieting and exercise.

Men produce less testosterone (and estrogen) as they age.  This may also contribute to bone loss.

Bone loss can result from the damaging effects of excess cortisol, as in Cushing’s syndrome.  This may result from a pituitary gland tumour, but more commonly develops as a result of long-term use of corticosteroid medications used to treat inflammatory disorders like rheumatoid arthritis or asthma.

Other hormone imbalances that may increase the risk of osteoporosis include an overactive thyroid gland, diabetes, and hyperprolactinemia, in which the pituitary gland produces too much of the hormone prolactin.

Thyroid cancer survivors whose treatment includes high doses of thyroid hormone also have a higher risk.

Eating disorders, especially anorexia nervosa, increase the risk of osteoporosis. Bone loss occurs partly because of poor nutrition and, in women, partly because the ovaries stop functioning normally, producing less estrogen.

THE RISKS OF DEVELOPING OSTEOPOROSIS INCREASE:

  • In older age groups
  • In those with a family history of osteoporosis
  • In those who have a thin or small build
  • In those who have completed menopause
  • In those of Caucasian or Asian origin
  • In those who have had a fracture as an adult
  • In those whose parent had a hip fracture

OTHER FACTORS THAT MAY INCREASE THE RISK OF BONE LOSS INCLUDE:

  • Amenorrhea (missing periods)
  • Anorexia nervosa
  • An inactive lifestyle
  • A diet low in calcium or vitamin D
  • Low testosterone (hypogonadism)
  • Rheumatoid arthritis
  • Hyperparathyroidism
  • Excessive thyroid replacement therapy
  • Smoking
  • Drinking too much alcohol
  • Certain medications, including some anti-seizure medications, large doses of thyroid hormone, or steroids
  • Certain hormonal conditions (described above)

Those at risk for bone loss, and particularly those who have experienced a fracture after age 50 should have a bone mineral density scan (DEXA). This safe, simple, and non-invasive test measures the amount of bone present in the spine and hips, which helps diagnose osteoporosis or osteopenia. It is recommended that all women of 65 and older, and men of 70 or older, should have a test. It is also recommended that younger postmenopausal women and men aged 50 to 69 with risk factors for osteoporosis should be tested.

Others who need to be tested include:

  • Adults with a condition, such as rheumatoid arthritis, or taking a medication, such as regular corticosteroids, that may contribute to bone loss
  • Anyone whose doctor is considering prescribing osteoporosis drug therapy
  • Postmenopausal women who are discontinuing estrogen therapy

TREATMENT OPTIONS

Good osteoporosis care depends on understanding the causes and knowing the risks.

Prevention and treatment include exercise and a sufficient intake of calcium and Vitamin D.

Medical treatments include:

  • Bisphosphonates (inhibit the breakdown of bone)
  • Denosumab
  • Teriparatide (stimulates bone formation)
  • Selective Estrogen Receptor Modulators (SERMs): Raloxifene
  • Estrogen – where there are other indications for Estrogen treatment
  • Calcitonin – is rarely used as a long term treatment