How is osteoporosis diagnosed, prevented and treated?
- Good: high index of suspicion in susceptible patients maintained; Dual-energy x-ray absorptiometry (DEXA) diagnostic.
- Bad: faded bones seen on xray (ie advanced osteoporosis as 30% loss of bone does not show up).
- Worst: low energy fracture sustained.
- Primary prevention includes diet supplementation with calcium and vitamin D.
- Pharmaceuticals are typically not used in prevention, but bisphosphonates and raloxifene are approved for preventative use, typically in patients with a DEXA between 2.0 and 2.5.
- Weight bearing exercise also can prevent osteoporosis.
- Avoiding excess alcohol ("excess" defined as "more than I drink") and smoking cessation can also improve bone density.
- Non-Pharmaceutical treatment includes calcium (1500mg daily) and vitamin D supplementation (800 IU daily).
- First-line pharmacologic treatment includes bisphophonates such as alendronate, which inhibit osteoclasts, reducing bone resorption and turnover.
- Estrogen-progestin therapy is now rarely used in postmenopausal women due to cardiovascular side effects.