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How is osteoporosis diagnosed, prevented and treated

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How is osteoporosis diagnosed, prevented and treated?
Diagnosis:

  • 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.

     

Prevention:

  • 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.


Treatment:

  • 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.

 

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