Osteoporosis, AIIMS, AIPGME, PGI
Osteoporosis, AIIMS, AIPGME, PGI
    • Osteoporosis
      • characterised by a diffuse reduction in the bone densitydue to a decrease in the bone mass.
      • rate of boneresorption exceedsthe rate of bone formation.
    • Causes
      • Commonest factor in males issenility and in females is menopause (MCQ)
    • Clinical features
      • Dorso-lumbar spine is the most frequent site
      • fractures whose aetiology has been linked to underlying osteoporosis(MCQ)
        • Colles’ fracture
        • fracture of the neck of femur.
      • A slight loss of height and increased kyphosis due to compression of the anterior part of the vertebral bodies is seen in most cases.(MCQ)
    • Radiological features
      • about30 per cent of the bone mass must be lost before it becomes apparent on X-rays (MCQ)
      • Following features may benoticed on X-rays:(MCQ)
        • Loss of vertical heightof a vertebra due tocollapse,
        • Cod fish appearance: (MCQ)
          • The disc bulges into theadjacent vertebral bodies so that the discbecomes biconvex.
        • Ground  glass   appearance  of  the  bones,conspicuous in bones like the pelvis.(MCQ)
        • Singh’s index:
          • Osteoporosis is graded into 6 grades based on the trabecular patternof the femoral neck trabeculae.
        • Metacarpal index and vertebral index are othermethods of quantification of osteoporosis.
    • Biochemistry:
      • Serum calcium, phosphates andalkaline phosphataseare within normal limits (A very important MCQ)
      • Total plasma proteins and plasma albuminmay be low.
    • Densitometry:
      • This is a method to quantifyosteoporosis
      • DEXA scanis an X-ray based bone densitometry, and is thegold standard in the quantification of bonemass.(MCQ)
    • Neutron activation analysis:
    • Bone biopsy.
    • Treatment
    • Medical treatment: (MCQ)
      • High protein diet:
      • Calcium supplementation
      • Androgens
      • Estrogens
      • Vitamin D
      • Fluoride:
      • Alandronate:
        • These are used in once a day dose,empty stomach
        • Oesophagitis is a troublingcomplication.(MCQ)
      • Calcitonin:
    • Orthopaedic treatment:
      • Exercises

        • Prophylactic bracing of the spine byusing an ASH brace or Taylor brace may beuseful in prevention of pathological fracturesin a severely osteoporotic spine
      • Causes of generalisedosteoporosis(MCQ)
        • Senility
        • Post-immobilisatione.g. a bed-ridden patient
        • Post-menopausal
        • Protein deficiency
        • Inadequate intake – old age, illness
        • Malnutrition
        • Mal-absorption
        • Excess protein loss (3rd degree burns, CRF etc.}
        • Endocrine
      • Cushing’s disease
      • Cushing’s syndrome
      • Hyperthyroid state
    • Drug induced(MCQ)
      • Long term steroid therapy
      • Phenobarbitone therapy