osteoporosis
OSTEOPOROSIS
Osteoporosis is a progressive, systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration of bone tissue leading to increased bone fragility and susceptibility to fractures.
The more risk factors (eg history of fracture, advanced age, comorbidities, etc) that are present, the greater the risk of fracture.

Osteoporosis Signs and Symptoms

Definition

  • Progressive, systemic skeletal disease characterized by decreased bone mass and micro-architectural deterioration of bone tissue leading to increased bone fragility and susceptibility to fractures
    • Bone strength, reflecting both density and quality of the bone, is compromised thus increasing fracture risk
    • Fractures commonly occur in the hip, spine and wrist with the hip fractures having a high morbidity
  • Often asymptomatic until patient presents with a fragility fracture  
    • Vertebral fracture can cause back pain, height loss and increasing kyphosis
  • Though osteoporosis in Asia is very much underdiagnosed and undertreated, it is projected that by 2050, >50% of osteoporotic hip fractures will happen in Asia
    • In most developing countries, dual energy X-ray absorptiometry (DXA) is expensive and is widely unavailable particularly in the rural areas
  • Calcium intake in almost all Asian countries is below the FAO/WHO recommendations of 1-1.3 g/day
  • Studies done in both sexes and all age groups in different Southeast Asian countries demonstrated widespread incidence of vitamin D deficiency or insufficiency

Glucocorticoid-induced Osteoporosis (GIOP)

  • When on oral glucocorticoid therapy, bone loss occurs in 6-12 months and fracture risk increases within 3-6 months of initiating glucocorticoids
  • Intake of ≥5 mg daily of Prednisolone or its equivalent for ≥3 months is associated with osteoporosis
    • Similar risk is also shown with higher glucocorticoid dose taken for a shorter period of time
    • Strong glucocorticoids inhaled for 7 years are associated with significant bone loss

Risk Factors

Risk Factors in Women for Fracture and Osteoporosis

The more risk factors that are present, the greater the risk of fracture


Non-modifiable
  • Previous history of fracture as an adult
  • History of osteoporotic hip fracture in 1st-degree relative
  • Advanced age [low body weight and older age (Osteoporosis Self-Assessment Tool for Asians - OSTA)]
  • Poor health/frailty
  • Ethnic group (Asians generally have lower risk compared to Caucasians)
  • Early natural or surgical menopause before 45 year of age or prolonged premenopausal amenorrhea >1 year
  • Genetic diseases: Cystic fibrosis, osteogenesis imperfecta, Ehlers-Danlos, hemochromatosis, Marfan syndrome
Modifiable
  • Recurrent falls
  • Decreased body weight [<57.6 kg (<127 lbs)]
  • Impaired vision
  • Medical conditions: Rheumatoid arthritis, estrogen deficiency, vitamin D deficiency due to lack of sunlight exposure or low intake, thyrotoxicosis, or prolonged Levothyroxine intake
  • Cigarette smoking
  • Excessive alcohol and caffeine intake (≥3 drinks/day)
  • Low calcium (Ca) intake, excessive salt and vitamin A intake
  • Oral glucocorticoid use ≥5 mg/day of prednisone for ≥3 month
  • Sedentary lifestyle (lack of physical activity)
Risk Factors in Men for Fracture and Osteoporosis
  • Non-traumatic fractures of the hip, vertebrae or wrist
  • Prior osteoporotic fracture from age 50 years
  • Hypogonadism, growth hormone deficiency
  • Idiopathic hypercalciuria
  • Hyperparathyroidism
  • Rheumatoid arthritis
  • Lymphoma, multiple myeloma
  • Hyperthyroidism
  • Oral glucocorticoid use ≥5 mg/day of Prednisone for ≥3 months
  • Physical inactivity
  • Low body mass index (kg/m2)
  • Anticonvulsants (eg Phenytoin, Phenobarbital)
  • Smoking
  • Alcohol intake (≥3 drinks/day)

Factors Associated with Glucocorticoid-induced Osteoporosis or Fractures

  • Low bone density
  • Cumulative steroid dose
  • Age >65 years
  • BMI ≤20 kg/m2
  • Smoking, excessive alcohol use
  • Diseases associated with low bone density (eg rheumatoid arthritis, inflammatory bowel disease), sex hormone deficiency, family history of osteoporosis, history of fracture and immobilization
Using FRAX™ score to categorize patient's risk, treatment is recommended for postmenopausal women with:
  • Low risk of major osteoporotic fracture (<10%) and intake of  ≥75 mg daily of Prednisolone or its equivalent for >3 months
  • Moderate risk of major osteoporotic fracture (10-19%) and intake of glucocorticoid at any dose for >3 months
  • High risk of major osteoporotic fracture (≥20%) and intake of glucocorticoid at any dose for any length of time
Digital Edition
Asia's trusted medical magazine for healthcare professionals. Get your MIMS Endocrinology - Malaysia digital copy today!
Sign In To Download
Editor's Recommendations
Most Read Articles
Stephen Padilla, 22 Jul 2019
Zinc supplementation significantly lowers key glycaemic indicators, particularly fasting glucose (FG) in individuals with diabetes and in those who received an inorganic supplement, results of a systematic review and meta-analysis have shown.
Elaine Soliven, 15 Oct 2020

Higher levels of exercise appear to be associated with a lower risk of all-cause mortality in adults with type 2 diabetes (T2D) compared with no exercise at all, according to a study presented at EASD 2020.

Elvira Manzano, 07 Oct 2020
Exendin-4 imaging targeting GLP-1* receptor (GLP-1R) ably detects residual, dysfunctional pancreatic beta cells in individuals with long-standing type 1 diabetes (T1D), according to a study presented at EASD 2020. This breakthrough brings research closer to the possibility of restoring insulin-producing cells depleted in T1D.
Elaine Soliven, 4 days ago
Ultra rapid lispro (URLi) was noninferior to lispro in reducing HbA1c levels in adults with type 1 diabetes (T1D), according to the PRONTO-Pump-2* study presented at EASD 2020.