Apex Sports Physician

What is osteoporosis?

Osteoporosis is defined as a skeletal disorder characterized by compromised bone strength that predisposes to an increased risk of fracture. It affects 22% of females, and 17% of males and is the cause of 15,000 hip fractures a year; 65,000 osteoporotic fractures per year in over 60 age-groups. Up to 30% of postmenopausal women have osteoporosis.

What are the common regions to get osteoporotic fractures?

Vertebral fractures 46%
Wrist 16%
Hip 16%
Other fractures 22%

Mortality after 1 year with osteoporotic hip fracture is approximately 20%.

What are the secondary causes of Osteoporosis?

● Hormone related
● GUT/Nutrition related
● Disorders of blood and Bone Marrow
● Congenital causes
● Medication related

What are the other risk factors for Osteoporosis?

● Female gender
● Family history
● Low calcium and Vit D levels
● Low Body weight- Anorexia
● Minimal Physical activity
● Early Menopause

How is Osteoporosis diagnosed?

Commonly, Osteoporosis is diagnosed with DEXA scan. Other blood tests can be done to find out the secondary causes of the condition.

What is the criteria for diagnosis of Osteoporosis in Post menopausal females?

WHO Criteria (depending on T- scores)

T score	Diagnosis
Between 1 to -1	Normal
Between -1.0 to -2.5	Osteopenia
<-2.5	Osteoporosis
<-2.5 plus one or more fragility fractures	Severe Osteoporosis

What is the FRAX assessment Tool?

This is a method to assess fracture risk associated with osteoporosis, which is a more important consideration than just the T-scores. The FRAX tool can be accessed at:

https://www.sheffield.ac.uk/FRAX/

How can Osteoporotic fractures be prevented?

Non-pharmacological strategies:

-Adequate Nutrition especially calcium
-Physical activity
-Adequate Sunlight exposure
-Prevention of falls
-Prevention of Relative Energy deficiency-Syndrome in Athletes

Pharmacological strategies

-Calcium and Vit D supplementation
-Anti bone resorptive treatments

Who needs Pharmacological treatment for Osteoporosis?

Condition	To start treatment or not
Men and Women with Osteoporosis with fracture (T score<-2.5)	Yes
Men and Women with Osteoporosis without fracture (T score<-2.5)	Yes, if secondary risk for fracture present and age >60 in men and>55 in Women
Men and Women with Osteoporosis without fracture (T score<-2.5)	No, if only modifiable factors present in age<60 in men and <55 in women
Women and men with secondary Osteoporosis (T score<-2.5)	Yes
Men and Women with Osteopenia with fracture (T score -1.0 to -2.5)	Recommended for people with vertebral fracture Generally recommended for people with on-vertebral fracture
Men and Women with Osteopenia without fracture (T score -1.0 to -2.5)	Limited Data Consider treatment for men and women aged over 65 if T-score is very low (-2.0 to -2.5) and if other risk factors are present. Monitor and maintain adequate calcium intake and vitamin D levels and recommend a regular exercise program. Educate regarding the signs of a spinal fracture. Repeat DXA scan in 2-5 years.
Special circumstances	All people on corticosteroid therapy (oral or inhaled) of 7.5 mg per day for at least 3 months with a T-Score of -1.5 or less should receive drug therapy Women with breast cancer starting treatment with aromatase inhibitors should be assessed for their absolute fracture risk and may benefit from treatment with anti-resorptive agents.
People with Normal BMD	No need But if risk factors then monitor calcium and Vit D Repeat DEXA in 2-5 years

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OSTEOPOROSIS