Physiology
Endocrine
Which of the following is the main risk factor for osteoporosis:
Answer:
Risk factors include:- Oestrogen deficiency
- Ageing
- Family history
- Smoking
- Alcohol
- Vitamin D deficiency
Osteoporosis
Physiology / Endocrine / Calcium and Bone
Last Updated: 21st April 2019
Osteoporosis is a disease characterised by reduced bone mass and increased bone fragility resulting in an increased risk of fracture after minimal trauma (particularly of the hip, spine and distal radius). It is very common in postmenopausal women.
Bone densitometry, measured by dual energy X-ray absorptiometry (DXA) scan, is the mainstay of diagnosis. Osteoporosis, defined according the the T score, occurs when bone density is >2.5 standard deviations below normal peak bone mass.
Risk Factors for Primary Osteoporosis
This is multifactorial, usually resulting from a combination of oestrogen deficiency and aging. Risk factors include:
- Oestrogen deficiency
- Ageing
- Family history
- Smoking
- Alcohol
- Vitamin D deficiency
Causes of Secondary Osteoporosis
(Consider when osteoporosis occurs in non-'at risk' groups including men and premenopausal women)
- Hypogonadism
- Hyperthyroidism
- Hyperparathyroidism
- Cushing's syndrome
- Exogenous steroids
- Hyperprolactinaemia
Management
Clinical risk prediction of fracture is a better guide to treatment than DXA scanning alone. Algorithms exist to calculate the 10 -year fracture risk e.g. the FRAX score.
- Non-pharmacological
- Balanced diet
- Exercise
- Smoking cessation
- Falls prevention
- Avoidance of excessive alcohol intake
- Avoidance of drugs that cause osteoporosis e.g. corticosteroids
- Pharmacological
- Calcium and vitamin D supplementation
- Bisphosphonates
- Selective oestrogen receptor modulators (SERMs)
- Parathyroid hormone
- Hormone replacement therapy (HRT)
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- Biochemistry
- Blood Gases
- Haematology
| Biochemistry | Normal Value |
|---|---|
| Sodium | 135 – 145 mmol/l |
| Potassium | 3.0 – 4.5 mmol/l |
| Urea | 2.5 – 7.5 mmol/l |
| Glucose | 3.5 – 5.0 mmol/l |
| Creatinine | 35 – 135 μmol/l |
| Alanine Aminotransferase (ALT) | 5 – 35 U/l |
| Gamma-glutamyl Transferase (GGT) | < 65 U/l |
| Alkaline Phosphatase (ALP) | 30 – 135 U/l |
| Aspartate Aminotransferase (AST) | < 40 U/l |
| Total Protein | 60 – 80 g/l |
| Albumin | 35 – 50 g/l |
| Globulin | 2.4 – 3.5 g/dl |
| Amylase | < 70 U/l |
| Total Bilirubin | 3 – 17 μmol/l |
| Calcium | 2.1 – 2.5 mmol/l |
| Chloride | 95 – 105 mmol/l |
| Phosphate | 0.8 – 1.4 mmol/l |
| Haematology | Normal Value |
|---|---|
| Haemoglobin | 11.5 – 16.6 g/dl |
| White Blood Cells | 4.0 – 11.0 x 109/l |
| Platelets | 150 – 450 x 109/l |
| MCV | 80 – 96 fl |
| MCHC | 32 – 36 g/dl |
| Neutrophils | 2.0 – 7.5 x 109/l |
| Lymphocytes | 1.5 – 4.0 x 109/l |
| Monocytes | 0.3 – 1.0 x 109/l |
| Eosinophils | 0.1 – 0.5 x 109/l |
| Basophils | < 0.2 x 109/l |
| Reticulocytes | < 2% |
| Haematocrit | 0.35 – 0.49 |
| Red Cell Distribution Width | 11 – 15% |
| Blood Gases | Normal Value |
|---|---|
| pH | 7.35 – 7.45 |
| pO2 | 11 – 14 kPa |
| pCO2 | 4.5 – 6.0 kPa |
| Base Excess | -2 – +2 mmol/l |
| Bicarbonate | 24 – 30 mmol/l |
| Lactate | < 2 mmol/l |
