Osteoporosis
This booklet is intended as a practical guide to patient care for registrars, medical officers, interns and medical students attached to the gynaecology units at the University of the Witwatersrand Academic Hospitals. Anyone can use it.
Osteoporosis is defined as a bone mineral density (BMD) of more than 2.5 multiples of the median (MoM) less than the average in a young healthy person (T score) as opposed to in an aged matched person (Z score). Osteopenia is between -1MoM to -2.5. This is calculated on a DEXA scan (dual energy X ray absorptiometry); these machines are expensive & may not be available. X rays are old fashioned but may suggest the condition. Ultrasound of the heel is an alternative. The commonest fractures are vertebral.
Diagnosis
Certain women are at risk. Risk factors include: family history, premature menopause, Caucasian, smokers, alcohol abusers, those with reduced BMIs, thyroid disorders, epileptics, steroid use, immobility. A fracture risk assessment tool (FRAX index) may be used.
Treatment
Avoidance is better than cure. Healthy active living, Vit D 1,000-2,000 IU daily & 500mg calcium daily are recommended. HRT/HT has returned as a preventative measure & adjunct to treatment. Bisphosphonates, e.g. alendronate (Fosamax) 5-10mg po daily must be taken standing up with water only. SERMS may prevent fracture. Many agents (fluoride, strontium) come into & go out of use.