Osteoporosis

Asymptomatic prior to fx, back pain or fx or collapse of vertebra, loss of height, fx femoral neck & distal radius

Medication hx, diet ca, vit d, caffeine intake, endocrine status, family hx, smoking and alcohol use, physical activity

Weight/body mass (wt < 127, BMI < 19 risk), yearly height, historical height loss of 1.5 inches

Serum CA, phosphate and PTH. Alkaline phospatase usually normal or elevated with fx. Vit D deficiency common

Xray spine & pelvis (demineralization), Xray spine (compression vertebra), Dual-energy xray absorptiometry, CT

T score-1.0 Normal, 1.0-2.5 Osteopenia, < -2.5 Osteoporosis, < -2.5 w/fx severe osteoporosis

Every 5 years T score 1.0-1.5, 3-5 years 1.5-2.0, 1-2 years under 2.0

Diet w/ protein, calories, CA, Vit D. D/c or reduce corticosteroids, high impact physical activity, avoid ETOH & smoking

CA & Vit D to prevent. Calcium citrate .4-.7 g or carbonate 1.0-1.5 mg, vit D 800-2000 daily

Increase bone density, reduce fx, prevent corticosteroid , take in am w/ 8 oz water, 30-60 min before other food, remain upright 30 min

Hypocalcemia, renal insufficiency, unable to stand or sit for 30-60 min, esophageal abnormalities

Severe bone, joint and muscle pain, osteonecrosis of jaw w/ delayed healing, increase in fx risk for pt on PPIs

Intranasal tx of postmenapausal osteo, reduces bone resorption less effective thanbisphosphonates, causes rhinitis. Avalible in IM/SQ

Prevention and treatment of osteoporosis, increases bone density w/o risk of CA, first linefor women who don

Contraindicated for allegy to calcitonin, Hx DVT/PE

Hot flashes, leg cramps, increased chance of venus thromboembolic events

SQ for osteoporosis, increase spinal bone density and decrease vertebral fx risk *stimulates bone formation

incrased risk of osteosarcoma (Paget's dx, high alkaline pos, hx bone CA, or mets, metabolic bone dx, hypercalcemia)

Mild-nausea, dizziness, cramps, injection site pain