Overview Snapshot A 68-year-old woman presents to her primary care physician with lower back pain of acute onset. She denies any trauma to the spine or any radiation of pain. Her last menstrual period was when she was 51-years-old. On physical exam, she has tenderness to palpation at the level of L4-L5, as well as a loss of lumbar lordosis. A dual-energy x-ray absorptiometry (DEXA) scan reveals a T-score of -2.7. Introduction Clinical definition decreased bone mass (osteopenia) that significantly increases the patient's risk of fracture Epidemiology incidence most common types of osteoporosis are login to view 2 more bullets risk factors post-menopausal women being ≥ 65 years of age people of Caucasian and Asian descent lifestyle factors login to view 4 more bullets medications login to view 4 more bullets hyperparathyroidism hyperthyroidism multiple myeloma malabsorption syndromes low body weight login to view 1 more bullet Pathogenesis in young adulthood, peak bone mass is achieved and this is determined by a number of factors (e.g., genetics) after this peak bone mass is attained, there is a small decrease in bone formation with every cycle of bone remodeling login to view 13 more bullets Prognosis generally good if detected early and appropriately managed Presentation Symptoms fractures (e.g., vertberal and hip), otherwise, patients are typically asymptomatic Physical exam may see loss in height Imaging DEXA indication all women ≥ 65 and all men ≥ 70 years of age notes T-score ≤ -2.5 Studies Labs serum calcium, phosphorus, parathyroid hormone, and alkaline phosphatase are normal Histology histologically normal; however, there is a decreased quantity of normal bone Differential Laboratory Abnormalities in Select Bone Disorders Etiology Serum Phosphate Serum Calcium Serum Alkaline Phosphatase Parathyroid Hormone Osteomalacia / rickets Decreased Decreased Increased Increased Osteoporosis Normal Normal Normal Normal Osteopetrosis Normal Normal or decreased Normal Normal Paget disease of the bone Normal Normal Increased Normal Osteitis fibrosa cystica Primaryhyperparathyroidism decreased Secondaryhyperparathyroidism increased Primaryhyperparathyroidism increased Secondaryhyperparathyroidism decreased Primary and secondary hyperparathyroidism increased Primary and secondary hyperparathyroidism increased Hypervitaminosis D Increased Increased Normal Decreased Treatment Conservative calcium and vitamin D supplementation strength training smoking cessation Medical bisphosphonates indication login to view 1 more bullet teriparatide indication login to view 1 more bullet Complications Fragility fractures hip distal radius vertebral body proximal humerus