It is a common condition seen in the elderly population. With advancing age there is a decrease in bone mass and disruption in bone micro-architecture resulting in bones becoming increasingly fragile, resulting in a high risk of fracture following even a trivial trauma. Women in the post-menopausal age group are the most vulnerable population. Common sites of fractures include hip, spine, femur (thigh bone) and forearm. The risk is higher in those with a history of fractures in the past. As they carry a high morbidity and adversely affect their quality of life, it is of utmost importance to prevent these osteoporotic fractures in the elderly. General measures that need to be addressed include prevention of falls, avoiding prolonged immobilization, diet adequate in calcium and vitamin D.
In addition, specific medication with anti-osteoporotic drugs like bisphosphonates, teriparatide, denosumab, romosumumab etc. are beneficial in increasing the density of bones and prevent fractures. Osteoporosis is diagnosed by measuring bone mineral density (BMD) using DEXA scan or by calculation of FRAX score. Though osteoporosis is primarily a disease affecting the elderly population, certain endocrine conditions can cause osteoporosis in young people as well, which include Cushing syndrome (excess cortisol state), hypogonadism (low sex hormone levels- testosterone in men and estrogen in women), thyrotoxicosis (high thyroid hormone levels), primary hyperparathyroidism (e.g. parathyroid hormone secreting tumors). Other common conditions associated with osteoporosis in younger population include chronic kidney disease, chronic liver disease, coeliac disease and chronic inflammatory conditions like rheumatoid arthritis and inflammatory bowel disease. Therefore, osteoporosis in young requires a thorough workup for these conditions.
