bisphosphonates

Osteoporosis

Epidemiology

 

1/3 caucasian women > 64

 

Risk Factors

 

Insufficient bone mass at time of skeletal maturity

- peak bone mass is achieved at age 25

 

Rapid loss of bone after menopause

 

Low body weight / weight loss / history of smoking / steroids

 

Primary

 

Type 1

- postmenopausal

- high turnover / osteoclast mediated

- F x 6

Management

Management Summary

 

Stage 0

 

Natural history mixed

- depends on size of lesion and diagnosis

- treat if becomes asymptomatic

- may benefit from bisphosphonates

 

Stage 1 / Normal X-ray, abnormal MRI

 

Forage: 80% G/E

Bisphosphonates

 

Stage 2 / Abnormal X-ray with cysts and sclerosis

 

A:  As for Stage I

Avascular necrosis

Shoulder AVN

 

Epidemiology

 

Much less common than hip OA

- usually presents late

 

Aetiology

 

Similar causes as hip (AS IT GRIPS 3C)

 

Alcohol / Steroid / Trauma / Idiopathic

 

Gauchers

 

RA / RTx

 

Sickle Cell 

Osteogenesis Imperfecta

Defect

 

Abnormality of type 1 collagen

- amino acid substitution of glycine with another amino acid

- prevents triple helix formation

 

Many many deformities described

- some 286 mutations of Type 1 collagen described

 

Sillence Classification

 

There are actually now 7 

 

Type I

- mild

- AD

- blue sclera