Osteoporosis is a condition which occurs in postmenopausal females as well as elderly males due to a change in the hormone milieu in the body. This condition decreases the density of the bone (i.e. not simply a decrease in the calcium content, which only forms part of the bone components) and predisposes patients to so-called insufficiency fractures. These fractures occur at the hip, knee, wrist, shoulder as well as the spine. The treatment of these fractures has been revolutionised by technical advances in trauma orthopaedics such as locked plating technology as well as modern total hip replacement implants and techniques and vertebroplasty, which allow extremely effective surgical management. While insufficiency fractures are increasingly managed with early surgical fixation or arthroplasty with a view to mobilising the patient as soon as possible, this does not provide any sustained advantage to the patient beyond the first year post injury. Correct management of osteoporosis may prolong the patient’s life expectancy.
We subscribe to the school of thought that insufficiency fractures are an indication of severe osteoporosis regardless of the bone density and that these patients should receive therapy regardless of the Z-score on the DEXA scan (dual energy X-ray absorbtiometry). Patients nonetheless require a DEXA scan prior to commencement of therapy in order to determine the reference Z-score to which future DEXA scores will be compared.
Treatment of Osteoporosis with bisphosphonate medication has eclipsed hormone therapy and provides extremely effective treatment without significant side effects. Patients are treated with these drugs (daily oral dose or monthly intravenous infusion) for five years and then bone density is re-checked with a DEXA scan to determine the degree of improvement in bone density. Bisphosphonate therapy of Osteoporosis is more effective the earlier it is instituted.
