Osteoporosis 

causes / risk factors 

vitamin D deficiency 

female - post menopasual 

smokers 

Symptoms : fractures - hip fractures, kyphosis,  thoracic vertbrae compression fractures 

Labs : TSH, calcum phosphorus, parathyroid hormone 

X ray - reduced bone density 

DEXA scan 

Preventive measures 

• weight bearing exercises 

• stop smoking 

• monthly vitamin D 

• calcium supplement 

• Fosamax ( alendronate ) - fortnightly 

adverse effect oesophagitis, give with caution if creatine clearance less than 35 

• zoledronic acid 4mg / 5mg through IV - every 18 months - 24 months,

• risedronate every fortnightly 5mg - 

• alternative: adenosumab 

• calcitonin - inhibit bone resorption 

*** estrogen risk more than benefit