Low bone mass and microarchitectural deterioration leading to increased fracture risk. The diagnosis may be made clinically, or on bone densitometry scanning.
A positive family history increases the risk of osteoporosis.
Smoking increases the risk of osteoporosis.
Osteoporosis is a risk factor for broken bones rather than a disease in itself.
If there is a history of broken bones, document the trauma involved to determine whether this was low impact and therefore of relevance or not.
Loss of height indicates vertebral collapse, carrying the same risk of further fractures as acute vertebral collapses.
Hyperparathyroidism is a recognised cause of osteoporosis. Ask about constipation, tiredness, depression, thirst, polyuria, renal stones, nausea and weight loss.
Overt and sub-clinical Cushing’s syndrome increase the risk of developing osteoporosis. Ask about changes in appearance, skin, weight, blood pressure and diabetes.
Premature menopause is an independent risk factor for osteoporosis.
Depot progesterone preparations and long periods of amenorrhoea are also associated with increased risk.
Hypopituitarism and growth hormone deficiency are risk factors for osteoporosis.
Long term hyperprolactinaemia also causes hypogonadism.
Hypogonadism of any cause is a risk factor for osteoporosis.
Long standing biochemical thyrotoxicosis, for example sub clinical disease with TSH suppression due to a multinodular goitre, increases the risk of osteoporosis.
Patients taking restricted diets may be at increased risk of osteoporosis.
Anorexia and low body mass index are both risk factors for osteoporosis.
Regular weight bearing exercise as well as normal or high body mass index are protective against osteoporosis.
Conversely, excessive exercise regimes may be associated with hypothalamic hypogonadism which may cause osteoporosis.
Complete coverage of the skin either with clothes or sunscreen may reduce vitamin D levels.
Certain conditions, such as rheumatoid arthritis, chronic liver disease, inflammatory bowel disease and coeliac disease, are independent risk factors for osteoporosis.
Patients on long term steroids (including via the trans dermal and inhaled routes) are at increased risk of osteoporosis, and should be treated during steroid therapy, irrespective of their bone mineral density.
Certain depot contraceptives may also lead to amenorrhoea and increased risk of osteoporosis.
Opiates, many psychotropic medications and other non prescribed drugs may also lead to hypogonadism, which is a risk factor for osteoporosis.
Anti retroviral drugs also increase the risk of osteoporosis.