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WHO Definition 1994:

A skeletal disease characterised by low bone mass and deterioration of the microarchitecture of bone tissue with a consequent increase in bone fragility and susceptibility to low trauma fractures.

Bone density measured relative to the population mean in young adults

Normal- bone mineral density above 1 standard deviation below the mean

Osteopenia- 1- 2.5 standard deviations below the mean for a young adult

Osteoporosis- > 2.5 standard deviations below the mean for a young adult

T score is the number of standard deviations away from the mean for a sex and race matched young healthy population

Z score is the number of standard deviations away from the mean for an age, sex and race matched population

Z score should not be used to define osteoporosis.

These are general guidelines, not used to dictate whether treatment should be given but to be used in conjunction with the history and examination to determine the best course of action for each individual.


Incidence is difficult to measure, as most cases are not recorded until a fracture has occurred.

 The National Osteoporosis Society  (UK) state that at least 1 in 3 women and 1 in 12 men will develop osteoporosis.


1. Genetic

  1. Ethnicity: Caucasian or Asian,

  2. Blond hair, red hair, freckles, hypermobility & adolescent scoliosis reported as having a genetic predisposition.

  3. Family history of fracture

  4. Low body mass index < 19KG/M2

2. Lifestyle and nutritional

  1. Smoking

  2. Excess alcohol

  3. Sedentary, or prolonged immobilisation

3. Medical conditions

  1. Anorexia Nervosa

  2. Rheumatoid Arthritis

  3. Early menopause <45 years of age

  4. Primary hypogonadism

  5. Secondary Amenorrhoea  for more than 1 year

  6. Hyperthyroidism

  7. Primary hyperparathyroidism

  8. Multiple Myeloma

  9. Transplantation

  10. Cushings disease/syndrome

  11. Chronic kidney, lung or GI diseases

4. Drugs

  1. Chronic corticosteroid therapy  (>7.5mg per day for > 1 year), increases risk of fracture by 2-3 x.

  2. Excessive thyroid therapy

  3. Anticoagulants

  4. Anticonvulsants

  5. Chemotherapy

  6. Gonadotrophin releasing hormone agonist or antagonist

5. In addition these factors should increase suspicion

  1. Previous history of a fragility fracture wrist, hip or vertebra especially. Previous wrist # doubles the risk of future hip # and triples the risk of future vertebral #.

  2. Loss of height suggesting a kyphosis

  3. Osteopenia or loss of vertebral morphology on plain Xray.

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