Osteoporosis for the practicing neurologist

Abstract

SummaryOsteoporosis is a common condition of impaired bone strength leading to fractures. A targeted history, physical exam, and blood work can help elucidate potentially reversible causes of low bone mass. In the neurology office, particular attention should be paid to the patient on glucocorticoids or antiepileptic medications, as these have distinct detrimental effects on bone. Patients can be risk-stratified by using the FRAX calculator, a tool that can help determine whether the patient is at sufficient risk of fracture to warrant pharmacologic therapy. Nonpharmacologic treatments such as calcium, vitamin D, and exercise should be discussed with the patient. The cornerstone of pharmacologic therapy has been treatment with bisphosphonates, but newer medications are available as well for the high-risk patient.T his article addresses the pathophysiology, diagnosis, and nonpharmacologic as well as pharmacologic treatment options for osteoporosis. Discussion is given to 2 particular areas of concern for neurologists-patients on glucocorticoids and antiepileptic medications. Clinical vignetteA 62-year-old man is admitted to the hospital for a left hip fracture after slipping on ice in front of his house. His daughter notes he has a history of unsteady gait and long term use of medication for seizures. A bone density study reveals a T-score of 22.7 at the right hip. What further workup and management is appropriate?