<prompt> In Osteoporosis which of these is seen?Normal calcium, normal ALPDecreased calcium, increased ALPDecreased calcium, decreased ALPNormal calcium, decreased ALP  <response>: Ans. a. Normal calcium, normal ALP Ref: Harrison 192493, 183120; Apley 9131-133Serum calcium, phosphate and alkaline phosphatase are normal in osteoporosis.OsteoporosisOsteoporosis is the MC metabolic bone disease.Osteoporosis is a state of decreased mass per unit volume low bone density of a normally mineralized bone.Causes of OsteoporosisDrugs Causing Osteoporosis Immobilization Senility Post-menopausalQ Cushings disease, Cushings syndrome Hyperparathyroidism Type 1 DM Acromegaly Hyperprolactinemia Osteogenesis imperfecta Marfans syndrome Hypophosphatasia Homocystinuria Ehlers Danlos syndrome Multiple myeloma GlucocorticoidsQ, Cytotoxic drugsQ Aromatase inhibitors LithiumQ, Aluminium CyclosporinQ, Excessive alcohol HeparinQ, Aromatase inhibitors Excessive thyroxineQ GnRH agonistsClinical features:Osteoporosis is an asymptomatic disorder unless complications predominantly fractures occurMC symptom of osteoporosis is back pain secondary to vertebral compression fractureSites of Osteoporotic Fragile FracturesMC site: Fracture vertebrae Dorsolumbar pine is the MC siteQColles fracture; Fracture neck femurSerum calcium, phosphate and alkaline phosphatase are normal in osteoporosisQDiagnosis:At least 30 of the bone mass must be lost before it becomes apparent on X-ray.Osteoporosis: X-ray findingsLoss of vertical height of a vertebra due to collapseQCod-fish appearance: The disc bulges into the adjacent vertebral bodies so that the disc becomes biconvexQ.Ground glass appearance of the bones, conspicuous in bones like the pelvisMeasurement of Bone MassNoninvasive techniques for estimating skeletal mass or density: Dual-Energy X-ray Absorptiometry DEXA, single-energy X-ray absorptiometry SEXA, quantitative CT, and ultrasound US.Dual energy X-ray Absorptiometry DEXA is the gold standard for the screening estimation of bone density and bone mass and for diagnosis of osteoporosisQ.Drugs useful in OsteoporosisInhibit Bone ResorptionStimulates Bone FormationBoth action Bisphosphonates: Alendronate, Risedronate,EtidronateQ Calcium receptor agonist: Cinacalcet CalcitoninQ SERMs: Tamoxifen. Raloxifene Gallium nitrateQ RANKL Inhibitors: Donesumab TeriparatideQ Calcium CalcitriolQ Fluoride Strontium ranelateQ 