Osteoporosis: Medical History

Medical history (history of illness) represents an important component in the diagnosis of osteoporosis. Family history

  • Are there people in your family who suffer from osteoporosis?

Social history

  • What is your profession?
  • Is there any evidence of psychosocial stress or strain due to your family situation?

Current medical history/systemic history (somatic and psychological complaints).

  • Do you have any pain? If yes: Did the pain occur after a minor fall or did the pain occur spontaneously? Do you fall more frequently?
  • Where do you have pain? Is the pain mainly in your back?
  • Have you noticed a reduction in height?
  • Do you have muscle pain?
  • Have you noticed any muscle stiffness?
  • Do you have any functional limitations of the skeleton/joints?

Vegetative anamnesis incl. nutritional anamnesis.

  • Are you underweight? Please tell us your body weight (in kg) and height (in cm).
  • Do you have a balanced diet?
    • Do you eat enough foods that contain calcium (e.g., milk and dairy products) or do you eat too many foods high in phosphates, oxalic acid (Swiss chard, cocoa powder, spinach, rhubarb) and phytic acid/phytates (cereals and legumes)?
    • Do you take vitamin D supplements (dietary supplements)?
  • Do you get enough exercise every day?
  • Do you smoke? If so, how many cigarettes, cigars or pipes per day?
  • Do you drink alcohol? If yes, what drink(s) and how many glasses per day? At what age did you enter menopause?

Self history including medication history.

  • Pre-existing conditions (diseases of bones/joints, vertebral fractures; falls in the last 12 months; metabolic diseases; lactose intolerance; intestinal diseases; pulmonary diseases).
  • Operations
  • Allergies
  • Pregnancies

Medication history

  • Aluminum-containing drugs
  • Antacids
    • Phosphate-containing antacids
  • Antibiotics
    • Aminoglycosides (neomycin)
    • Chloramphenicol
    • Sulfonamides
  • Antidepressants
    • Selective serotonin reuptake inhibitors (SSRIs).
  • Antidiabetic agents
  • Anticonvulsants/antiepileptics (carbamazepine, diazepam, gabapentin, lamotrigine, lamictal, levetiracetam, phenobarbital, phenytoin, valproic acid).
  • Anticoagulants
    • Heparin – for longer-term therapy
    • Coumarin derivatives (vitamin K antagonists, VKA) [long-term therapy (> 12 months) with a coumarin derivative is an independent risk factor for osteoporotic fractures]
    • Low-molecular-weight heparins (NMHs) – certoparin, dalteparin, enoxaparin, nadroparin, reviparin, tinzaparin).
    • Thyroid hormones
    • Synthetic heparin analogues (fondaparinux)
    • Unfractionated heparin (UFH)
  • Antiviral therapy
    • Protease inhibitors
  • Barbiturates
  • Benzodiazepines
  • Cortisone
  • Dicumarol
  • Diuretics
    • Loop diuretics
  • Bile acid adsorbent (colestyramine)
  • Hormones
  • Immunosuppressants – ciclosporin (cyclosporin A).
  • Laxatives
  • Lithium
  • Proton pump inhibitors (proton pump inhibitors, PPI; acid blockers) – esomeprazole, lansoprazole, omeprazole, pantoprazole, rabeprazole; due to hypochlorhydria, proton pump inhibitors may decrease calcium absorption and thus exacerbate osteoporosis, resulting in an increased risk of femoral neck fractures)
  • Statins: from a dosage of 20 mg for simvastatin, atorvastatin and rosuvastatin.
  • Thiazolidine
  • Cytostatics
  • Long-term side effects of tumor therapy: tumor therapy-induced osteoporosis/osteopenia (TTIO); may have a role in the development of TTI osteoporosis: