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The most common cause of delayed puberty in boys is constitutional delay in growth and puberty. These boys remain shorter and looks more “child-like” compared to other boys at the same age. However, they enter puberty later than normal and eventually catch up by 18-19 years of age.
Rather than waiting for these boys to enter puberty endlessly, it is better to get them checked by an endocrinologist. It is important to know if they have hypogonadism and then take appropriate actions at the earliest.

Puberty is delayed when there is no sign of pubertal development in boys by 14 years and in girls by 13 years. The first sign of puberty in girls is breast enlargement. It is mostly visible and sometimes mildly painful. In boys, the first sign of puberty is enlargement of the testes. This is usually not noticeable. However, most boys are brought to the endocrinologists only when parents fail to notice pubic hair growth.
But pubic hair growth can be present even in people with pubertal delay.

Of the various medicines available for osteoporosis, the endocrinologist can decide the best choice based on the risk of fractures for the patient, the BMD, age, cause for osteoporosis and safety of the medicines.

This will be an informed decision made in discussion with you. In general, your doctor will use medicines that add bone when you have very poor BMD or you have had fractures in the past. This includes medicines like Teriparatide. Otherwise he may use drug classes like bisphosphonates or denosumab. Sometimes, the doctor may use a combination of drugs.

Osteoporosis is a treatable medical condition. Treating osteoporosis can strengthen the bone and prevent fractures. Depending on the severity of osteoporosis, we can use various drugs.

Medicines that prevent bone destruction

• Bisphosphonates
• Denosumab
• Raloxifene

Medicines that build bones

• Teriparatide
• Abaloparatide
• Romosozumab

Osteoporosis is one of most common chronic disease. Everyone should be aware of the risk factors for osteoporosis. Being a metabolic disease of bone, osteoporosis is primarily managed by endocrinologists. They do tests to understand the reason for osteoporosis and treats it. Osteoporosis is strongly associated with arthritis and is also treated by rheumatologists. Many people with osteoporosis patients will never know that they have the disease till they sustain the first fracture. They will be treated by orthopaedic surgeons.

• Your risk of breaking a bone is more than just your bone density score. Your risk is based on a variety of factors, including family history, medical conditions you’ve had and medicines you’ve taken.
• The FRAX® tool, an osteoporosis risk assessment test, uses information about your bone density and other risk factors for breaking a bone to estimate your 10-year fracture risk.
• Your FRAX® score estimates your chance of breaking a hip as well as your combined chance of breaking a hip or other major bones over the next ten years. Other major bones include the spine, hip, forearm and shoulder.

• Osteoporosis cannot be diagnosed with blood tests, however, blood and urine tests can be used to identify if you have another medical condition that is causing bone loss.
• Some of these tests include: Blood calcium levels, thyroid function tests, parathyroid hormone levels, testosterone levels in men,25-hydroxy vitamin D
• Also tests of the blood and/or urine may help to estimate how fast you’re losing or making bone, which are important when you are on treatment.

Your bone density test results are reported using T-scores.

• A T-score shows how much your bone density is higher or lower than the bone density of a healthy 30-year old adult.
• A T-score of -1.0 or above is normal bone density.
• A T-score between -1.0 and -2.5 means you have low bone density or osteopenia.
• A T-score of -2.5 or below is a diagnosis of osteoporosis.

Osteoporosis is usually diagnosed by using DXA (Dual Energy Xray Absorptiometry)for
measuring Bone Mineral Density (BMD). It is a non invasive test and is not painful. It involves checking your spine, hip and wrist for bone thinning. Other tests include qCT ( quantitative CT ) and ultrasound based screening for osteoporosis.

Once osteoporosis is diagnosed, we need to look into the reasons why it has occurred.
The reasons can be very diverse from calcium and vitamin D deficiency to malignancies like multiple myeloma or hormonal diseases like hyperparathyroidism.

You are at risk of osteoporosis if you have any of the following risk factors.

• Post menopausal
• Low calcium intake
• Low hormone levels e.g. estrogen deficiency or testosterone deficiency
• Excessive thyroid replacement ( and hyperthyroidism)
• Long term use of steroids
• Inflammatory arthritis
• Family history of osteoporosis
• Hyperparathyroidism
• Smoking
• Alcohol