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| '''For patient information click [[{{PAGENAME}} (patient information)|here]]'''
| | __NOTOC__ |
| | | {| class="infobox" style="float:right;" |
| {{Infobox_Disease | | | |- |
| | | [[File:Siren.gif|30px|link=Osteoporosis resident survival guide]]|| <br> || <br> |
| | | [[Osteoporosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] |
| | |} |
| | {{DiseaseDisorder infobox | |
| Name = Osteoporosis | | | Name = Osteoporosis | |
| Image = | | | Image = Osteoporosis Locations.png| |
| Caption = | | | Caption = By BruceBlaus - via Wikimedia.org <ref>https://commons.wikimedia.org/w/index.php?curid=46602308 </ref> | |
| DiseasesDB = 9385 |
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| ICD10 = {{ICD10|M|80||m|80}}-{{ICD10|M|82||m|80}}|
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| ICD9 = {{ICD9|733.0}} |
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| ICDO = |
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| OMIM = |
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| MedlinePlus = |
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| MeshID = D010024 |
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| }} | | }} |
| {{Osteoporosis}} | | {{Osteoporosis}} |
| {{CMG}}
| | '''For patient information click [[{{PAGENAME}} (patient information)|here]]''' |
| __NOTOC__
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| '''Associate Editor(s)-In-Chief:''' {{CZ}}, [[User:Raviteja Reddy Guddeti|Raviteja Guddeti, M.B.B.S.]] [mailto:rgudetti@perfuse.org]
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| {{Editor Join}}
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| ==Overview==
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| ==Classification==
| | {{CMG}}; {{AE}}{{EG}} |
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| | {{SK}} Bone loss, bone density loss, decreased bone density, porous bones, osteoporotic bones |
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| ==History== | | ==[[Osteoporosis overview|Overview]]== |
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| | ==[[Osteoporosis historical perspective|Historical Perspective]]== |
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| ==Epidemiology== | | ==[[Osteoporosis classification|Classification]]== |
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| | ==[[Osteoporosis pathophysiology|Pathophysiology]]== |
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| ===Hip fractures=== | | ==[[Osteoporosis causes|Causes]]== |
| Hip fractures are responsible for the most serious consequences of osteoporosis. In the United States, osteoporosis causes a predisposition to hip fractures -- more than 250,000 occur annually. It is estimated that a 50-year-old white woman has a 17.5% lifetime risk of fracture of the proximal [[femur]]. The incidence of hip fractures increases each decade from the sixth through the ninth for both women and men for all populations. The highest incidence is found among those men and women ages 80 or older.
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| ===First vertebral fractures=== | | ==[[Differentiating Osteoporosis from other diseases|Differentiating Osteoporosis from other Diseases]]== |
| An estimated 700,000 women have a first [[vertebral]] fracture each year. The lifetime risk of a clinically detected symptomatic vertebral fracture is about 15% in a 50-year-old white woman. However, because symptoms are often overlooked or thought to be a normal part of getting older, it is believed that only about one-third of vertebral compression fractures are actually diagnosed.
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| ===Distal radius fractures=== | | ==[[Osteoporosis epidemiology and demographics|Epidemiology and Demographics]]== |
| Distal [[radius (bone)|radius]] fractures, usually of the Colles type, are the third most common type of osteoporotic fractures. In the United States, the total annual number of Colles' fractures is about 250,000. The lifetime risk of sustaining a Colles' fracture is about 16% for white women. By the time women reach age 70, about 20% have had at least one wrist fracture.
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| ==Risk factors== | | ==[[Osteoporosis risk factors|Risk Factors]]== |
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| | ==[[Osteoporosis screening|Screening]]== |
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| | | ==[[Osteoporosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]== |
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| ===Diseases and disorders=== | |
| There are many disorders associated with osteoporosis:
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| *[[Hypogonadism|Hypogonadal]] states - [[Turner syndrome]], [[Klinefelter syndrome]], [[Kallmann syndrome]], [[anorexia nervosa]], [[hypothalamus|hypothalamic]] [[amenorrhea]], [[hyperprolactinemia]]. In females, the effect of hypogonadism is mediated by [[estrogen]] deficiency. It can appear as early [[menopause]] (<45 years) or from prolonged premenopausal amenorrhea (>1 year). A bilateral [[oophorectomy]] (surgical removal of the ovaries) or a [[premature ovarian failure]] cause deficient estrogen production. In males, [[testosterone]] deficiency is the cause.
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| *Other endocrine disorders - [[Cushing's syndrome]], [[hyperparathyroidism]], [[thyrotoxicosis]], [[hypothyroidism]], insulin-dependent [[diabetes mellitus]], [[acromegaly]], [[adrenal insufficiency]]
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| *Nutritional and gastrointestinal disorders - [[malnutrition]], parenteral nutrition, [[malabsorption]] syndromes (e.g. [[coeliac disease]], [[Crohn's disease]]), [[gastrectomy]], severe [[liver disease]] (especially [[primary biliary cirrhosis]]) - those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium.
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| *Rheumatologic disorders - [[rheumatoid arthritis]], [[ankylosing spondylitis]]
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| *Hematologic disorders/malignancy - [[multiple myeloma]], [[lymphoma]] and [[leukemia]], [[mastocytosis]], [[hemophilia]], [[thalassemia]].
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| *Inherited disorders of the bone - [[osteogenesis imperfecta]], [[Marfan syndrome]], [[hemochromatosis]], [[hypophosphatasia]], [[glycogen storage disease]]s, [[homocystinuria]], [[Ehlers-Danlos syndrome]], [[porphyria]], [[Menkes disease|Menkes' syndrome]], [[epidermolysis bullosa]], [[Gaucher's disease]].
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| *Other disorders - immobilization, [[scoliosis]]
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| ===Medication===
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| Medication - for medication potentially causing osteoporosis, the positive effects of them needs to be compared with the degenerative effects on bone.
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| * Steroid-induced osteoporosis (SIOP) arises due to use of [[glucocorticoid]]s - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug [[prednisone]] is a main candidate after prolonged intake. Some professional guidelines recommend prophylaxis in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.<ref>{{cite book |author=Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians |title=Glucocorticoid-induced Osteoporosis |year=2003 |publisher=Royal College of Physicians of London |location=London, UK |isbn=1-860-16173-1 | url=http://www.rcplondon.ac.uk/pubs/contents/966c62dd-8011-4f65-a61d-dd0c7fe4fa4b.pdf }}</ref>
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| * [[Barbiturate]]s (probably due to accelerated metabolism of vitamin D) and some other enzyme-inducing [[antiepileptic]]s.<ref>{{cite journal |author=Petty SJ, O'Brien TJ, Wark JD |title=Anti-epileptic medication and bone health |journal=Osteoporosis international |volume=18 |issue=2 |pages=129–42 |year=2007 |pmid=17091219 |doi=10.1007/s00198-006-0185-z}}</ref>
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| * [[Proton pump inhibitors]] - these drugs inhibit the production of [[gastric acid|stomach acid]]; it is thought that this interferes with calcium absorption.<ref>{{cite journal | author = {{subst:CURRENTMONTHNAME}} {{subst:CURRENTYEAR}}ang YX, Lewis JD, Epstein S, Metz DC | title=Long-term proton pump inhibitor therapy and risk of hip fracture | journal=JAMA | year=2006 | volume=296 | pages=2947-53 | id=PMID 17190895 }}</ref>
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| ==Pathogenesis==
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| ==Signs and symptoms==
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| ==Diagnosis== | | ==Diagnosis== |
| | | [[Osteoporosis history and symptoms|History and Symptoms]] | [[Osteoporosis physical examination|Physical Examination]] | [[Osteoporosis laboratory findings|Laboratory Findings]] | [[Osteoporosis electrocardiogram|Electrocardiogram]] | [[Hashiomoto's thyroiditis chest x ray|Chest X Ray]] | [[Osteoporosis CT|CT]] | [[Osteoporosis MRI|MRI]] | [[Osteoporosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Osteoporosis other imaging findings|Other Imaging Findings]] | [[Osteoporosis other diagnostic studies|Other Diagnostic Studies]] |
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| ===Dual energy X-ray absorptiometry===
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| ===Screening===
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| ==Treatment== | | ==Treatment== |
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| ==Prognosis==
| | [[Osteoporosis life style modification|Life style Modification]] | [[Osteoporosis medical therapy|Medical Therapy]] | [[Osteoporosis surgery|Surgery]] | [[Osteoporosis primary prevention|Primary Prevention]] | [[Osteoporosis secondary prevention|Secondary Prevention]] | [[Osteoporosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Osteoporosis future or investigational therapies|Future or Investigational Therapies]] |
| {| class="wikitable" align="right"
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| |+ Hip fractures per 1000 patient-years<ref name="pmid17846439">{{cite journal |author=Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD |title=Low bone mineral density and fracture burden in postmenopausal women |journal=CMAJ |volume=177 |issue=6 |pages=575–80 |year=2007 |pmid=17846439 |doi=10.1503/cmaj.070234}}</ref>
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| ! WHO category !! Age 50-64 !! Age > 64 || Overall
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| | Normal || 5.3 || 9.4 || 6.6
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| | [[Osteopenia]] || 11.4 || 19.6 || 15.7 | |
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| | Osteoporosis || 22.4 || 46.6 || 40.6
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| |}
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| Although osteoporosis patients have an increased mortality rate due to the complications of fracture, most patients die ''with'' the disease rather than ''of'' it.
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| Hip fractures can lead to decreased mobility and an additional risk of numerous complications (such as [[deep venous thrombosis]] and/or [[pulmonary embolism]], [[pneumonia]]). The 6-month mortality rate following hip fracture is approximately 13.5%, and a substantial proportion (almost 13%) of people who have suffered a hip fracture need total assistance to mobilize after a hip fracture.<ref>{{cite journal |author=Hannan EL, Magaziner J, Wang JJ, ''et al'' |title=Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes |journal=JAMA |volume=285 |issue=21 |pages=2736–42 |year=2001 |pmid=11386929 |doi=}}</ref>
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| Vertebral fractures, while having a smaller impact on mortality, can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare, multiple vertebral fractures can lead to such severe hunch back ([[kyphosis]]) that the resulting pressure on internal organs can impair one's ability to breathe.
| | ==Case Studies== |
| | [[Osteoporosis case study one|Case #1]] |
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| Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.<ref>{{cite journal |author=Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES |title=Impact of recent fracture on health-related quality of life in postmenopausal women |journal=J. Bone Miner. Res. |volume=21 |issue=6 |pages=809–16 |year=2006 |pmid=16753011 |doi=10.1359/jbmr.060301}}</ref>
| | ==Related Chapters== |
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| ==Prevention==
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| ==See also==
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| *[[Bone healing]] | | *[[Bone healing]] |
| *[[Back pain]] | | *[[Back pain]] |
| *[[bone mineral density]] | | *[[bone mineral density]] |
| *Hip protector | | *[[Dental x-ray]] |
| *Dental X-ray
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| *[[Osteopetrosis]], the opposite of osteoporosis | | *[[Osteopetrosis]], the opposite of osteoporosis |
| *[[Osteoimmunology]] | | *[[Osteoimmunology]] |
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| ==References==
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| {{Reflist|2}}
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| ==External links== | | ==External links== |
| * [http://www.fore.org/ Foundation for Osteoporosis Research and Education] Non-profit organization
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| * [http://www.iofbonehealth.org/ The International Osteoporosis Foundation]
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| * [http://www.osteoporosis.org.au/ Osteoporosis Australia]
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| * [http://www.osteoporosis.ca/ Osteoporosis Canada]
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| * [http://www.irishosteoporosis.ie/ Irish Osteoporosis Society]
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| * [http://www.bones.org.nz/ Osteoporosis New Zealand Inc]
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| * [http://www.nos.org.uk/ National Osteoporosis Society] (UK)
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| * [http://www.nof.org/ The National Osteoporosis Foundation](USA)
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| * [http://www.hormone.org/public/osteoporosis.cfm The Osteoporosis Section] of [[The Hormone Foundation]]
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| * [http://www.rad.washington.edu/mskbook/osteopenia.html University of Washington]
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| * [http://gotbones.healthdiaries.com/osteopenia/ Osteopenia] - A controversial diagnosis.
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| * [http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including osteoporosis) by a Joint [[WHO]]/FAO Expert consultation (2003) | | * [http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including osteoporosis) by a Joint [[WHO]]/FAO Expert consultation (2003) |
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| {{Geriatrics}} | | {{Geriatrics}} |
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| [[Category:Disease]]
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| [[Category:Geriatrics]]
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| [[Category:Aging-associated diseases]]
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| [[Category:Skeletal disorders]]
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| [[Category:Orthopedics]]
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| [[Category:Grammar]]
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| {{Link FA|ar}}
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| [[ar:هشاشة العظام]] | | [[ar:هشاشة العظام]] |
| [[bg:Остеопороза]] | | [[bg:Остеопороза]] |
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