Osteoporosis overview: Difference between revisions
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==Overview== | ==Overview== | ||
[[Osteoporosis]] is a [[bone]] [[disease]], characterized by lowered [[bone mineral density]]; leads to increased risk of [[bone fracture|fracture]]. The pathology is negative balance between old bone resorption and new bone formation. Aging, female gender, thin and small stature, Asian or Caucasian races, [[alcoholism]], [[hypogonadism]], and [[steroid]] abuse are among the primary risk factors associated with osteoporosis. It can be prevented with lifestyle modification, or [[calcium]] and [[vitamin D]] supplementation. Preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. [[Bisphosphonate]]s, [[calcium]], and [[vitamin D]] supplementation form the main stay of treatment. | [[Osteoporosis]] is a [[bone]] [[disease]], characterized by lowered [[bone mineral density]]; leads to increased risk of [[bone fracture|fracture]]. The pathology is negative balance between old bone resorption and new bone formation. Aging, female gender, thin and small stature, Asian or Caucasian races, [[alcoholism]], [[hypogonadism]], and [[steroid]] abuse are among the primary risk factors associated with osteoporosis. It can be prevented with lifestyle modification, or [[calcium]] and [[vitamin D]] supplementation. Preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. [[Bisphosphonate]]s, [[calcium]], and [[vitamin D]] supplementation form the main stay of treatment. | ||
==Historical Perspective== | ==Historical Perspective== | ||
Albright and Reifenstein in 1948, have defined the primary osteoporosis as consistent of two factors: one associated with estrogen loss during menopause and another with growing age. <ref name= "osteoporosis">{{cite book | last = Marcus | first = Robert | title = Osteoporosis | publisher = Elsevier/Academic Press | location = Amsterdam | year = 2013 | isbn = 9780124158535 }}</ref>The idea was differed by Riggs, after 34 years; stated as two types of osteoporosis: the bone loss in female following menopause as type I, and age-related bone loss as type II.<ref name="pmid7119111">{{cite journal| author=Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB et al.| title=Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes. | journal=J Clin Invest | year= 1982 | volume= 70 | issue= 4 | pages= 716-23 | pmid=7119111 | doi= | pmc=370279 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7119111 }} </ref> | Albright and Reifenstein in 1948, have defined the primary osteoporosis as consistent of two factors: one associated with estrogen loss during menopause and another with growing age. <ref name="osteoporosis">{{cite book | last = Marcus | first = Robert | title = Osteoporosis | publisher = Elsevier/Academic Press | location = Amsterdam | year = 2013 | isbn = 9780124158535 }}</ref>The idea was differed by Riggs, after 34 years; stated as two types of osteoporosis: the bone loss in female following menopause as type I, and age-related bone loss as type II.<ref name="pmid7119111">{{cite journal| author=Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB et al.| title=Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes. | journal=J Clin Invest | year= 1982 | volume= 70 | issue= 4 | pages= 716-23 | pmid=7119111 | doi= | pmc=370279 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=7119111 }} </ref> | ||
==Classification== | ==Classification== |
Revision as of 20:30, 31 July 2017
Osteoporosis Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
Overview
Osteoporosis is a bone disease, characterized by lowered bone mineral density; leads to increased risk of fracture. The pathology is negative balance between old bone resorption and new bone formation. Aging, female gender, thin and small stature, Asian or Caucasian races, alcoholism, hypogonadism, and steroid abuse are among the primary risk factors associated with osteoporosis. It can be prevented with lifestyle modification, or calcium and vitamin D supplementation. Preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. Bisphosphonates, calcium, and vitamin D supplementation form the main stay of treatment.
Historical Perspective
Albright and Reifenstein in 1948, have defined the primary osteoporosis as consistent of two factors: one associated with estrogen loss during menopause and another with growing age. [1]The idea was differed by Riggs, after 34 years; stated as two types of osteoporosis: the bone loss in female following menopause as type I, and age-related bone loss as type II.[2]
Classification
There is no established classification system for osteoporosis.
Pathophysiology
The pathophysiology of osteoporosis involves an imbalance between bone resorption and bone formation, leading to poor mineralization and fragility of the bone. Factors that contribute to the development of osteoporosis include advanced age, female sex and hypogonadism.
Causes
Osteoporosis is caused by imbalance between bone resorption and bone formation. The most common causes of osteoporosis includeaging, chronic renal failure, nutritional deficiency of calcium and / or vitamin D, immobility, hyperparathyroidism, menopause, and chronic glucocorticoid abuse.
Differentiating Osteoporosis from other Diseases
Osteoporosis must be distinguished from idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria and hypermetabolic resorptive osteoporosis which can also present with similar features.
Epidemiology and Demographics
Osteoporosis is a major health problem affecting 44 million people in the United States. The disease is most common in females over the age of 50.
Risk Factors
Risk factors for osteoporosis include both non-modifiable risk factors, such as advanced age, female gender, and causcasian or asian race, and modifiable risk factors such as alcohol use, steroid use, smoking, poor diet and lack of exercise.
Natural History, Complications and Prognosis
Osteoporosis can be complicated by the development of fractures. The prognosis is good. Mortality from the disease depends on the type of fracture. The major type of fractures contributing to mortality in these patients are vertebral fractures and hip fractures.
Diagnosis
Symptoms
Osteoporosis itself has no symptoms, until a fracture due to brittle bones has already occurred. The disease state causes increased fragility of the bones and thus making them more prone to fractures. The precursor disease to osteoporosis is osteopenia, which is poor mineralization of the bone, which can only be diagnosed through medical tests.
Physical Examination
Osteoporosis is associated with the presence of fractures on physical examination.
Laboratory Findings
Laboratory tests for the diagnosis of osteoporosis include some baseline tests including a complete blood count (CBC), serum calcium, serum phosphate, alkaline phosphatase, and 25(OH) vitamin D, as well as tests for diagnosing secondary osteoporosis, which include 24 hr serum calcium, serum protein electrophoresis, and bone marrow biopsy.
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical therapy
Drugs, especially bisphosphonates are the main medications in the treatment of osteoporosis. However, lifestyle changes are also emphasized. No treatment can completely reverse established osteoporosis. Medical management can only halt the progression of the disease process.
Surgery
Surgical therapy is employed for fractures caused by osteoporosis. Vertebroplasty and kyphoplasty are used to treat patients with vertebral compression fractures. For fractures of the hip open reduction and internal fixation is done.
Primary Prevention
Secondary Prevention
Cost-Effectiveness of Therapy
Future or Investigational Therapies
References
- ↑ Marcus, Robert (2013). Osteoporosis. Amsterdam: Elsevier/Academic Press. ISBN 9780124158535.
- ↑ Riggs BL, Wahner HW, Seeman E, Offord KP, Dunn WL, Mazess RB; et al. (1982). "Changes in bone mineral density of the proximal femur and spine with aging. Differences between the postmenopausal and senile osteoporosis syndromes". J Clin Invest. 70 (4): 716–23. PMC 370279. PMID 7119111.