Osteoporosis natural history: Difference between revisions
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==Complications== | ==Complications== | ||
Disease can be complicated by the development of: | Disease can be complicated by the development of: | ||
* [[Fractures]] - hip, | * [[Fractures]] - hip, vertebrae are among the most frequent sites | ||
* [[DVT]] - from prolonged immobility | * [[DVT]] - from prolonged immobility | ||
* [[Kyphosis]] (Dowager's hump) | * [[Kyphosis]] (Dowager's hump) |
Revision as of 13:37, 21 July 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
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.
Natural History
The symptoms of the disease typically develop in the sixth decade of life. Risk increases with age proportionately. DXA bone densitometry is recommended every 2–3 years as a screening tool. Outcome is usually good with appropriate and timely usage of medications and with calcium and / or vitamin D supplementation.
Complications
Disease can be complicated by the development of:
- Fractures - hip, vertebrae are among the most frequent sites
- DVT - from prolonged immobility
- Kyphosis (Dowager's hump)
- Restrictive lung disease
- Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.[1]
- Drug side-effects:
- Bisphosphonates - Esophagitis, Osteonecrosis of the jaw, bone pain, muscle pain etc.,
- Raloxifene - thromboembolism, aggravates hot flashes, nausea, weight gain, depression, insomnia, leg cramps, rash
- Teriparitide - orthostatic hypotension, asthenia, nausea, leg cramps, hypercalcemia (if taken along with corticosteroids, thiazide diuretics, and calcium supplementation), must not be given to patients with Paget's disease or a history of osteosarcoma or chondrosarcoma
- Nasal calcitonin-salmon - bronchospasm, rhinitis, epistaxis, arthralgias
Prognosis
- The prognosis of the disease is good if the decrease in bone mass density is identified early and appropriate anti-osteoporotic medications are started.
- DVT caused by prolonged immobility from hip fractures, is associated with a poorer prognosis among patients with disease.
WHO category | Age 50-64 | Age > 64 | Overall |
---|---|---|---|
Normal | 5.3 | 9.4 | 6.6 |
Osteopenia | 11.4 | 19.6 | 15.7 |
Osteoporosis | 22.4 | 46.6 | 40.6 |
- The lifetime fracture risk in white women is 18% for hip fractures, 16% for spine fractures, 16% for wrist fractures and in men the same fractures account for 6%, 5%, and 3% respectively.
- More than half of all women and one third of all men have osteoporotic fractures in their lifetime.
- Men have a higher mortality from fractures compared to women.
- The 6-month mortality rate following hip fracture is approximately 13.5%
- 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
References
- ↑ Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES (2006). "Impact of recent fracture on health-related quality of life in postmenopausal women". J. Bone Miner. Res. 21 (6): 809–16. doi:10.1359/jbmr.060301. PMID 16753011.
- ↑ Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD (2007). "Low bone mineral density and fracture burden in postmenopausal women". CMAJ. 177 (6): 575–80. doi:10.1503/cmaj.070234. PMID 17846439.