Osteoporosis overview
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Osteoporosis Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Osteoporosis overview On the Web |
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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 disease of the bone characterized by low bone mineral density. which leads to an increased risk of fracture. The pathology involves negative balance between bone resorption and new bone formation. Aging, female gender, thin and small stature, asian or caucasian race, alcoholism, hypogonadism, and steroid abuse are among the primary risk factors associated with osteoporosis. It can be prevented with lifestyle modification, calcium and vitamin D supplementation, and medication. 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.
Clinical practice guidelines are available from both non-specialty organizations[1][2] and specialty societies[3][4].
Historical Perspective
Classification
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
- ↑ Qaseem A, Snow V, Shekelle P, Hopkins R, Forciea MA, Owens DK; et al. (2008). "Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians". Ann Intern Med. 149 (6): 404–15. PMID 18794560.
- ↑ U.S. Preventive Services Task Force (2011). "Screening for osteoporosis: U.S. preventive services task force recommendation statement". Ann Intern Med. 154 (5): 356–64. doi:10.1059/0003-4819-154-5-201103010-00307. PMID 21242341.
- ↑ "Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society". Menopause. 17 (1): 25–54, quiz 55-6. 2010 Jan-Feb. doi:10.1097/gme.0b013e3181c617e6. PMID 20061894. Check date values in:
|year=(help) - ↑ National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation;2008.