Osteoporosis

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Osteoporosis
ICD-10	M80-M82
ICD-9	733.0
DiseasesDB	9385
MeSH	D010024

Osteoporosis Microchapters
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Epidemiology and Demographics
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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]

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Epidemiology

Hip fractures

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.

First vertebral fractures

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.

Distal radius fractures

Distal 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.

Risk factors

Diseases and disorders

There are many disorders associated with osteoporosis:

• Hypogonadal states - Turner syndrome, Klinefelter syndrome, Kallmann syndrome, anorexia nervosa, 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.

• Other endocrine disorders - Cushing's syndrome, hyperparathyroidism, thyrotoxicosis, hypothyroidism, insulin-dependent diabetes mellitus, acromegaly, adrenal insufficiency

• 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.

• Rheumatologic disorders - rheumatoid arthritis, ankylosing spondylitis

• Hematologic disorders/malignancy - multiple myeloma, lymphoma and leukemia, mastocytosis, hemophilia, thalassemia.

• Inherited disorders of the bone - osteogenesis imperfecta, Marfan syndrome, hemochromatosis, hypophosphatasia, glycogen storage diseases, homocystinuria, Ehlers-Danlos syndrome, porphyria, Menkes' syndrome, epidermolysis bullosa, Gaucher's disease.

• Other disorders - immobilization, scoliosis

Medication

Medication - for medication potentially causing osteoporosis, the positive effects of them needs to be compared with the degenerative effects on bone.

• Steroid-induced osteoporosis (SIOP) arises due to use of glucocorticoids - 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.
• Barbiturates (probably due to accelerated metabolism of vitamin D) and some other enzyme-inducing antiepileptics.
• Proton pump inhibitors - these drugs inhibit the production of stomach acid; it is thought that this interferes with calcium absorption.

Prognosis

Hip fractures per 1000 patient-years

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

Although osteoporosis patients have an increased mortality rate due to the complications of fracture, most patients die with the disease rather than of it.

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.

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.

Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.

See also

• Bone healing
• Back pain
• bone mineral density
• Hip protector
• Dental X-ray
• Osteopetrosis, the opposite of osteoporosis
• Osteoimmunology

External links

• Foundation for Osteoporosis Research and Education Non-profit organization
• The International Osteoporosis Foundation
• Osteoporosis Australia
• Osteoporosis Canada
• Irish Osteoporosis Society
• Osteoporosis New Zealand Inc
• National Osteoporosis Society (UK)
• The National Osteoporosis Foundation(USA)
• The Osteoporosis Section of The Hormone Foundation

• University of Washington
• Osteopenia - A controversial diagnosis.
• Diet, Nutrition and the prevention of chronic diseases (including osteoporosis) by a Joint WHO/FAO Expert consultation (2003)

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