Osteoporosis and Osteopenia
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Basics
Description
A skeletal disease characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture.
Epidemiology
- Most common bone disease in humans
- Predominant age: elderly >60 years of age
- Predominant sex: female > male (80%/20%)
Incidence
There are poor data on the incidence of osteoporosis and osteopenia; however, there are an estimated 9 million fractures annually attributed to osteoporosis worldwide.
- >10.2 million Americans have osteoporosis
- >43.4 million Americans have osteopenia
- Women >50 years of age: osteoporosis 15.4% and osteopenia 51.4%
- Men >50 years of age: osteoporosis 4.3% and osteopenia 35.2%
- One in three women and one in five men will experience an osteoporotic fracture in their lifetime
Etiology and Pathophysiology
- Imbalance between bone resorption and bone formation
- Aging
- Hypoestrogenemia
Genetics
- Familial predisposition
- More common in Caucasians and Asians than in African Americans and Hispanics
Risk Factors
- Nonmodifiable:
- Age >65 years
- Female gender and menopause
- Caucasian or Asian race
- Family history of osteoporosis
- History of atraumatic fracture
- Modifiable:
- Low body weight (<58 kg or body mass index [BMI] <21)
- Calcium/vitamin D deficiency
- Inadequate physical activity
- Cigarette smoking
- Excessive alcohol intake (>3 drinks per day)
- Medications: See “Commonly Associated Conditions”
General Prevention
The aim in the prevention and treatment of osteoporosis is to prevent fracture:
- Regularly perform weight-bearing exercise
- Consume a diet that includes adequate calcium (1,000 mg/day for men ages 50 to 70 years and 1,200 mg/day for women ages 51+ years and men 70+ years) and vitamin D (800 to 1,000 IU/day).
- Evidence is insufficient to recommend daily supplementation with >1,000 mg of calcium and >400 IU of vitamin D3 for the primary prevention of fractures in community-dwelling postmenopausal women. The U.S. Preventive Services Task Force (USPSTF) recommends against daily supplementation with ≤1,000 mg calcium and ≤400 IU vitamin D3 for the primary prevention of fractures in this group (1)[B].
- Avoid smoking
- Limit alcohol consumption (<3 drinks per day)
- Fall prevention (home safety assessment, correction of visual impairment)
- Screen (USPSTF recommendations):
- All women ≥65 years of age (1)[B]
- Women >50 years of age with a 10-year risk of major osteoporotic fracture (using the World Health Organization’s [WHO] Fracture Risk Assessment [FRAX] Tool) >8.4% (2)
- The current evidence is insufficient to recommend screening for osteoporosis in men; however, the National Osteoporosis Foundation recommends screening men age >70 years, especially if at increased risk.
- Limited evidence from good-quality studies found no benefit in predicting fractures from repeating bone mineral density (BMD) testing 4–8 years after initial screening (2).
Commonly Associated Conditions
- Malabsorption syndromes: gastrectomy, inflammatory bowel disease, celiac disease
- Hypoestrogenism: menopause, hypogonadism, eating disorders, functional hypothalamic amenorrhea
- Endocrinopathies: hyperparathyroidism, hyperthyroidism, hypercortisolism, diabetes mellitus
- Hematologic disorders: hemophilia, sickle cell disease, multiple myeloma, thalassemia, hemochromatosis
- Other chronic diseases: multiple sclerosis, end-stage renal disease, rheumatoid arthritis, lupus, chronic obstructive pulmonary disease (COPD), HIV/AIDS
- Medications: antiepileptics, aromatase inhibitors (raloxifene), chronic corticosteroids (>5 mg prednisone or equivalent for >3 months), medroxyprogesterone acetate, heparin, SSRIs, thyroid hormone (in supraphysiologic doses), PPIs
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Basics
Description
A skeletal disease characterized by low bone mass, deterioration of bone tissue, and disruption of bone architecture that leads to compromised bone strength and an increased risk of fracture.
Epidemiology
- Most common bone disease in humans
- Predominant age: elderly >60 years of age
- Predominant sex: female > male (80%/20%)
Incidence
There are poor data on the incidence of osteoporosis and osteopenia; however, there are an estimated 9 million fractures annually attributed to osteoporosis worldwide.
- >10.2 million Americans have osteoporosis
- >43.4 million Americans have osteopenia
- Women >50 years of age: osteoporosis 15.4% and osteopenia 51.4%
- Men >50 years of age: osteoporosis 4.3% and osteopenia 35.2%
- One in three women and one in five men will experience an osteoporotic fracture in their lifetime
Etiology and Pathophysiology
- Imbalance between bone resorption and bone formation
- Aging
- Hypoestrogenemia
Genetics
- Familial predisposition
- More common in Caucasians and Asians than in African Americans and Hispanics
Risk Factors
- Nonmodifiable:
- Age >65 years
- Female gender and menopause
- Caucasian or Asian race
- Family history of osteoporosis
- History of atraumatic fracture
- Modifiable:
- Low body weight (<58 kg or body mass index [BMI] <21)
- Calcium/vitamin D deficiency
- Inadequate physical activity
- Cigarette smoking
- Excessive alcohol intake (>3 drinks per day)
- Medications: See “Commonly Associated Conditions”
General Prevention
The aim in the prevention and treatment of osteoporosis is to prevent fracture:
- Regularly perform weight-bearing exercise
- Consume a diet that includes adequate calcium (1,000 mg/day for men ages 50 to 70 years and 1,200 mg/day for women ages 51+ years and men 70+ years) and vitamin D (800 to 1,000 IU/day).
- Evidence is insufficient to recommend daily supplementation with >1,000 mg of calcium and >400 IU of vitamin D3 for the primary prevention of fractures in community-dwelling postmenopausal women. The U.S. Preventive Services Task Force (USPSTF) recommends against daily supplementation with ≤1,000 mg calcium and ≤400 IU vitamin D3 for the primary prevention of fractures in this group (1)[B].
- Avoid smoking
- Limit alcohol consumption (<3 drinks per day)
- Fall prevention (home safety assessment, correction of visual impairment)
- Screen (USPSTF recommendations):
- All women ≥65 years of age (1)[B]
- Women >50 years of age with a 10-year risk of major osteoporotic fracture (using the World Health Organization’s [WHO] Fracture Risk Assessment [FRAX] Tool) >8.4% (2)
- The current evidence is insufficient to recommend screening for osteoporosis in men; however, the National Osteoporosis Foundation recommends screening men age >70 years, especially if at increased risk.
- Limited evidence from good-quality studies found no benefit in predicting fractures from repeating bone mineral density (BMD) testing 4–8 years after initial screening (2).
Commonly Associated Conditions
- Malabsorption syndromes: gastrectomy, inflammatory bowel disease, celiac disease
- Hypoestrogenism: menopause, hypogonadism, eating disorders, functional hypothalamic amenorrhea
- Endocrinopathies: hyperparathyroidism, hyperthyroidism, hypercortisolism, diabetes mellitus
- Hematologic disorders: hemophilia, sickle cell disease, multiple myeloma, thalassemia, hemochromatosis
- Other chronic diseases: multiple sclerosis, end-stage renal disease, rheumatoid arthritis, lupus, chronic obstructive pulmonary disease (COPD), HIV/AIDS
- Medications: antiepileptics, aromatase inhibitors (raloxifene), chronic corticosteroids (>5 mg prednisone or equivalent for >3 months), medroxyprogesterone acetate, heparin, SSRIs, thyroid hormone (in supraphysiologic doses), PPIs
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