Osteoporosis and Osteopenia

Description

A metabolic bone disease characterized by low bone mass, with deterioration of bone microarchitecture leading to compromised bone strength and increased risk of fragility fracture

Epidemiology

Prevalence

• 10.2 million Americans have osteoporosis (1).
• >43.3 million Americans have low bone mass (1).
• Women >50 years of age: osteoporosis 19.6% and osteopenia 51.5%
• Men >50 years of age: osteoporosis 4.4% and osteopenia 33.5%

Etiology and Pathophysiology

Imbalance between bone resorption and formation results in a net loss of bone mass and density over time, leading to weakened and porous bones.

Genetics

• Familial predisposition
• More common in Caucasians and Asians than in African Americans and Hispanics

Commonly Associated Conditions

• Malabsorption syndromes: gastrectomy, inflammatory bowel disease, celiac disease
• Hypoestrogenism: menopause, hypogonadism, eating disorders, etc.
• Endocrinopathies: hyperparathyroidism, hyperthyroidism, hypercortisolism, diabetes mellitus
• Hematologic disorders: sickle cell disease, multiple myeloma, thalassemia, hemochromatosis
• Many other chronic diseases including end-stage renal disease
• Medications: chemotherapy agents, antiepileptics, aromatase inhibitors (raloxifene), chronic corticosteroids (equivalent to at least 5 mg of prednisone daily for at least 3 months), medroxyprogesterone acetate, heparin, SSRIs, thyroid hormone (in supraphysiologic doses), PPIs