Osteoporosis and Osteopenia

BASICS

DESCRIPTION

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

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: Glucocorticoids (prednisone, dexamethasone, hydrocortisone); anticonvulsants (phenytoin, carbamazepine, phenobarbital); proton pump inhibitor (PPI) (omeprazole, esomeprazole, lansoprazole); selective serotonin reuptake inhibitors (SSRIs) (fluoxetine, sertraline, paroxetine); thiazolidinedione (TZD) (pioglitazone, rosiglitazone); heparin and low molecular weight heparin (enoxaparin); aromatase inhibitors; gonadotropin-releasing hormone (GnRH) agonists; anticoagulants (warfarin); chemotherapy (methotrexate, cyclophosphamide); medroxyprogesterone acetate; and excessive thyroid hormone replacement.

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