Osteoporosis and Osteopenia



A skeletal disease characterized by low bone mass, with disruption of bone architecture leading to compromised bone strength and risk of fracture.


  • Predominant age: elderly >60 years of age
  • Predominant sex: female > male (80%/20%)


  • >2 million fractures annually attributed to osteoporosis in the United States.
  • >9.9 million Americans have osteoporosis.
  • >43.1 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%

Etiology and Pathophysiology

  • Imbalance between bone resorption/formation
  • Hypoestrogenemia


  • Familial predisposition
  • More common in Caucasians and Asians than in African Americans and Hispanics (1)

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
  • Other chronic diseases: multiple sclerosis, end-stage renal disease, rheumatoid arthritis, lupus, COPD, HIV/AIDS
  • Medications: chemotherapy agents, antiepileptics, aromatase inhibitors (raloxifene), chronic corticosteroids (equivalent to at least 5 mg prednisone daily for at least 3 months), medroxyprogesterone acetate, heparin, SSRIs, thyroid hormone (in supraphysiologic doses), PPIs

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