Osteoporosis and Osteopenia

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Basics

Description

A skeletal disease characterized by low bone mass, with disruption of bone architecture leading to compromised bone strength and 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 more than 2 million fractures annually attributed to osteoporosis in the United States.

Prevalence
  • >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

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
  • Modifiable:
    • Low body weight (<58 kg or BMI <21)
    • Calcium/vitamin D deficiency
    • Inadequate physical activity
    • Cigarette smoking
    • Excessive alcohol intake (>3 drinks per day)
    • Various medications

General Prevention

The aim is to prevention fracture:

  • Regularly perform weight-bearing exercise.
  • A diet with adequate calcium (1,000 mg/day for men aged 50 to 70 years and 1,200 mg/day for women aged 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 primary fracture prevention.
  • 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
    • 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%
    • Evidence is insufficient to recommend screening men; however, the National Osteoporosis Foundation recommends screening men age >70 years, especially if at increased risk.
    • No clear benefit in predicting fractures from repeating bone mineral density (BMD) testing 4 to 8 years after initial screening.

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: 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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Basics

Description

A skeletal disease characterized by low bone mass, with disruption of bone architecture leading to compromised bone strength and 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 more than 2 million fractures annually attributed to osteoporosis in the United States.

Prevalence
  • >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

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
  • Modifiable:
    • Low body weight (<58 kg or BMI <21)
    • Calcium/vitamin D deficiency
    • Inadequate physical activity
    • Cigarette smoking
    • Excessive alcohol intake (>3 drinks per day)
    • Various medications

General Prevention

The aim is to prevention fracture:

  • Regularly perform weight-bearing exercise.
  • A diet with adequate calcium (1,000 mg/day for men aged 50 to 70 years and 1,200 mg/day for women aged 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 primary fracture prevention.
  • 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
    • 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%
    • Evidence is insufficient to recommend screening men; however, the National Osteoporosis Foundation recommends screening men age >70 years, especially if at increased risk.
    • No clear benefit in predicting fractures from repeating bone mineral density (BMD) testing 4 to 8 years after initial screening.

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: 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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