Osteoporosis and Osteopenia

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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


  • Most common bone disease in humans
  • Predominant age: elderly >60 years of age
  • Predominant sex: female > male (80%/20%)

There is 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.

Etiology and Pathophysiology

  • Imbalance between bone resorption and bone formation
  • Aging
  • Hypoestrogenemia

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

Risk Factors

  • Nonmodifiable
    • Advanced age (>65 years)
    • Female gender and menopause
    • Caucasian or Asian
    • 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 aged 50 to 70 years, 1,200 mg/day for women aged 51+ years and men 70+ years), and vitamin D (800 to 1,000 IU/day).
  • The USPSTF recommends against vitamin D supplementation to prevent falls in community-dwelling adults aged 65 years or older who are not known to have osteoporosis or vitamin D deficiency (1)[A].
  • Evidence is insufficient to assess the balance of the benefits and harms of daily supplementation with >400 IU of vitamin D3 and >1,000 mg of calcium for the primary prevention of fractures in community-dwelling postmenopausal women (2)[B].
  • USPSTF recommends against daily supplementation with 400 IU or less of vitamin D3 and 1,000 mg or less of calcium for the primary prevention of fractures in noninstitutionalized postmenopausal women (2)[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 (2)[B]
    • Women >50 years of age with ≤10-year fracture risk (using the WHO’s Fracture Risk Assessment [FRAX] Tool) >9.3%
    • 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.

Commonly Associated Conditions

  • Malabsorption syndromes: gastrectomy, inflammatory bowel disease, celiac disease
  • Hypoestrogenism: menopause, hypogonadism, eating disorders, female athlete triad
  • Endocrinopathies: hyperparathyroidism, hyperthyroidism, hypercortisolism, diabetes mellitus
  • Hematologic disorders: hemophilia, sickle cell disease, multiple myeloma, thalassemia, hemochromatosis
  • Other disorders: 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, SSRI, thyroid hormone (in supraphysiologic doses), PPI

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