Osteoporosis

Aka: Osteoporosis, Osteopenia

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II. Epidemiology

  1. Osteoporosis Prevalence in U.S.
    1. More than 10 Million older adults in U.S. have Osteoporosis
    2. wright (2014) J Bone Miner Res 29(11):2520-6 +PMID:24771492 [PubMed]
  2. Osteoporotic Fractures/year in U.S.: 2 to 3 Million
  3. Gender
    1. Women affected more often than men by ratio of 5:1
  4. Costs (hospitalizations, Nursing Home Admissions, office and ED Visits)
    1. Year 2002: $18 Billion/year
    2. Year 2026: $25 Billion/year (projected)

III. Pathophysiology

  1. See Bone Physiology
  2. Osteoporosis mechanism
    1. Hypogonadism (Menopause or orchiectomy)
      1. Osteoclastic overactivity
    2. Age related loss: Osteoblast Underactivity
    3. Trabecular Bone turnover is much more rapid
      1. Osteoporosis first seen in spine and Pelvis
      2. Trabecular Bone greater in spine and Pelvis

IV. Risk Factors

  1. See Osteoporosis Risk Factors

V. Course

  1. Normal bone mass
    1. Peak bone mass occurs at 20-35 years
    2. Decline in bone mass starts after age 35-50 years
    3. Normal bone density loss is 1% per year
  2. Hypogonadism accelerates decline to 3-4% per year
    1. Menopause in women
    2. Orchiectomy in men (Prostate Cancer)
  3. Age 50 years
    1. Osteopenia in Men: 33-47%
    2. Osteoporosis in Men: 4-6%
  4. Age 65 years
    1. Men and women have similar rates of decline
  5. Age 75 years
    1. Dramatic increase in Incidence of Hip Fracture in men
  6. Age 80 years
    1. Women: 90% have Osteoporosis (15% Hip Fracture risk)
    2. Men: 50% have Osteoporosis
  7. Age 90 years
    1. Women: Hip Fracture in 33%
    2. Men: Hip Fracture in 17%

VI. Types

  1. Type 1 Osteoporosis
    1. Postmenopausal women
    2. Trabecular Bone mass decreased
    3. Fracture sites
      1. Vertebral body (T7-T9)
      2. Distal Forearm (Colles Fracture)
  2. Type 2 Osteoporosis
    1. Both sexes, Age over 60 years
    2. Both cortical and Trabecular Bone mass decreased
    3. Fracture sites
      1. Femoral neck (Most common)
      2. Proximal Humerus
      3. Proximal Tibia
      4. Pelvis

VII. Complications: Fractures

  1. Total Fracture Incidence: 1.3 Million per year
  2. Hip Fracture Incidence: 250,000 per year
    1. See Hip Fracture for morbidity and mortality
  3. Vertebral Compression Fracture
    1. Occurs in 33% of women over age 50 years

VIII. Evaluation

  1. See Osteoporosis Secondary Causes
  2. See Osteoporosis Evaluation

IX. Management

  1. See Osteoporosis Management

X. Resources

  1. National Osteoporosis Foundation
    1. http://www.nof.org
    2. Phone: (800) 223-9994
  2. Physicians Guide to Prevention and Treatment of Osteoporosis
    1. http://www.nof.org/physguide/index.htm

XI. References

  1. Bilezikian (1999) J Clin Endocrinol Metab 84:3431-4 [PubMed]
  2. Goddard (1998) Postgrad Med 104(4):54-72 [PubMed]
  3. Harris (2023) Am Fam Physician 107(3): 238-46 [PubMed]
  4. Heaney (1998) Endocrinol Metab Clin North Am 27:255-65 [PubMed]
  5. Jeremiah (2015) Am Fam Physician 92(4): 261-8 [PubMed]
  6. Orwoll (1998) Endocrinol Metab Clin North Am 27:349-67 [PubMed]
  7. South-Paul (2001) Am Fam Physician 63(5):897-904 [PubMed]
  8. Taxel (1998) Geriatrics 53(8): 22-3 [PubMed]

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