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Osteoporosis
Aka: Osteoporosis, Osteopenia
- See Also
- Osteoporosis Secondary Causes
- Medication Causes of Osteoporosis
- Osteoporosis Evaluation
- Osteoporosis Management
- Epidemiology
- Prevalence
- As many as 10 Million older adults in U.S. have Osteoporosis
- wright (2014) J Bone Miner Res 29(11):2520-6 +PMID:24771492 [PubMed]
- Gender
- Women affected more often than men by ratio of 5:1
- Costs (hospitalizations, Nursing Home admissions, office and ED Visits)
- Year 2002: $18 Billion/year
- Year 2026: $25 Billion/year (projected)
- Pathophysiology
- See Bone Physiology
- Osteoporosis mechanism
- Hypogonadism (Menopause or orchiectomy)
- Osteoclastic overactivity
- Age related loss: Osteoblast Underactivity
- Trabecular Bone turnover is much more rapid
- Osteoporosis first seen in spine and Pelvis
- Trabecular Bone greater in spine and Pelvis
- Risk Factors
- See Osteoporosis Risk Factors
- Course
- Normal bone mass
- Peak bone mass occurs at 20-35 years
- Decline in bone mass starts after age 35-50 years
- Normal bone density loss is 1% per year
- Hypogonadism accelerates decline to 3-4% per year
- Menopause in women
- Orchiectomy in men (Prostate Cancer)
- Age 50 years
- Osteopenia in Men: 33-47%
- Osteoporosis in Men: 4-6%
- Age 65 years
- Men and women have similar rates of decline
- Age 75 years
- Dramatic increase in Incidence of Hip Fracture in men
- Age 80 years
- Women: 90% have Osteoporosis (15% Hip Fracture risk)
- Men: 50% have Osteoporosis
- Age 90 years
- Women: Hip Fracture in 33%
- Men: Hip Fracture in 17%
- Types
- Type 1 Osteoporosis
- Postmenopausal women
- Trabecular Bone mass decreased
- Fracture sites
- Vertebral body (T7-T9)
- Distal Forearm (Colles Fracture)
- Type 2 Osteoporosis
- Both sexes, Age over 60 years
- Both cortical and Trabecular Bone mass decreased
- Fracture sites
- Femoral neck (Most common)
- Proximal Humerus
- Proximal Tibia
- Pelvis
- Complications: Fractures
- Total Fracture Incidence: 1.3 Million per year
- Hip FractureIncidence: 250,000 per year
- See Hip Fracture for morbidity and mortality
- Vertebral Compression Fracture
- Occurs in 33% of women over age 50 years
- Evaluation
- See Osteoporosis Secondary Causes
- See Osteoporosis Evaluation
- Management
- See Osteoporosis Management
- Resources
- National Osteoporosis Foundation
- http://www.nof.org
- Phone: (800) 223-9994
- Physicians Guide to Prevention and Treatment of Osteoporosis
- http://www.nof.org/physguide/index.htm
- References
- Bilezikian (1999) J Clin Endocrinol Metab 84:3431-4 [PubMed]
- Goddard (1998) Postgrad Med 104(4):54-72 [PubMed]
- Heaney (1998) Endocrinol Metab Clin North Am 27:255-65 [PubMed]
- Jeremiah (2015) Am Fam Physician 92(4): 261-8 [PubMed]
- Orwoll (1998) Endocrinol Metab Clin North Am 27:349-67 [PubMed]
- South-Paul (2001) Am Fam Physician 63(5):897-904 [PubMed]
- Taxel (1998) Geriatrics 53(8): 22-3 [PubMed]