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Osteoporosis and Osteopenia

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Other Names

  • Greek term for "porous bones"

Background

  • Most common bone disease in humans and is characterized by low bone mass and skeletal fragility
  • Annually, two million fractures are attributed to osteoporosis
    • Causes more than 432,000 hospital admissions, almost 2.5 million medical office visits, and about 180,000 nursing home admissions in the USA [1]

Pathophysiology

  • Characterized by low bone mass, microarchitectural disruption, and skeletal fragility
    • Results in decreased bone strength and increased risk of fracture
  • Decreased bone strength is related to many factors other than bone mineral density
    • includes rates of bone formation and resorption or turnover, bone geometry, and microarchitecture

Clinical Features

Differential Diagnosis

  • Osteomalacia
  • Malignancy (eg, multiple myeloma)
  • Paget disease
  • Hyperparathyroidism
  • Renal osteodystrophy

Risk Factors

Evaluation

Classification

Management

Nonpharmacologic

  • Lifestyle factors should be implemented for all patients at risk or diagnosed with osteoporosis or osteopenia
    • Regular weight bearing exercise and muscle strengthening exercises (some professional societies recommend at least 30 mins daily)
      • Has been shown to reduce falls and also slightly increased BMD
    • Formal fall reduction program for at least 5 months recommended for patients that have had fragility fracture or with osteoporosis
      • Should include challenging balance exercises
      • Core-strength and pilates exercises shown to have high compliance, Tai Chi shown to reduce falls
    • Smoking cessation
      • Encouragement and implementation of cessation program
    • Avoid heavy daily alcohol use
      • Recent meta-analysis showed 1.34 times risk in persons consuming 1-2 drinks per day and 1.63 times risk in individuals consuming >2 drinks per day [2]
      • Conflicting evidence in regards to light to moderate alcohol use overall
    • Adequate calcium intake
      • Institute of Medicine (IOM) recommends that women age 51 or older and men aged 71 and older consume 1200 mg/day of calcium [3]
        • The average daily dietary calcium intake in adults age 50 and older is 600 to 700 mg per day
      • May need supplementation if dietary intake not sufficient
    • Adequate vitamin D intake
      • National Osteoporosis Foundation recommends an intake of 800 to 1000 international units (IU) for adults aged 50 and older
        • Most dietary sources of vitamin D are usually fortified and include milk, fish, liver, juices and cereal
      • Levels are typically measured with serum studies
      • Treatment typically occurs with levels below 30 ng/mL and a maintenance dose is recommended at this level
      • If levels are below 20 ng/mL, many providers will treat with 50,000 IU once a week for 8-12 weeks and then recheck the vitamin D levels
        • If normalized, dosages between 1000-3000 IU are started as a maintenance dose and adjusted depending on follow up levels.

Complications

See Also

References

  1. ↑ Office of the Surgeon General (US) (2004) Bone health and osteoporosis: a report of the Surgeon General. Office of the Surgeon General (US), Rockville (MD)
  2. ↑ Cheraghi Z, Doosti-Irani A, Almasi A, Baigi V, Mansournia N, Etminan M, et al. The effect of alcohol on osteoporosis; a systematic review and meta-analysis. Drug Alcohol Depend. 2019;197:197–202
  3. ↑ Ross AC, Manson JE, Abrams SA, et al. The 2011 report on dietary reference intakes for calcium and vitamin D from the Institute of Medicine: what clinicians need to know. J Clin Endocrinol Metab. 2011;96(1):53–58
Created by:
John Kiel on 13 June 2019 10:26:25
Last edited:
16 August 2019 05:43:23
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