American Journal of Obstetrics and Gynecology
Epidemiology, etiology, and diagnosis of osteoporosis
Section snippets
Prevalence
Elderly people are the fastest growing population in the world and, as people age, bone mass declines and the risk of fractures increases.1 Osteoporosis, defined as a skeletal disorder characterized by compromised bone strength predisposing to an increased risk of fracture, is a major public health problem throughout the world.2 The social and economic burden of osteoporosis is increasing steadily because of the aging of the world population.1 Currently affecting more than 10 million people in
Patient history and physical examination
Many metabolic bone diseases, such as hyperparathyroidism and osteomalacia, also are associated with low BMD measurements; therefore a complete and thorough history taking and physical examination are essential to establishing a correct diagnosis of osteoporosis.12 A complete history should be obtained, with specific attention given to the previously discussed risk factors, including medical, family, and medication histories.12
Although patients with decreased BMD values usually have no specific
Assessments of BMD
BMD is the standard tool used to diagnose osteoporosis. Several methods of imaging have been developed to measure BMD, including DXA and quantitative computed tomography (QCT). The WHO guidelines for the diagnosis of osteoporosis are based on DXA measurements of the hip or spine.15
DXA
DXA is considered the gold standard of methods used to diagnose osteoporosis.58 This test is capable of measuring bone mineral content at any site in the body but usually is used at central sites (the lumbar spine and
Conclusion
The clinical consequences and economic burden of osteoporosis indicate a need for intervention in women at high risk. Many risk factors are associated with osteoporosis and fracture, including low-peak bone mass achieved during growth, hormonal factors, the use of certain drugs, cigarette smoking, low physical activity, low intake of calcium and vitamin D, race, small body size, and a personal or family history of fracture. All these factors should be taken into account when assessing the risk
Acknowledgment
Dr Lane would like to thank Julia Schroeder for assistance in the preparation of this manuscript.
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