Epidemiology, etiology, and diagnosis of osteoporosis

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Osteoporosis, a major public health problem, is becoming increasingly prevalent with the aging of the world population. Osteoporosis is a skeletal disorder characterized by compromised bone strength, which predisposes the individual to an increased risk of fractures of the hip, spine, and other skeletal sites. The clinical consequences and economic burden of this disease call for measures to assess individuals who are at high risk to allow for appropriate intervention. Many risk factors are associated with osteoporotic fracture, including low peak bone mass, hormonal factors, the use of certain drugs (eg, glucocorticoids), cigarette smoking, low physical activity, low intake of calcium and vitamin D, race, small body size, and a personal or a family history of fracture. All of these factors should be taken into account when assessing the risk of fracture and determining whether further treatment is required. Because osteoporotic fracture risk is higher in older women than in older men, all postmenopausal women should be evaluated for signs of osteoporosis during routine physical examinations. Radiologic laboratory assessments of bone mineral density generally should be reserved for patients at highest risk, including all women over the age of 65, younger postmenopausal women with risk factors, and all postmenopausal women with a history of fractures. The evaluation of biochemical markers of bone turnover has been useful in clinical research. However, the predictive factor of these measurements is not defined clearly, and these findings should not be used as a replacement for bone density testing. Together, clinical assessment of osteoporotic risk factors and objective measures of bone mineral density can help to identify patients who will benefit from intervention and, thus, can potentially reduce the morbidity and mortality associated with osteoporosis-associated fractures in this population.

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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