What is the most common bone disorder in the US?
Osteoporosis
- 8 million women
- 2 million men
How is osteoporosis defined?
A reduction in bone strength that leads to increased fracture risk
Why is osteoporosis considered a silent disease?
Patients are often asymptomatic until a fracture occurs
What are signs and symptoms of osteoporosis if they do occur?
Fracture related -pain -lack of mobility -depressed mood due to physical limitations -decreased height —greater than 1.5 inch loss -rounding of the spine
What does osteoporosis result from?
Imbalance in bone remodeling
-osteoclast activity (bone resorption) exceeds osteoblast activity (bone formation)
—causes decreased bone mineral density (BMD)
When does the imbalance in bone modeling occur?
A normal age related process
- begins around age 30
- for women: becomes more apparent after menopause
What are important ways to develop and maintain adequate BMD?
- physical activity
- adequate vitamin D and calcium intake
What are other factors that can contribute to low BMD or osteoporotic fracture?
-low body weight
-premature menopause
-chronic disease
-smoking
-alcohol use
—3 or more drinks per day
-medications
—corticosteroids
How is osteoporosis diagnosed clinically?
Presence of a fracture without major trauma
-known as a fragility fracture
What scan is used to diagnose osteoporosis based on BMD?
-DXA
—dual energy x-ray absorptiometry
—measures bone density at the hip and spine
What does the DXA report include?
- actual bone density
- T score
- Z score
What is the T score?
- used for diagnosis
- compares the patient’s bone density to the peak bone density of a healthy 20-29 year old adult
- is the number of standard deviations from the mean reference population
What is the Z score?
Compares the patient’s bone density to that of an individual of the same:
- age
- sex
- ethnic background
When are Z scores used?
To help diagnose osteoporosis in:
- men younger than age 50
- children
- premenopausal women
What organization has defined bone density levels?
The World Health Organization (WHO)
What tool calculates the estimated risk of fracture based on BMD and individual patient factors, developed by the WHO?
The Fracture Risk Assessment Tool (FRAX)
How can the incidence of osteoporosis be reduced?
- by optimizing skeletal development and peak bone mass early in life
- prevention of age related and secondary causes of bone loss
What are the goals once osteoporosis develops?
- prevent fractures
- stabilize the skeletal system
- improve strength and bone mass
What organizations provide recommendations for the prevention and management of osteoporosis using both lifestyle modifications and pharmacologic therapies?
- American Academy of Clinical Endocrinologists (AACE)
- American College of Rheumatology (ACR)
- National Osteoporosis Foundation (NOF)
What organizations provide additional guidelines that focus on the pharmacologic treatment of osteoporosis?
- Endocrine Society
- American Society for Bone and Mineral Research (ASBMR)
- American College of Physicians
What can reduce the risk of fractures?
-maintenance of a bone healthy lifestyle
What is adequate calcium intake essential for?
- development of bone mass during childhood
- maintenance of bone mass throughout life
How should calcium be primarily obtained?
Through a patient’s diet
When is calcium supplementation recommended?
When dietary intake is inadequate?
