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{| class="infobox" style="float:right;"
{{Infobox_Disease |
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| [[File:Siren.gif|30px|link=Osteoporosis resident survival guide]]|| <br> || <br>
| [[Osteoporosis resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{DiseaseDisorder infobox |
   Name          = Osteoporosis |
   Name          = Osteoporosis |
   Image          = |
   Image          = Osteoporosis Locations.png|
   Caption        = |
   Caption        = By BruceBlaus - via Wikimedia.org <ref>https://commons.wikimedia.org/w/index.php?curid=46602308 </ref> |
  DiseasesDB    = 9385 |
  ICD10          = {{ICD10|M|80||m|80}}-{{ICD10|M|82||m|80}}|
  ICD9          = {{ICD9|733.0}} |
  ICDO          = |
  OMIM          = |
  MedlinePlus    = |
  MeshID        = D010024 |
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{{SI}}
{{Osteoporosis}}
{{CMG}}
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==Overview==
 
'''Osteoporosis''' is a [[disease]] of [[bone]] leading to an increased risk of [[bone fracture|fracture]]. In osteoporosis the [[bone mineral density]] (BMD) is reduced, bone microarchitecture is disrupted, and the amount and variety of non-[[collagen]]ous proteins in bone is altered. Osteoporosis is defined by the [[World Health Organization]] (WHO) in women as a bone mineral density 2.5 [[standard deviation]]s below peak bone mass (20-year-old sex-matched healthy person average) as measured by [[Dual energy X-ray absorptiometry|DXA]]; the term "established osteoporosis" includes the presence of a [[fragility fracture]].<ref name=WHO1994>{{cite journal |author=WHO |title=Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group |journal=World Health Organization technical report series |volume=843 |issue= |pages=1–129 |year=1994 |pmid=7941614 |doi=}}</ref>  '''Osteopenia''' which is defined as [[bone mineral density]] ranging from less than -1.0 and more than -2.5,  can be a precursor condition to [[osteoporosis]].<ref name="WHOcriteria">{{cite web |author=WHO Scientific Group on the Prevention and Management of Osteoporosis (2000 : Geneva, Switzerland)|url=http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf |title=Prevention and management of osteoporosis : report of a WHO scientific group|year=2003 |accessdate=2007-05-31 |format=pdf |work=}}</ref>Osteoporosis is most common in women after the [[menopause]], when it is called '''postmenopausal osteoporosis''', but may develop in men and premenopausal women in the presence of particular hormonal disorders and other [[Chronic (medicine)|chronic]] diseases or as a result of [[tobacco smoking|smoking]] and [[medications]], specifically [[glucocorticoid]]s, when the disease is called '''steroid-''' or '''glucocorticoid-induced osteoporosis''' (SIOP or GIOP).
It is also a sign of normal [[aging]], in contrast to [[osteoporosis]] which is present in pathologic aging. 
Osteoporosis can be prevented with lifestyle advice and medication, and preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. Osteoporosis can be treated with [[bisphosphonate]]s and various other medical treatments.
 
==History==
The link between age-related reductions in bone density and fracture risk goes back at least to Astley Cooper, and the term "osteoporosis" and recognition of its pathological appearance is generally attributed to the French pathologist Lobstein.<ref>Lobstein JGCFM. ''Lehrbuch der pathologischen Anatomie.'' Stuttgart: Bd II, 1835.</ref> The American endocrinolgist Fuller Albright linked osteoporosis with the postmenopausal state.<ref>{{cite journal | author=Albright F, Bloomberg E, Smith PH |year=1940 |month= |title= Postmenopausal osteoporosis |journal=Trans. Assoc. Am. Physicians. |volume=55 |pages=298-305}}</ref> Bisphosponates, which revolutionized the treatment of osteoporosis, were discovered in the 1960s.<ref>{{cite journal |author=Patlak M |title=Bone builders: the discoveries behind preventing and treating osteoporosis |journal=FASEB J. |volume=15 |issue=10 |pages=1677E–E |year=2001 |pmid=11481214 |doi=}}</ref>
 
==Epidemiology==
It is estimated that 1 in 3 women and 1 in 12 men over the age of 50 worldwide have osteoporosis. It is responsible for millions of fractures annually, mostly involving the lumbar [[vertebrae]], [[hip]], and wrist. Fragility fractures of ribs are also common in men.
 
===Hip fractures===
Hip fractures are responsible for the most serious consequences of osteoporosis. In the United States, osteoporosis causes a predisposition to hip fractures -- more than 250,000 occur annually. It is estimated that a 50-year-old white woman has a 17.5% lifetime risk of fracture of the proximal [[femur]]. The incidence of hip fractures increases each decade from the sixth through the ninth for both women and men for all populations. The highest incidence is found among those men and women ages 80 or older.
 
===First vertebral fractures===
An estimated 700,000 women have a first [[vertebral]] fracture each year. The lifetime risk of a clinically detected symptomatic vertebral fracture is about 15% in a 50-year-old white woman.  However, because symptoms are often overlooked or thought to be a normal part of getting older, it is believed that only about one-third of vertebral compression fractures are actually diagnosed.


===Distal radius fractures===
{{CMG}}; {{AE}}{{EG}}
Distal [[radius (bone)|radius]] fractures, usually of the Colles type, are the third most common type of osteoporotic fractures. In the United States, the total annual number of Colles' fractures is about 250,000. The lifetime risk of sustaining a Colles' fracture is about 16% for white women. By the time women reach age 70, about 20% have had at least one wrist fracture.


==Risk factors==
{{SK}} Bone loss, bone density loss, decreased bone density, porous bones, osteoporotic bones
Risk factors for osteoporotic fracture can be split between non-modifiable and (potentially) modifiable. In addition, there are specific diseases and disorders in which osteoporosis is a recognized complication. Medication use is theoretically modifiable, although in many cases the use of medication that increases osteoporosis risk is unavoidable.


===Nonmodifiable===
==[[Osteoporosis overview|Overview]]==
The most important risk factors for osteoporosis are advanced age (in both men and women) and [[female]] sex; [[estrogen]] deficiency following [[menopause]] is correlated with a rapid reduction in BMD, while in men a decrease in [[testosterone]] levels has a comparable (but less pronounced) effect. While osteoporosis occurs in people from all ethnic groups, European or Asian ancestry predisposes for osteoporosis.<ref>{{cite journal |author=Melton LJ |title=Epidemiology worldwide |journal=Endocrinol. Metab. Clin. North Am. |volume=32 |issue=1 |pages=1–13, v |year=2003 |pmid=12699289 |doi=}}</ref> Those with a [[family history (medicine)|family history]] of fracture or osteoporosis are at an increased risk; the [[heritability]] of the fracture as well as low bone mineral density are relatively high, ranging from 25 to 80 percent. There are at least 30 genes associated with the development of osteoporosis.<ref name=Raisz/> Those who have already had a fracture is at least twice as likely to have another fracture compared to someone of the same age and sex.<ref>{{cite journal |author=Ojo F, Al Snih S, Ray LA, Raji MA, Markides KS |title=History of fractures as predictor of subsequent hip and nonhip fractures among older Mexican Americans |journal=Journal of the National Medical Association |volume=99 |issue=4 |pages=412-8 |year=2007 |pmid=17444431 |doi=}}</ref>


===Potentially modifiable===
==[[Osteoporosis historical perspective|Historical Perspective]]==
*[[Tobacco smoking]] - tobacco smoking inhibits the activity of osteoblasts, and is an independent risk factor for osteoporosis.<ref>{{cite journal |author=Wong PK, Christie JJ, Wark JD |title=The effects of smoking on bone health |journal=Clin. Sci. |volume=113 |issue=5 |pages=233–41 |year=2007 |pmid=17663660 |doi=10.1042/CS20060173}}</ref>
*Low [[body mass index]] - being overweight protects against osteoporosis, either by increasing load or through the hormone [[leptin]].<ref>{{cite journal |author=Shapses SA, Riedt CS |title=Bone, body weight, and weight reduction: what are the concerns? |journal=J. Nutr. |volume=136 |issue=6 |pages=1453–6 |year=2006 |pmid=16702302 |doi=}}</ref>
*Low [[calcium]] and vitamin D intake - [[calcium]] and/or [[vitamin D]] deficiency from malnutrition increases the risk of osteoporosis. The problem occasionally arises in calcium deficient adolescents.
*[[Alcoholism]]
*Insufficient physical activity - bone performs remodeling in response to physical stress. People who remain physically active throughout life have a lower risk of osteoporosis. The kind of physical activity that have most effects on bone are weight bearing exercises. The bony prominences and attachments in runners are different in shape and size than those in weightlifters. Physical activity has its greatest impact during adolescence, affecting peak bone mass most. In adults, physical activity helps maintain bone mass, and can increase it by 1 or 2%. [[Physical fitness]] in later life is associated more with a decreased risk of falling than with an increased bone mineral density. Conversely, people who are bedridden are at a significantly increased risk.
*Excess physical activity - excessive exercise can lead to constant damages to the bones which can cause exhaustion of the structures as described above. There are numerous examples of marathon runners who developed severe osteoporosis later in life. In females, heave exercise leads to [[amenorrhea]] (suppression of the menstrual cycle), which is associated with decreased estrogen levels.
*[[Heavy metals]] - a strong association between [[cadmium]], lead and bone disease has been established. Low level exposure to cadmium is associated with an increased loss of bone mineral density readily in both genders, leading to pain and increased risk of fractures, especially in elderly and in females. Higher cadmium exposure results in [[osteomalacia]] (softening of the bone).<ref>{{cite journal | author = Staessen J, Roels H, Emelianov D, Kuznetsova T, Thijs L, Vangronsveld J, Fagard R | title = Environmental exposure to cadmium, forearm bone density, and risk of fractures: prospective population study. Public Health and Environmental Exposure to Cadmium (PheeCad) Study Group. | journal = Lancet | volume = 353 | issue = 9159 | pages = 1140-4 | year = 1999 | month = Apr 3 | id = PMID 10209978}}</ref>
*Soft drinks - some studies indicate that soft drinks (many of which contain [[phosphoric acid]]) may increase risk of osteoporosis;<ref>{{cite journal |author=Tucker KL, Morita K, Qiao N, Hannan MT, Cupples LA, Kiel DP |title=Colas, but not other carbonated beverages, are associated with low bone mineral density in older women: The Framingham Osteoporosis Study |journal=Am. J. Clin. Nutr. |volume=84 |issue=4 |pages=936–42 |year=2006 |pmid=17023723 |doi=}}</ref> others suggest soft drinks may displace calcium-containing drinks from the diet rather than directly causing osteoporosis.<ref>{{cite journal |author= |title=Soft drinks in schools |journal=Pediatrics |volume=113 |issue=1 Pt 1 |pages=152–4 |year=2004 |pmid=14702469 |doi=}}</ref>
* This disease can occur in young women who are athletes.  It is associated with [[female athlete triad]] syndrome as one of the three components, the other two being [[amenorrhea]] and [[disordered eating]].  Female athletes tend to have lower body weight, lower fat percentage, and higher incidence of asthma than their less active peers.  The low estrogen levels (stored in body fat) and/or use of corteosteroids to treat asthma can significantly weaken bone over long periods of time.  Distance runners in particular are also discouraged from consuming milk products when training, which would result in lower calcium absorption than other groups.


===Diseases and disorders===
==[[Osteoporosis classification|Classification]]==
There are many disorders associated with osteoporosis:


*[[Hypogonadism|Hypogonadal]] states - [[Turner syndrome]], [[Klinefelter syndrome]], [[Kallmann syndrome]], [[anorexia nervosa]], [[hypothalamus|hypothalamic]] [[amenorrhea]], [[hyperprolactinemia]]. In females, the effect of hypogonadism is mediated by [[estrogen]] deficiency. It can appear as early [[menopause]] (<45 years) or from prolonged premenopausal amenorrhea (>1 year). A bilateral [[oophorectomy]] (surgical removal of the ovaries) or a [[premature ovarian failure]] cause deficient estrogen production. In males, [[testosterone]] deficiency is the cause.
==[[Osteoporosis pathophysiology|Pathophysiology]]==


*Other endocrine disorders - [[Cushing's syndrome]], [[hyperparathyroidism]], [[thyrotoxicosis]], [[hypothyroidism]], insulin-dependent [[diabetes mellitus]], [[acromegaly]], [[adrenal insufficiency]]
==[[Osteoporosis causes|Causes]]==


*Nutritional and gastrointestinal disorders - [[malnutrition]], parenteral nutrition, [[malabsorption]] syndromes (e.g. [[coeliac disease]], [[Crohn's disease]]), [[gastrectomy]], severe [[liver disease]] (especially [[primary biliary cirrhosis]]) - those with an otherwise adequate calcium intake can develop osteoporosis due to the inability to absorb calcium.
==[[Differentiating Osteoporosis from other diseases|Differentiating Osteoporosis from other Diseases]]==


*Rheumatologic disorders - [[rheumatoid arthritis]], [[ankylosing spondylitis]]
==[[Osteoporosis epidemiology and demographics|Epidemiology and Demographics]]==


*Hematologic disorders/malignancy - [[multiple myeloma]], [[lymphoma]] and [[leukemia]], [[mastocytosis]], [[hemophilia]], [[thalassemia]].
==[[Osteoporosis risk factors|Risk Factors]]==


*Inherited disorders of the bone - [[osteogenesis imperfecta]], [[Marfan syndrome]], [[hemochromatosis]], [[hypophosphatasia]], [[glycogen storage disease]]s, [[homocystinuria]], [[Ehlers-Danlos syndrome]], [[porphyria]], [[Menkes disease|Menkes' syndrome]], [[epidermolysis bullosa]], [[Gaucher's disease]].
==[[Osteoporosis screening|Screening]]==


*Other disorders - immobilization, [[scoliosis]]
==[[Osteoporosis natural history, complications and prognosis|Natural History, Complications and Prognosis]]==
 
===Medication===
Medication - for medication potentially causing osteoporosis, the positive effects of them needs to be compared with the degenerative effects on bone.
* Steroid-induced osteoporosis (SIOP) arises due to use of [[glucocorticoid]]s - analogous to Cushing's syndrome and involving mainly the axial skeleton. The synthetic glucocorticoid prescription drug [[prednisone]] is a main candidate after prolonged intake. Some professional guidelines recommend prophylaxis in patients who take the equivalent of more than 30 mg hydrocortisone (7.5 mg of prednisolone), especially when this is in excess of three months.<ref>{{cite book |author=Bone and Tooth Society of Great Britain, National Osteoporosis Society, Royal College of Physicians |title=Glucocorticoid-induced Osteoporosis |year=2003 |publisher=Royal College of Physicians of London |location=London, UK |isbn=1-860-16173-1 | url=http://www.rcplondon.ac.uk/pubs/contents/966c62dd-8011-4f65-a61d-dd0c7fe4fa4b.pdf }}</ref>
* [[Barbiturate]]s (probably due to accelerated metabolism of vitamin D) and some other enzyme-inducing [[antiepileptic]]s.<ref>{{cite journal |author=Petty SJ, O'Brien TJ, Wark JD |title=Anti-epileptic medication and bone health |journal=Osteoporosis international |volume=18 |issue=2 |pages=129–42 |year=2007 |pmid=17091219 |doi=10.1007/s00198-006-0185-z}}</ref>
* [[Proton pump inhibitors]] - these drugs inhibit the production of [[gastric acid|stomach acid]]; it is thought that this interferes with calcium absorption.<ref>{{cite journal | author = {{subst:CURRENTMONTHNAME}} {{subst:CURRENTYEAR}}ang YX, Lewis JD, Epstein S, Metz DC | title=Long-term proton pump inhibitor therapy and risk of hip fracture | journal=JAMA | year=2006 | volume=296 | pages=2947-53 | id=PMID 17190895 }}</ref>
 
==Pathogenesis==
The underlying mechanism in all cases of osteoporosis is an imbalance between [[bone resorption]] and [[Bone#Formation|bone formation]]. In normal bone, there is constant [[matrix (biology)|matrix]] remodeling of bone; up to 10% of all bone mass may be undergoing remodeling at any point in time. The process takes place in bone multicellular units (BMUs) as first described by Frost in 1963.<ref>Frost HM, Thomas CC. Bone Remodeling Dynamics. Springfield, IL: 1963.</ref> Bone is resorbed by [[osteoclast]] cells (which derive from the [[bone marrow]]), after which new bone is deposited by [[osteoblast]] cells. <ref name=Raisz>{{cite journal | author = Raisz L | title = Pathogenesis of osteoporosis: concepts, conflicts, and prospects. | journal = J Clin Invest | volume = 115 | issue = 12 | pages = 3318-25 | year = 2005 | id = PMID 16322775 | url=http://www.jci.org/cgi/content/full/115/12/3318 | doi=10.1172/JCI27071}}</ref>
 
The three main mechanisms by which osteoporosis develops are an inadequate ''peak bone mass'' (the skeleton develops insufficient mass and strength during growth), excesive bone resorption and inadequate formation of new bone during remodeling. An interplay of these three mechanisms underlies the development of fragile bone tissue.<ref name=Raisz/> Hormonal factors strongly determine the rate of bone resorption; lack of [[estrogen]] (e.g. as a result of menopause) increases bone resorption as well as decreasing the deposition of new bone that normally takes place in weight-bearing bones. The amount of estrogen needed to suppress this process is lower that than normally needed to stimulate the [[uterus]] and [[Mammary gland|breast gland]]. The α-form of the [[estrogen receptor]] appears to be the most important in regulating bone turnover.<ref name=Raisz/> In addition to estrogen, [[calcium metabolism]] plays a significant role in bone turnover, and deficiency of [[calcium in biology|calcium]] and [[vitamin D]] leads to impaired bone deposition; in addition, the [[parathyroid gland]]s react to low calcium levels by secreting [[parathyroid hormone]] (parathormone, PTH), which increases bone resorption to ensure sufficient calcium in the blood. The role of [[calcitonin]], a hormone generated by the [[thyroid]] that increases bone deposition, is less clear and probably less significant.<ref name=Raisz/>
 
The activation of osteoclasts is regulated by various molecular signals, of which [[RANKL]] (receptor activator for [[NF-kB|nuclear factor κB]] ligand) is one of best studied. This molecule is produced by osteoblasts and other cells (e.g. [[lymphocyte]]s), and stimulates [[RANK]] (receptor activator of nuclear factor κB). [[Osteoprotegerin]] (OPG) binds RANKL before it has an opportunity to bind to RANK, and hence suppresses its ability to increase bone resorption. RANKL, RANK and OPG are closely related to [[tumor necrosis factor]] and its receptors. The role of the [[Wnt signaling pathway|''wnt'' signalling pathway]] is recognized but less well understood. Local production of [[eicosanoid]]s and [[interleukin]]s is thought to participate in the regulation of bone turnover, and excess or reduced production of these mediators may underlie the development of osteoporosis.<ref name=Raisz/>
 
[[Trabecular bone]] is the sponge-like bone in the center of long bones and vertebrae. [[Cortical bone]] is the hard outer shell of bones. Because osteoblasts and osteoclasts inhabit the surface of bones, trabecular bone is more active, more subject to bone turnover, to remodeling. Not only is bone density decreased, but the microarchitecture of bone is disrupted. The weaker spicules of trabecular bone break ("microcracks"), and are replaced by weaker bone. Common osteoporotic fracture sites, the wrist, the hip and the spine, have a relatively high trabecular bone to cortical bone ratio. These areas rely on trabecular bone for strength, and therefore the intense remodeling causes these areas to degenerate most when the remodeling is imbalanced.
 
==Signs and symptoms==
Osteoporosis itself has [[asymptomatic|no specific symptoms]]; its main consequence is the increased risk of fracture. Osteoporotic fractures are those that occur in situations where healthy people would not normally break a bone; they are therefore regarded as ''[[fragility fracture]]s''. Typical fragility fractures occur in the [[vertebral column]], [[hip fracture|hip]] and [[wrist]].
 
The symptoms of a [[vertebra]]l collapse ("compression fracture") are acute [[back pain]], often with [[Radiculopathy|radiculopathic pain]] (shooting pain due to compression of a [[nerve]]) and rarely with [[spinal cord compression]] or [[cauda equina syndrome]]. Multiple vertebral fractures lead to a stooped posture, loss of height, and chronic pain with resultant reduction in mobility.<ref>{{cite journal |author=Kim DH, Vaccaro AR |title=Osteoporotic compression fractures of the spine; current options and considerations for treatment |journal=The spine journal : official journal of the North American Spine Society |volume=6 |issue=5 |pages=479–87 |year=2006 |pmid=16934715 |doi=10.1016/j.spinee.2006.04.013}}</ref>
 
Fractures of the long bones acutely impair mobility and may require [[surgery]]. [[Hip fracture]], in particular, usually requires prompt surgery, as there are serious risks associated with a hip fracture, such as [[deep vein thrombosis]] and a [[pulmonary embolism]], and increased mortality.
 
The increased risk of falling associated with aging leads to fractures of the wrist, spine and hip. The risk of falling, in turn, is increased by impaired eyesight due to any cause (e.g. [[glaucoma]], [[macular degeneration]]), [[balance disorder]], [[movement disorder]]s (e.g. [[Parkinson's disease]]), [[dementia]], and [[sarcopenia]] (age-related loss of [[skeletal muscle]]). [[Collapse (medical)|Collapse]] (transient loss of postural tone, with or without loss of consciousness, leads to  a significant risk of falls; causes of syncope are manifold but may include [[cardiac arrhythmia]]s, [[vasovagal syncope]], [[orthostatic hypotension]] and [[seizure]]s. Removal of obstacles and loose carpets in the living environment may substantially reduce falls. Those with previous falls, as well as those with a gait or balance disorder, are most at risk.<ref>{{cite journal |author=Ganz DA, Bao Y, Shekelle PG, Rubenstein LZ |title=Will my patient fall? |journal=JAMA |volume=297 |issue=1 |pages=77–86 |year=2007 |pmid=17200478 |doi=10.1001/jama.297.1.77}}</ref>


==Diagnosis==
==Diagnosis==
The diagnosis of osteoporosis is made on measuring the [[bone mineral density]] (BMD). The most popular method is [[dual energy X-ray absorptiometry]] (DXA or DEXA). In addition to the detection of abnormal BMD, the diagnosis of osteoporosis requires investigations into potentially modifiable underlying causes; this may be done with [[blood test]]s and [[X-ray]]s. Depending on the likelihood of an underlying problem, investigations for [[cancer]] with [[metastasis]] to the bone, [[multiple myeloma]], [[Cushing's disease]] and other above mentioned causes may be performed.
[[Osteoporosis history and symptoms|History and Symptoms]] | [[Osteoporosis physical examination|Physical Examination]] | [[Osteoporosis laboratory findings|Laboratory Findings]] | [[Osteoporosis electrocardiogram|Electrocardiogram]] | [[Hashiomoto's thyroiditis chest x ray|Chest X Ray]] | [[Osteoporosis CT|CT]] | [[Osteoporosis MRI|MRI]] | [[Osteoporosis echocardiography or ultrasound|Echocardiography or Ultrasound]] | [[Osteoporosis other imaging findings|Other Imaging Findings]] | [[Osteoporosis other diagnostic studies|Other Diagnostic Studies]]
 
===Dual energy X-ray absorptiometry===
[[Dual energy X-ray absorptiometry]] (DXA, formerly DEXA) is considered the [[gold standard (test)|gold standard]] for the diagnosis of osteoporosis. Osteoporosis is diagnosed when the [[bone mineral density]] is less than or equal to 2.5 standard deviations below that of a young adult reference population.  This is translated as a [[Bone mineral density#T-score|T-score]]. The [[World Health Organization]] has established the following diagnostic guidelines:<ref name=WHO1994/><ref name="WHOcriteria">{{cite web | author=WHO Scientific Group on the Prevention and Management of Osteoporosis (2000 : Geneva, Switzerland) |url=http://whqlibdoc.who.int/trs/WHO_TRS_921.pdf |title=Prevention and management of osteoporosis : report of a WHO scientific group| year=2003 |accessdate=2007-05-31 |format=pdf |work=}}</ref>
* [[Bone mineral density#T-score|T-score]] -1.0 or greater is "normal"
* T-score between -1.0 and -2.5 is "low bone mass" (or "[[osteopenia]]")
* T-score -2.5 or below is osteoporosis
 
When there has also been an osteoporotic fracture (also termed "low trauma-fracture" or "fragility fracture"), defined as one that occurs as a result of a fall from a standing height, the term "severe or established" osteoporosis is used.<ref name=WHO1994/>
 
===Screening===
The US Preventive Services Task Force (USPSTF)] recommends that all women 65 years of age or older should be screened with bone densitometry.<ref name="pmid12230355">{{cite journal |author=U.S. Preventive Services Task Force |title=Screening for osteoporosis in postmenopausal women: recommendations and rationale |journal=Ann. Intern. Med. |volume=137 |issue=6 |pages=526-8 |year=2002 |pmid=12230355 |doi=}}</ref> The Task Force recommends screening women 60 to 64 years of age who are at increased risk. The best risk factor for indicating increased risk is lower body weight (weight < 70 kg).
 
Clinical prediction rules are available to guide selection of women for screening. The Osteoporosis Risk Assessment Instrument (ORAI) may be the most [[sensitivity (tests)|sensitive]] strategy<ref name="pmid17552058">{{cite journal |author=Martínez-Aguilà D, Gómez-Vaquero C, Rozadilla A, Romera M, Narváez J, Nolla JM |title=Decision rules for selecting women for bone mineral density testing: application in postmenopausal women referred to a bone densitometry unit |journal=J. Rheumatol. |volume=34 |issue=6 |pages=1307-12 |year=2007 |pmid=17552058 |doi=}}</ref> The ORAI is available online at http://osteoed.org/tools.php?type=orai.
 
Regarding the screening of men, a cost-analysis study suggests that screening may be "cost-effective for men with a self-reported prior fracture beginning at age 65 years and for men 80 years and older with no prior fracture".<ref name="pmid17684185">{{cite journal |author=Schousboe JT, Taylor BC, Fink HA, ''et al'' |title=Cost-effectiveness of bone densitometry followed by treatment of osteoporosis in older men |journal=JAMA |volume=298 |issue=6 |pages=629-37 |year=2007 |pmid=17684185 |doi=10.1001/jama.298.6.629}}</ref>
 
== Differential Diagnosis of Causes of {{PAGENAME}}==
 
 
==Most common==
 
 
 
*[[Aging]]
 
*[[Alcoholism]]
 
*[[Anorexia nervosa]]
 
*[[Calcium deficiency]]
 
*[[Chronic renal failure]]
 
*[[Female athlete triad]]
 
*[[Gonadal dysgenesis]]
 
*[[Hyperparathyroidism]]
*[[Hyperthyroidism]]
 
*[[Hypophosphatemic rickets]]
 
*[[Idiopathic]]
*[[Immobility]]
 
*[[Menopause]]
 
*[[Mixed connective tissue disease]]
 
*[[Paget's disease of bone]]
 
*[[Prednisolone]]
 
*[[Primary hypoparathyroidism]]
 
==Organ system ==
 
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" | [[Werner syndrome]],[[Storm syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| [[Ethanol]], [[White Phosphorus poisoning]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"| [[Dyskeratosis Congenita]], [[Fontaine-Farriaux-Blanckaert syndrome]], [[Fanconi-ichthyosis-dysmorphism]], [[Nodulosis-arthropathy-osteolysis syndrome]], [[Osteoporosis -- oculocutaneous -- hypopigmentation syndrome]], [[Xylosylprotein 4-beta-galactosyltransferase]] (XGPT) deficiency, [[Tuberous sclerosis]], [[Winchester syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"| [[Cyproterone]], [[Exemestane]], [[Heparin]], [[Prednisolone]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"| [[Eccentrochondrodysplasia]], [[Osteopaenia -- myopia -- hearing loss -- intellectual deficit -- facial dysmorphism]], [[Otospondylomegaepiphyseal dysplasia]], [[Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa]] , [[Rajab-Spranger syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| [[Adrenal adenoma]], [[Adrenal incidentaloma]], [[Adrenocortical carcinoma]], [[Andropause]], [[Acromegaly]], [[Aromatase deficiency]], [[Cushing's disease]], [[Cushing's syndrome]], [[Diabetes Mellitus]], [[Functioning pancreatic endocrine tumor]], [[Gonadal dysgenesis]], [[Hashimoto's Thyroiditis]], [[Hyperadrenalism]], [[Hyperparathyroidism]], [[Hyperthyroidism]], [[Hypogonadotropic hypogonadism]] -- [[Syndactyly]], [[Hypopituitaryism]], [[Multiple endocrine neoplasia type 1]], [[Oncogenic osteomalacia]], [[Ovarian insufficiency due to FSH resistance]], [[Primary hypoparathyroidism]], [[Sub clinical hypothyroidism]], [[Galactorrhoea]]-[[Hyperprolactinaemia]], [[Prader-Willi syndrome]], [[Ovarian insufficiency]], [[Wolcott-Rallison syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic'''
|bgcolor="Beige"| [[Celiac Disease]], [[Cholestasis]], [[Chronic Hepatitis]], [[Chronic Liver Disease]], [[Crohn's disease]], [[Cystic Fibrosis]], [[Fanconi-Albertini-Zellweger syndrome]], [[Haemochromatosis]], [[Maldigestion]], [[Primary biliary cirrhosis]], [[Tricho-hepato-enteric syndrome]], [[Ulcerative colitis]], [[Wilson's Disease]], [[Wolman syndrome]], [[Wolcott-Rallison syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"| [[Abderhalden-Kaufmann-Lignac syndrome]], [[Acroosteolysis neurogenic]], [[Albright's hereditary osteodystrophy]], [[Chromosome 1, deletion q21 q25]], [[Down Syndrome]], [[Ehlers-Danlos syndrome]] - progeroid form , [[Geroderma osteodysplastica]], [[Hajdu-Cheney syndrome]], [[Hutchinson Gilford Syndrome]], [[Hyper IgE syndrome]] / [[Job syndrome]], [[Iridogoniodysgenesis and skeletal anomalies]], [[Larsen syndrome, recessive type]], [[Lobstein disease]], [[Lockwood-Feingold syndrome]], [[Lysinuric protein intolerance]], [[Marfan syndrome]], [[Metaphyseal chondrodysplasia Spahr type]], [[Metaphyseal dysplasia Pyle type]], [[Menkes Disease]], [[Morquio syndrome]], [[Osteogenesis imperfecta]], [[Osteolysis hereditary multicentric]], [[Osteoporosis-pseudoglioma syndrome]], [[Otospondylomegaepiphyseal dysplasia]], [[Pelizaeus-Merzbacher disease, recessive, acute infantile]], [[Pena Shokeir syndrome]], [[Prolidase deficiency]], [[Sakati syndrome]], [[Singleton-Merten syndrome]], [[Sponastrime dysplasia]], [[Spondyloepimetaphyseal dysplasia with multiple dislocations]], [[Spondylometaphyseal dysplasia with dentinogenesis imperfecta]], [[Spondylo-ocular syndrome]], [[Snyder-Robinson syndrome]]
, [[Storm syndrome]], [[Thick skull syndrome]], [[Urban rogers meyer syndrome]], [[Spinocerebellar ataxia -- dysmorphism]], [[Wolcott-Rallison syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| [[Alpha thalassemia]], [[Beta thalassemia]], [[Diamond-Blackfan anemia]], [[Generalized mastocytosis]], [[Hemoglobin H disease]], [[Leukemia]], [[Lymphoma]], [[Multiple Myeloma]], [[Waldenstrom's macroglobulinemia]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| [[Albright's hereditary osteodystrophy]], [[Boyd-Stearns syndrome]], [[Ehlers-Danlos syndrome]] - progeroid form, [[Female athlete triad]], [[Fanconi-ichthyosis-dysmorphism]], [[Fontaine-Farriaux-, lanckaert syndrome]], [[Gnathodiaphyseal dysplasia]], [[Geroderma osteodysplastica]], [[Hyperostosis corticalis deformans juvenilis]], [[Hajdu-Cheney syndrome]], [[Hyper IgE syndrome]] / [[Job syndrome]], [[Hypertrichotic osteochondrodysplasia]], [[Kaler-Garrity-Stern syndrome]], [[Lobstein disease]], [[Lockwood-Feingold syndrome]], [[Osteogenesis imperfecta]], [[Pena Shokeir syndrome]], [[Oncogenic osteomalacia]], [[Osteoporosis -- macrocephaly -- mental retardation -- blindness]], [[Otospondylomegaepiphyseal dysplasia]], [[Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa]], [[Paget's disease of bone]], [[Pointer syndrome]], [[Prader-Willi syndrome]], [[Richieri-Costa Da Silva syndrome]], [[Riley Shwachman syndrome]], [[Schwartz-Jampel Syndrome]], [[Singleton-Merten syndrome]], [[Sponastrime dysplasia]], [[Spondyloepimetaphyseal dysplasia with multiple dislocations]], [[Spondylometaphyseal dysplasia with dentinogenesis imperfecta]], [[Spondylo-ocular syndrome]], [[Shprintzen-Golberg craniosynostosis]], [[Systemic infantile hyalinosis]], [[Torg osteolysis syndrome]],[[Snyder-Robinson syndrome]], [[Thick skull syndrome]], [[Winchester syndrome]], [[Xylosylprotein 4-beta-galactosyltransferase]] (XGPT) deficiency
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"| [[Acroosteolysis neurogenic]], [[Brown-Sequard Syndrome]], [[Fanconi-Albertini-Zellweger syndrome]], [[Lactotroph adenoma]], [[Osteopaenia -- myopia -- hearing loss -- intellectual deficit -- facial dysmorphism]]
, [[Pelizaeus-Merzbacher disease, recessive, acute infantile]], [[Rajab-Spranger syndrome]], [[Snyder-Robinson syndrome]], [[Spinocerebellar ataxia -- dysmorphism]], [[Shprintzen-Golberg craniosynostosis]] , [[Tuberous sclerosis]],[[Werner syndrome]], [[Wilson's Disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|  [[Anorexia nervosa]], [[Calcium deficiency]], [[Copper deficiency]], [[Cystathionine beta-synthase deficiency]], [[Dibasic aminoaciduria 2]], Excessive [[Dieting]], [[Fabry's disease]], [[Glycerol kinase deficiency]], [[Homocystinuria]], [[Hyperglycerolemia - infantile form]], [[Haemochromatosis]], [[Hypophosphatemic rickets]], [[Infantile sialic acid storage disorder]], [[Lysinuric protein intolerance]], [[Menkes Disease]], [[Methylmalonic acidemia]], [[Oxalosis]], [[Peroxisomal bifunctional enzyme deficiency]], [[Prolidase deficiency]], [[Protein deficiency]], [[Underweight]], [[Vitamin C deficiency]] / [[Scurvy]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetric/Gynecologic'''
|bgcolor="Beige"| [[Female athlete triad]], [[Menopause]], [[Ovarian insufficiency]], [[Pregnancy]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"| [[Adrenal adenoma]], [[Adrenal incidentaloma]], [[Adrenocortical carcinoma]], [[Functioning pancreatic endocrine tumor]], [[Leukemia]], [[Lactotroph adenoma]], [[Lymphoma]], [[Multiple Myeloma]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| [[Eccentrochondrodysplasia]], [[Osteopaenia -- myopia -- hearing loss -- intellectual deficit -- facial dysmorphism]], [[Osteoporosis -- macrocephaly -- mental retardation -- blindness]], [[Osteoporosis-pseudoglioma syndrome]], [[Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa]], [[Osteoporosis -- oculocutaneous -- hypopigmentation syndrome]], [[Spondylo-ocular syndrome]], [[Schwartz-Jampel Syndrome]], [[Winchester syndrome]], [[Werner syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[Chronic obstructive pulmonary disease]], [[Cystic Fibrosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"| [[Abderhalden-Kaufmann-Lignac syndrome]], [[Chronic acidosis]], [[Chronic hypophosphatemia]], [[Chronic renal failure]], [[Fanconi-ichthyosis-dysmorphism]], [[Fanconi-Albertini-Zellweger syndrome]], [[Kidney disease]], [[Renal osteodystrophy]], [[Short stature -- hyperkaliemia -- acidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"| [[Ankylosing spondylitis]], [[Dyskeratosis Congenita]], [[Rheumatoid disease]], [[Sarcoidosis]]
|-
|-bgcolor="LightSteelBlue"
| '''Sexual'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"| [[Aging]], [[Alcoholism]], [[Athletes]], [[Bonnet-Dechaume-Blanc syndrome]], [[Davis syndrome]], [[Idiopathic]], [[Immobility]], [[Lack of exercise]], [[Marie-Bamberg syndrome]], [[Mixed connective tissue disease]], [[Orchidectomy]], [[Postgastrectomy]], [[Premature aging]], [[Pseudoprogeria syndrome]], [[Reflex sympathetic dystrophy syndrome]], [[Zero gravity]]
|-
|}
 
==Alphabetical order==
{{MultiCol}}
*[[Abderhalden-Kaufmann-Lignac syndrome]]
 
*[[Acromegaly]]
 
*[[Acroosteolysis neurogenic]]
 
*[[Adrenal adenoma]]
 
*[[Adrenal incidentaloma]]
 
*[[Adrenocortical carcinoma]]
 
*[[Aging]]
 
*[[Albright's hereditary osteodystrophy]]
 
*[[Alcoholism]]
 
*[[Alpha thalassemia]]
 
*[[Andropause]]
 
*[[Ankylosing spondylitis]]
 
*[[Anorexia nervosa]]
 
*[[Aromatase deficiency]]
 
*[[Athletes]]
 
*[[Beta thalassemia]]
 
*[[Bonnet-Dechaume-Blanc syndrome]]
 
*[[Boyd-Stearns syndrome]]
 
*[[Brown-Sequard Syndrome]]
 
*[[Calcium deficiency]]
 
*[[Celiac Disease]]
 
*[[Cholestasis]]
 
*[[Chromosome 1, deletion q21 q25]]
 
*[[Chronic acidosis]]
 
*[[Chronic Hepatitis]]
 
*[[Chronic hypophosphatemia]]
 
*[[Chronic Liver Disease]]
 
*[[Chronic obstructive pulmonary disease]]
 
*[[Chronic renal failure]]
 
*[[Copper deficiency]]
 
*[[Crohn's disease]]
 
*[[Cushing's disease]]
 
*[[Cushing's syndrome]]
 
*[[Cyproterone]]
 
*[[Cystathionine beta-synthase deficiency]]
 
*[[Cystic Fibrosis]]
 
*[[Davis syndrome]]
 
*[[Diabetes Mellitus]]
 
*[[Diamond-Blackfan anemia]]
 
*[[Dibasic aminoaciduria 2]]
 
*[[Down Syndrome]]
 
*[[Dyskeratosis Congenita]]
 
*[[Eccentrochondrodysplasia]]
 
*[[Ehlers-Danlos syndrome]]- progeroid form
 
*[[Ethanol]]
 
*Excessive [[Dieting]]
 
*[[Exemestane]]
 
*[[Fabry's disease]]
 
*[[Fanconi-Albertini-Zellweger syndrome]]
 
*[[Fanconi-ichthyosis-dysmorphism]]
 
*[[Female athlete triad]]
 
*[[Fontaine-Farriaux-Blanckaert syndrome]]
 
*[[Functioning pancreatic endocrine tumor]]
 
*[[Galactorrhoea]]-[[Hyperprolactinaemia]]
 
*[[Generalized mastocytosis]]
 
*[[Geroderma osteodysplastica]]
 
{{ColBreak}}
 
*[[Glycerol kinase]] deficiency
 
*[[Gnathodiaphyseal dysplasia]]
 
*[[Gonadal dysgenesis]]
 
*[[Haemochromatosis]]
 
*[[Hajdu-Cheney syndrome]]
 
*[[Hashimoto's Thyroiditis]]
 
*[[Hemoglobin H disease]]
 
*[[Heparin]]
 
*[[Homocystinuria]]
 
*[[Hutchinson Gilford Syndrome]]
 
*[[Hyper IgE syndrome]] / [[Job syndrome]]
 
*[[Hyperadrenalism]]
 
*[[Hyperglycerolemia - infantile form]]
 
*[[Hyperostosis corticalis deformans juvenilis]]
 
*[[Hyperparathyroidism]]
 
*[[Hyperthyroidism]]
 
*[[Hypertrichotic osteochondrodysplasia]]
 
*[[Hypogonadotropic hypogonadism]] -- [[Syndactyly]]
 
*[[Hypophosphatemic rickets]]
 
*[[Hypopituitaryism]]
 
*[[Idiopathic]]
 
*[[Immobility]]
 
*[[Infantile sialic acid storage disorder]]
 
*[[Iridogoniodysgenesis and skeletal anomalies]]
 
*[[Kaler-Garrity-Stern syndrome]]
 
*[[Kidney disease]]
 
*[[Lack of exercise]]
 
*[[Lactotroph adenoma]]
 
*[[Larsen syndrome, recessive type]]
 
*[[Leukemia]]
 
*[[Lobstein disease]]
 
*[[Lockwood-Feingold syndrome]]
 
*[[Lymphoma]]
 
*[[Lysinuric protein intolerance]]
 
*[[Maldigestion]]
 
*[[Marfan syndrome]]
 
*[[Marie-Bamberg syndrome]]
 
*[[Menkes Disease]]
 
*[[Menopause]]
 
*[[Metaphyseal chondrodysplasia Spahr type]]
 
*[[Metaphyseal dysplasia Pyle type]]
 
*[[Methylmalonic acidemia]]
 
*[[Mixed connective tissue disease]]
 
*[[Morquio syndrome]]
 
*[[Multiple endocrine neoplasia type 1]]
 
*[[Multiple Myeloma]]
 
*[[Nodulosis-arthropathy-osteolysis syndrome]]
 
*[[Oncogenic osteomalacia]]
 
*[[Orchidectomy]]
 
*[[Osteochondrodysplatic dwarfism -- deafness -- retinitis pigmentosa]]
 
*[[Osteogenesis imperfecta]]
 
*[[Osteolysis hereditary multicentric]]
 
*[[Osteopaenia -- myopia -- hearing loss -- intellectual deficit -- facial dysmorphism]]
 
*[[Osteoporosis -- macrocephaly -- mental retardation -- blindness]]
 
*[[Osteoporosis -- oculocutaneous -- hypopigmentation syndrome]]
 
*[[Osteoporosis-pseudoglioma syndrome]]
 
{{ColBreak}}
 
*[[Otospondylomegaepiphyseal dysplasia]]
 
*[[Ovarian insufficiency due to FSH resistance]]
 
*[[Ovarian insufficiency, familial]]
 
*[[Oxalosis]]
 
*[[Paget's disease of bone]]
 
*[[Pelizaeus-Merzbacher disease, recessive, acute infantile]]
 
*[[Pena Shokeir syndrome]]
 
*[[Peroxisomal bifunctional enzyme deficiency]]
 
*[[Pointer syndrome]]
 
*[[Postgastrectomy]]
 
*[[Prader-Willi syndrome]]
 
*[[Prednisolone]]
 
*[[Pregnancy]]
 
*[[Premature aging]]
 
*[[Primary biliary cirrhosis]]
 
*[[Primary hypoparathyroidism]]
 
*[[Prolidase deficiency]]
 
*[[Protein deficiency]]
 
*[[Pseudoprogeria syndrome]]
 
*[[Rajab-Spranger syndrome]]
 
*[[Reflex sympathetic dystrophy syndrome]]
 
*[[Renal osteodystrophy]]
 
*[[Rheumatoid disease]]
 
*[[Richieri-Costa Da Silva syndrome]]
 
*[[Riley Shwachman syndrome]]
 
*[[Sakati syndrome]]
 
*[[Sarcoidosis]]
 
*[[Schwartz-Jampel Syndrome]]
 
*[[Short stature -- hyperkaliemia -- acidosis]]
 
*[[Shprintzen-Golberg craniosynostosis]]
 
*[[Singleton-Merten syndrome]]
 
*[[Snyder-Robinson syndrome]]
 
*[[Spinocerebellar ataxia -- dysmorphism]]
 
*[[Sponastrime dysplasia]]
 
*[[Spondyloepimetaphyseal dysplasia with multiple dislocations]]
 
*[[Spondylometaphyseal dysplasia with dentinogenesis imperfecta]]
 
*[[Spondylo-ocular syndrome]]
 
*[[Storm syndrome]]
 
*[[Sub clinical hypothyroidism]]
 
*[[Systemic infantile hyalinosis]]
 
*[[Thick skull syndrome]]
 
*[[Torg osteolysis syndrome]]
 
*[[Tricho-hepato-enteric syndrome]]
 
*[[Tuberous sclerosis]]
 
*[[Ulcerative colitis]]
 
*[[Underweight]]
 
*[[Urban rogers meyer syndrome]]
 
*[[Vitamin C deficiency]] / [[Scurvy]]
 
*[[Waldenstrom's macroglobulinemia]]
 
*[[Werner syndrome]]
 
*[[White Phosphorus poisoning]]
 
*[[Wilson's Disease]]
 
*[[Winchester syndrome]]
 
*[[Wolcott-Rallison syndrome]]
 
*[[Wolman syndrome]]
 
*[[Xylosylprotein 4-beta-galactosyltransferase]] (XGPT) deficiency
 
*[[Zero gravity]]
 
{{EndMultiCol}}


==Treatment==
==Treatment==
There are several alternatives of medication to treat osteoporosis. However, lifestyle changes are also emphasised.
===Medication===
Bisphosphonates are the main pharmacological measures for treatment. However, newer drugs have appeared in the 1990s, such as teriparatide and strontium ranelate.
;Bisphosphonates
In osteoporosis, [[bisphosphonate]] drugs are prescribed. The most often prescribed bisphosphonates are as of 2005 sodium alendronate (Fosamax) 10&nbsp;mg a day or 70&nbsp;mg once a week, [[risedronate]] (Actonel) 5&nbsp;mg a day or 35&nbsp;mg once a week and or [[ibandronate]] (Boniva) once a month.
A 2007 manufacturer-supported study suggested that in patients who had suffered a low-impact hip fracture, annual infusion of 5&nbsp;mg [[Zoledronate|zoledronic acid]] reduced risk of any fracture by 35% (from 13.9 to 8.6%), vertebral fracture risk from 3.8% to 1.7% and non-vertebral fracture risk from 10.7% to 7.6%. This study also found a mortality benefit: after 1.9 years, 9.6% of the study group (as opposed to 13.3% of the control group) had died of any cause, indicating a mortality benefit of 28%.<ref>{{cite journal |author=Lyles KW, Colón-Emeric CS, Magaziner JS, ''et al'' |title=Zoledronic Acid and Clinical Fractures and Mortality after Hip Fracture |journal=N Engl J Med |volume= |issue= |pages=published online [[2007-09-17]] |year=2007 |pmid=17878149 |doi=10.1056/NEJMoa074941}}</ref>
;Teriparatide
Recently, [[teriparatide]] (Forteo, [[recombinant]] [[parathyroid hormone]] residues 1–34) has been shown to be effective in osteoporosis. It is used mostly for patients with established osteoporosis (who have already fractured), have particularly low BMD or several risk factors for fracture or cannot tolerate the oral bisphosphonates. It is given as a daily injection with the use of a pen-type injection device. Teriparatide is only licensed for treatment if bisphosphonates have failed or are contraindicated (however, this differs by country and is not required by the FDA in the USA. However, patients with previous radiation therapy, or Paget's disease, or young patients should avoid this medication).
;Strontium ranelate
Oral [[strontium ranelate]] is an alternative oral treatment, belonging to a class of drugs called "dual action bone agents" (DABAs) by its manufacturer. It has proven efficacy, especially in the prevention of vertebral fracture.<ref>{{cite journal |author=Meunier PJ, Roux C, Seeman E, ''et al'' |title=The effects of strontium ranelate on the risk of vertebral fracture in women with postmenopausal osteoporosis |journal=N. Engl. J. Med. |volume=350 |issue=5 |pages=459–68 |year=2004 |pmid=14749454 |doi=10.1056/NEJMoa022436}}</ref> In laboratory experiments, strontium ranelate was noted to stimulate the proliferation of osteoblasts, as well as inhibiting the proliferation of osteoclasts.
Strontium ranelate is taken as a 2&nbsp;g oral suspension daily, and is licenced for the treatment of osteoporosis to prevent vertebral and hip fracture. Strontium ranelate has side effect benefits over the bisphosphonates, as it does not cause any form of upper GI side effect, which is the most common cause for medication withdrawal in osteoporosis. In studies a small increase in the risk of venous thromboembolism was noted,<ref>{{cite journal |author=O'Donnell S, Cranney A, Wells GA, Adachi JD, Reginster JY |title=Strontium ranelate for preventing and treating postmenopausal osteoporosis |journal=Cochrane database of systematic reviews (Online) |volume= |issue=4 |pages=CD005326 |year=2006 |pmid=17054253 |doi=10.1002/14651858.CD005326.pub3}}</ref> suggesting it may be less suitable in patients at risk for thrombosis for different reasons.
===Nutrition===
;Calcium
The patient should include 1200 to 1500 mg of calcium daily either via dietary means (for instance, an 8 oz glass of milk contains approximately 300 mg of calcium) or via supplementation. The body absorbs only about 500 mg of calcium at one time and so intake should be spread throughout the day.
However, the benefit of supplementation of calcium alone remains, to a degree, controversial since several nations with high calcium intakes through milk-products (e.g. the USA, Sweden) have some of the highest rates of osteoporosis worldwide, though this may be linked to such countries' excess consumption of protein. A few studies even suggested an adverse effect of calcium excess on bone density and blamed the milk industry for misleading customers. Some nutritionists assert that excess consumption of dairy products causes acidification, which leaches calcium from the system, and argue that vegetables and nuts are a better source of calcium and that in fact milk products should be avoided. This theory has no proof from scientific clinical studies. Similarly, nutritionists believe that excess caffeine consumption can also contribute to leaching calcium from the bones.
A [[meta-analysis]] of [[randomized controlled trials]] concluded "Evidence supports the use of calcium, or calcium in combination with vitamin D supplementation, in the preventive treatment of osteoporosis in people aged 50 years or older. For best therapeutic effect, we recommend minimum doses of 1200 mg of calcium, and 800 IU of vitamin D (for combined calcium plus vitamin D supplementation)."<ref name="pmid17720017">{{cite journal |author=Tang BMP et al |title=Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis |journal=Lancet |volume=370 |issue= |pages=657-666 |year=2007 |pmid= |doi=10.1016/S0140-6736(07)61342-7}}</ref> A study that examined the relationship between calcium supplementation and clinical fracture risk in an elderly population, there was a significant decrease in fracture risk in patients that received calcium supplements versus those that received placebo. However, this benefit only applied to patients who were compliant with their treatment regimen.<ref>{{cite journal |author=Prince RL, Devine A, Dhaliwal SS, Dick IM |title=Effects of calcium supplementation on clinical fracture and bone structure: results of a 5-year, double-blind, placebo-controlled trial in elderly women |journal=Arch. Intern. Med. |volume=166 |issue=8 |pages=869–75 |year=2006 |pmid=16636212 |doi=10.1001/archinte.166.8.869}}</ref>
;Vitamin D
Increasing vitamin D intake has been shown to reduce fractures up to twenty-five percent in older people, according to recent studies.<ref>{{cite journal |author=Bischoff-Ferrari HA, Willett WC, Wong JB, Giovannucci E, Dietrich T, Dawson-Hughes B |title=Fracture prevention with vitamin D supplementation: a meta-analysis of randomized controlled trials |journal=JAMA |volume=293 |issue=18 |pages=2257–64 |year=2005 |pmid=15886381 |doi=10.1001/jama.293.18.2257}}</ref><ref name="pmid17720017"/>. The very large Women's Health Initiative study, however, did not find any fracture benefit from calcium and vitamin D supplementation, but these women were already taking (on average) 1200 mg/day of calcium .  Muscle weakness can contribute to falls so it is beneficial for people living with osteoporosis to improve muscle function.  Vitamin D deficiency causes muscle weakness.<ref>{{cite journal |author=Holick MF |title=Resurrection of vitamin D deficiency and rickets |journal=J. Clin. Invest. |volume=116 |issue=8 |pages=2062–72 |year=2006 |pmid=16886050 |doi=10.1172/JCI29449}}</ref>. A meta-analysis of five clinical trials showed 800 IU of vitamin D per day (plus calcium) reduced the risk of falls by 22%.<ref>{{cite journal |author=Bischoff-Ferrari HA, Giovannucci E, Willett WC, Dietrich T, Dawson-Hughes B |title=Estimation of optimal serum concentrations of 25-hydroxyvitamin D for multiple health outcomes |journal=Am. J. Clin. Nutr. |volume=84 |issue=1 |pages=18–28 |year=2006 |pmid=16825677 |doi=}}</ref>.  A different randomized, controlled study showed nursing home residents who took 800 IU of vitamin D per day (plus calcium) having a 72% reduction in the risk of falls.<ref>{{cite journal |author=Broe KE, Chen TC, Weinberg J, Bischoff-Ferrari HA, Holick MF, Kiel DP |title=A higher dose of vitamin d reduces the risk of falls in nursing home residents: a randomized, multiple-dose study |journal=Journal of the American Geriatrics Society |volume=55 |issue=2 |pages=234–9 |year=2007 |pmid=17302660 |doi=10.1111/j.1532-5415.2007.01048.x}}</ref>. New vitamin D intake recommendations (National Osteoporosis Foundation, July 2007) are adults up to age 50, 400-800 IU daily and those over 50, 800 - 1,000 IU daily.
;Excess protein
There are three elements relating to a person's levels of calcium: consumption, absorption, and excretion. High protein intake is known to encourage urinary calcium losses and has been shown to increase risk of fracture in research studies.<ref>{{cite journal |author=Feskanich D, Willett WC, Stampfer MJ, Colditz GA |title=Protein consumption and bone fractures in women |journal=Am. J. Epidemiol. |volume=143 |issue=5 |pages=472–9 |year=1996 |pmid=8610662 |doi=}}</ref><ref>{{cite journal |author=Abelow BJ, Holford TR, Insogna KL |title=Cross-cultural association between dietary animal protein and hip fracture: a hypothesis |journal=Calcif. Tissue Int. |volume=50 |issue=1 |pages=14–8 |year=1992 |pmid=1739864 |doi=}}</ref>.
;Others
There is some evidence to suggest bone density benefits from taking the following supplements (in addition to calcium and vitamin D): boron, magnesium, zinc, copper, manganese, silicon, strontium, folic acid, and vitamins B6, C, and K.<ref>Gaby, Alan R., ''Preventing and Reversing Osteoporosis,'' 1994. ISBN 0-7615-0022-7</ref><ref>Kessler, George J., ''The Bone Density Diet,'' 2000. ISBN 0-345-43284-3</ref>  This is weak evidence and quite controversial.
===Exercise===
Multiple studies have shown that aerobics, weight bearing, and resistance exercises can all maintain or increase BMD in postmenopausal women.<ref>{{cite journal |author=Bonaiuti D, Shea B, Iovine R, ''et al'' |title=Exercise for preventing and treating osteoporosis in postmenopausal women |journal=Cochrane database of systematic reviews (Online) |volume= |issue=3 |pages=CD000333 |year=2002 |pmid=12137611 |doi=}}</ref>  Many researchers have attempted to pinpoint which types of exercise are most effective at improving BMD and other metrics of bone quality, however results have varied.  One year of regular jumping exercises appears to increase the BMD and moment of inertia of the proximal tibia<ref>{{cite journal |author=Cheng S, Sipilä S, Taaffe DR, Puolakka J, Suominen H |title=Change in bone mass distribution induced by hormone replacement therapy and high-impact physical exercise in post-menopausal women |journal=Bone |volume=31 |issue=1 |pages=126–35 |year=2002 |pmid=12110425 |doi=}}</ref> in normal postmenopausal women.  Treadmill walking, gymnastic training, stepping, jumping, endurance, and strength exercises all resulted in significant increases of L2-L4 BMD in osteopenic postmenopausal women.<ref>{{cite journal |author=Chien MY, Wu YT, Hsu AT, Yang RS, Lai JS |title=Efficacy of a 24-week aerobic exercise program for osteopenic postmenopausal women |journal=Calcif. Tissue Int. |volume=67 |issue=6 |pages=443–8 |year=2000 |pmid=11289692 |doi=}}</ref><ref>{{cite journal |author=Iwamoto J, Takeda T, Ichimura S |title=Effect of exercise training and detraining on bone mineral density in postmenopausal women with osteoporosis |journal=Journal of orthopaedic science : official journal of the Japanese Orthopaedic Association |volume=6 |issue=2 |pages=128–32 |year=2001 |pmid=11484097 |doi=10.1007/s0077610060128}}</ref><ref>{{cite journal |author=Kemmler W, Engelke K, Weineck J, Hensen J, Kalender WA |title=The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results |journal=Archives of physical medicine and rehabilitation |volume=84 |issue=5 |pages=673–82 |year=2003 |pmid=12736880 |doi=}}</ref>  Strength training elicited improvements specifically in distal radius and hip BMD.<ref>{{cite journal |author=Kerr D, Morton A, Dick I, Prince R |title=Exercise effects on bone mass in postmenopausal women are site-specific and load-dependent |journal=J. Bone Miner. Res. |volume=11 |issue=2 |pages=218–25 |year=1996 |pmid=8822346 |doi=}}</ref>
==Prognosis==
{| class="wikitable" align="right"
|+ Hip fractures per 1000 patient-years<ref name="pmid17846439">{{cite journal |author=Cranney A, Jamal SA, Tsang JF, Josse RG, Leslie WD |title=Low bone mineral density and fracture burden in postmenopausal women |journal=CMAJ |volume=177 |issue=6 |pages=575–80 |year=2007 |pmid=17846439 |doi=10.1503/cmaj.070234}}</ref>
! WHO category !! Age 50-64  !! Age > 64 || Overall
|-
| Normal || 5.3 || 9.4 || 6.6
|-
| [[Osteopenia]] || 11.4 || 19.6 || 15.7
|-
| Osteoporosis || 22.4 || 46.6 || 40.6
|}
Although osteoporosis patients have an increased mortality rate due to the complications of fracture, most patients die ''with'' the disease rather than ''of'' it.


Hip fractures can lead to decreased mobility and an additional risk of numerous complications (such as [[deep venous thrombosis]] and/or [[pulmonary embolism]], [[pneumonia]]). The 6-month mortality rate following hip fracture is approximately 13.5%, and a substantial proportion (almost 13%) of people who have suffered a hip fracture need total assistance to mobilize after a hip fracture.<ref>{{cite journal |author=Hannan EL, Magaziner J, Wang JJ, ''et al'' |title=Mortality and locomotion 6 months after hospitalization for hip fracture: risk factors and risk-adjusted hospital outcomes |journal=JAMA |volume=285 |issue=21 |pages=2736–42 |year=2001 |pmid=11386929 |doi=}}</ref>
[[Osteoporosis life style modification|Life style Modification]] | [[Osteoporosis medical therapy|Medical Therapy]] | [[Osteoporosis surgery|Surgery]] | [[Osteoporosis primary prevention|Primary Prevention]] | [[Osteoporosis secondary prevention|Secondary Prevention]] | [[Osteoporosis cost-effectiveness of therapy|Cost-Effectiveness of Therapy]] | [[Osteoporosis future or investigational therapies|Future or Investigational Therapies]]


Vertebral fractures, while having a smaller impact on mortality, can lead to severe chronic pain of neurogenic origin, which can be hard to control, as well as deformity. Though rare, multiple vertebral fractures can lead to such severe hunch back ([[kyphosis]]) that the resulting pressure on internal organs can impair one's ability to breathe.
==Case Studies==
[[Osteoporosis case study one|Case #1]]


Apart from risk of death and other complications, osteoporotic fractures are associated with a reduced health-related quality of life.<ref>{{cite journal |author=Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES |title=Impact of recent fracture on health-related quality of life in postmenopausal women |journal=J. Bone Miner. Res. |volume=21 |issue=6 |pages=809–16 |year=2006 |pmid=16753011 |doi=10.1359/jbmr.060301}}</ref>
==Related Chapters==
 
==Prevention==
Methods to prevent osteoporosis include changes of lifestyle. However, there are medications that can be used for prevention as well.
 
===Lifestyle===
Lifestyle prevention of osteoporosis is in many aspects inversions from potentially modifiable risk factors.
*Exercise - achieving a higher peak bone mass through exercise and proper nutrition during adolescence is important for the prevention of osteoporosis. Exercise and nutrition throughout the rest of the life delays bone degeneration.
*Nutrition - a proper nutrition is a diet sufficient in calcium and vitamin D. Patients at risk for osteoporosis (e.g. [[steroid]] use) are generally treated with [[vitamin D]] and calcium supplements. In [[kidney|renal]] disease, more active forms of Vitamin D such as paracalcitol or  (1,25-dihydroxycholecalciferol or [[calcitriol]]  which is the main biologically active form of vitamin D) is used, as the kidney cannot adequately generate calcitriol from calcidiol (25-hydroxycholecalciferol) which is the storage form of vitamin D.
*Quiting tobacco smoking
*Drinking alcohol in moderation
 
===Medication===
Just as for treatment, [[bisphosphonate]] can be used in cases of very high risk. Other medicines prescribed for prevention of osteoporosis include [[raloxifene]] (Evista), a [[selective estrogen receptor modulator]] (SERM).
 
Estrogen replacement remains a good treatment for prevention of osteoporosis but, at this time, is not recommended unless there are other indications for its use as well. There is uncertainty and controversy about whether estrogen should be recommended in women in the first decade after the menopause; hopefully new research will provide guidance. In men, testosterone replacement therapy is also an effective treatment.
 
==See also==
*[[Bone healing]]
*[[Bone healing]]
*[[Back pain]]
*[[Back pain]]
*[[bone mineral density]]
*[[bone mineral density]]
*Hip protector
*[[Dental x-ray]]
*Dental X-ray
*[[Osteopetrosis]], the opposite of osteoporosis
*[[Osteopetrosis]], the opposite of osteoporosis
*[[Osteoimmunology]]
*[[Osteoimmunology]]
==References==
{{Reflist|2}}


==External links==
==External links==
* [http://www.fore.org/ Foundation for Osteoporosis Research and Education] Non-profit organization
* [http://www.iofbonehealth.org/ The International Osteoporosis Foundation]
* [http://www.osteoporosis.org.au/ Osteoporosis Australia]
* [http://www.osteoporosis.ca/ Osteoporosis Canada]
* [http://www.irishosteoporosis.ie/ Irish Osteoporosis Society]
* [http://www.bones.org.nz/ Osteoporosis New Zealand Inc]
* [http://www.nos.org.uk/ National Osteoporosis Society] (UK)
* [http://www.nof.org/ The National Osteoporosis Foundation](USA)
* [http://www.hormone.org/public/osteoporosis.cfm The Osteoporosis Section] of [[The Hormone Foundation]]


* [http://www.rad.washington.edu/mskbook/osteopenia.html University of Washington]
* [http://gotbones.healthdiaries.com/osteopenia/ Osteopenia] - A controversial diagnosis.
* [http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including osteoporosis) by a Joint [[WHO]]/FAO Expert consultation (2003)
* [http://www.who.int/nutrition/topics/dietnutrition_and_chronicdiseases/en/ Diet, Nutrition and the prevention of chronic diseases] (including osteoporosis) by a Joint [[WHO]]/FAO Expert consultation (2003)
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Latest revision as of 23:28, 29 July 2020
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Synonyms and keywords: Bone loss, bone density loss, decreased bone density, porous bones, osteoporotic bones

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Osteoporosis from other Diseases

Epidemiology and Demographics

Risk Factors

Screening

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Electrocardiogram | Chest X Ray | CT | MRI | Echocardiography or Ultrasound | Other Imaging Findings | Other Diagnostic Studies

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