Osteoporosis natural history

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Disease can be complicated by the development of fractures. The prognosis of disease is good. Mortality from the disease depends on the type of fracture. The major type of fractures contributing to mortality in these patients are vertebral fractures and Hip fractures.

Natural History

The symptoms of the disease typically develop in the sixth decade of life. The risk increases with age proportionately. DXA bone densitometry is recommended every 2–3 years. Outcome is usually good with appropriate usage of medications and with calcium and / or vitamin D supplementation.

Complications

Disease can be complicated by the development of:

• Fractures
• DVT - from prolonged immobility
• Kyphosis (Dowager's hump)
• Restrictive lung disease
• Drug side-effects:
  • Bisphosphonates - Esophagitis, Osteonecrosis of the jaw, bone pain, muscle pain etc.,
  • Raloxifene - thromboembolism, aggravates hot flashes, nausea, weight gain, depression, insomnia, leg cramps, rash
  • Teriparitide - orthostatic hypotension, asthenia, nausea, leg cramps, hypercalcemia (if taken along with corticosteroids, thiazide diuretics, and calcium supplementation), must not be given to patients with Paget's disease or a history of osteosarcoma or chondrosarcoma
  • Nasal calcitonin-salmon - bronchospasm, rhinitis, epistaxis, arthralgias

Prognosis

• The prognosis of the disease is good if the decrease in bone mass density is identified early and appropriate anti-osteoporotic medications are started.
• The presence of fractures, DVT is associated with a poorer prognosis among patients with disease.
• The lifetime fracture risk in white women is 18% for hip fractures, 16% for spine fractures, 16% for wrist fractures and in men the same fractures account for 6%, 5%, and 3% respectively.

• More than half of all women and one third of all men have osteoporotic fractures in their lifetime.