Rheumatology Book

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Osteoporosis

Aka: Osteoporosis, Osteopenia
  1. See Also
    1. Osteoporosis Secondary Causes
    2. Medication Causes of Osteoporosis
    3. Osteoporosis Evaluation
    4. Osteoporosis Management
  2. Epidemiology
    1. Prevalence
      1. As many as 10 Million older adults in U.S. have Osteoporosis
      2. wright (2014) J Bone Miner Res 29(11):2520-6 +PMID:24771492 [PubMed]
    2. Gender
      1. Women affected more often than men by ratio of 5:1
    3. Costs (hospitalizations, Nursing Home admissions, office and ED Visits)
      1. Year 2002: $18 Billion/year
      2. Year 2026: $25 Billion/year (projected)
  3. Pathophysiology
    1. See Bone Physiology
    2. Osteoporosis Mechanism
      1. Hypogonadism (Menopause or orchiectomy)
        1. Osteoclastic overactivity
      2. Age related loss: Osteoblast Underactivity
      3. Trabecular Bone turnover is much more rapid
        1. Osteoporosis first seen in spine and Pelvis
        2. Trabecular Bone greater in spine and Pelvis
  4. Risk Factors
    1. See Osteoporosis Risk Factors
  5. Course
    1. Normal bone mass
      1. Peak bone mass occurs at 20-35 years
      2. Decline in bone mass starts after age 35-50 years
      3. Normal bone density loss is 1% per year
    2. Hypogonadism accelerates decline to 3-4% per year
      1. Menopause in women
      2. Orchiectomy in men (Prostate Cancer)
    3. Age 50 years
      1. Osteopenia in Men: 33-47%
      2. Osteoporosis in Men: 4-6%
    4. Age 65 years
      1. Men and women have similar rates of decline
    5. Age 75 years
      1. Dramatic increase in Incidence of Hip Fracture in men
    6. Age 80 years
      1. Women: 90% have Osteoporosis (15% Hip Fracture risk)
      2. Men: 50% have Osteoporosis
    7. Age 90 years
      1. Women: Hip Fracture in 33%
      2. Men: Hip Fracture in 17%
  6. Types
    1. Type 1 Osteoporosis
      1. Postmenopausal women
      2. Trabecular Bone mass decreased
      3. Fracture sites
        1. Vertebral body (T7-T9)
        2. Distal Forearm (Colles Fracture)
    2. Type 2 Osteoporosis
      1. Both sexes, Age over 60 years
      2. Both cortical and Trabecular Bone mass decreased
      3. Fracture sites
        1. Femoral neck (Most common)
        2. Proximal Humerus
        3. Proximal Tibia
        4. Pelvis
  7. Complications: Fractures
    1. Total Fracture Incidence: 1.3 Million per year
    2. Hip FractureIncidence: 250,000 per year
      1. See Hip Fracture for morbidity and mortality
    3. Vertebral Compression Fracture
      1. Occurs in 33% of women over age 50 years
  8. Evaluation
    1. See Osteoporosis Secondary Causes
    2. See Osteoporosis Evaluation
  9. Management
    1. See Osteoporosis Management
  10. Resources
    1. National Osteoporosis Foundation
      1. http://www.nof.org
      2. Phone: (800) 223-9994
    2. Physicians Guide to Prevention and Treatment of Osteoporosis
      1. http://www.nof.org/physguide/index.htm
  11. References
    1. Bilezikian (1999) J Clin Endocrinol Metab 84:3431-4 [PubMed]
    2. Goddard (1998) Postgrad Med 104(4):54-72 [PubMed]
    3. Heaney (1998) Endocrinol Metab Clin North Am 27:255-65 [PubMed]
    4. Jeremiah (2015) Am Fam Physician 92(4): 261-8 [PubMed]
    5. Orwoll (1998) Endocrinol Metab Clin North Am 27:349-67 [PubMed]
    6. South-Paul (2001) Am Fam Physician 63(5):897-904 [PubMed]
    7. Taxel (1998) Geriatrics 53(8): 22-3 [PubMed]

Osteopenia (C0029453)

Definition (NCI_NCI-GLOSS) A condition in which there is a lower-than-normal bone mass or bone mineral density (the amount of bone mineral contained in a certain amount of bone). Osteopenia is a less severe form of bone loss than osteoporosis.
Definition (NCI) Decreased calcification or density of bone tissue.
Definition (CSP) decreased calcification, bone density, or bone mass due to inadequate osteoid synthesis.
Concepts Pathologic Function (T046)
MSH D001851
SnomedCT 203889002, 156879002, 312894000, 78441005
English Osteopenias, Bone Loss, osteopenia (diagnosis), osteopenia, Osteopaenia, bone loss, Bone loss, Bone demineralized, OSTEOPENIA, BONE LOSS, Osteopenia (disorder), Osteopenia (morphologic abnormality), bone; loss, loss; bone, Osteopenia
Japanese 骨減少症, コツゲンショウショウ, ホネソウシツ, 骨喪失, コツソウシツ
Czech osteopenie, Osteopenie, Kostní ztráta
Portuguese Osteopenia, Perda óssea
Spanish Osteopenia, Pérdida de hueso, osteopenia (anomalía morfológica), osteopenia (trastorno), osteopenia
French Ostéopénie, Perte osseuse
German Osteopenie, Knochenverlust
Italian Perdita ossea, Osteopenia
Dutch botverlies, bot; verlies, verlies; bot, osteopenie, Osteopenie
Hungarian Osteopenia, Csontvesztés
Norwegian Osteopeni
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Osteoporosis (C0029456)

Definition (MEDLINEPLUS)

Osteoporosis makes your bones weak and more likely to break. Anyone can develop osteoporosis, but it is common in older women. As many as half of all women and a quarter of men older than 50 will break a bone due to osteoporosis.

Risk factors include

  • Getting older
  • Being small and thin
  • Having a family history of osteoporosis
  • Taking certain medicines
  • Being a white or Asian woman
  • Having osteopenia, which is low bone density

Osteoporosis is a silent disease. You might not know you have it until you break a bone. A bone mineral density test is the best way to check your bone health. To keep bones strong, eat a diet rich in calcium and vitamin D, exercise and do not smoke. If needed, medicines can also help.

NIH: National Institute of Arthritis and Musculoskeletal and Skin Diseases

Definition (MSHCZE) Časté onemocnění charakterizované úbytkem kostní hmoty, „řídnutí kostí“. Typ I je tzv. o. postmenopauzální (výrazně častější u žen, časté jsou fraktury obratlů a distálního předloktí, postižena je zejm. trabekulární kost), typ II je o. senilní (poměr žen k mužům je asi 2:1, frakturami je postižen skelet axiální i apendikulární, bývají zlomeniny krčku stehenní kosti, postižena je kost trabekulární i kortikální). Příčina není zcela jasná, vyskytuje se ve vyšším věku častěji u žen po přechodu nebo po odstranění vaječníků ještě v plodném období, bývá následkem dlouhodobé nehybnosti, delší léčby kortikoidy nebo důsledkem některých vzácnějších chorob. Vliv má kouření, nadměrná konzumace kávy aj. Projevuje se bolestmi (např. zad) a představuje vyšší riziko zlomeniny (krček stehenní kosti, kompresivní fraktura obratle). K diagnostice lze využít rentgenové vyšetření, osteodenzitometrii, biochemická vyšetření sledující kostní metabolismus. Léčba je dlouhodobá a může spíše jen zastavit další vývoj onemocnění. Uplatňují se kalcium, vitamin D, fluoridy, bisfosfonáty zejm. alendronát, kalcitonin, HRT, SERM, anabolika, symptomatická a fyzikální terapie; velký význam má rehabilitace (a přiměřené zatěžování kostí). Důležitá je prevence (dostatek vápníku, pohyb, u žen podávání pohlavních hormonů po – zejm. předčasném – přechodu, srov. HRT). (cit. Velký lékařský slovník online, 2013 http://lekarske.slovniky.cz/ )
Definition (NCI) A condition of reduced bone mass, with decreased cortical thickness and a decrease in the number and size of the trabeculae of cancellous bone (but normal chemical composition), resulting in increased fracture incidence. Osteoporosis is classified as primary (Type 1, postmenopausal osteoporosis; Type 2, age-associated osteoporosis; and idiopathic, which can affect juveniles, premenopausal women, and middle-aged men) and secondary osteoporosis (which results from an identifiable cause of bone mass loss).
Definition (NCI_NCI-GLOSS) A condition that is marked by a decrease in bone mass and density, causing bones to become fragile.
Definition (NCI_CTCAE) A disorder characterized by reduced bone mass, with a decrease in cortical thickness and in the number and size of the trabeculae of cancellous bone (but normal chemical composition), resulting in increased fracture incidence.
Definition (MSH) Reduction of bone mass without alteration in the composition of bone, leading to fractures. Primary osteoporosis can be of two major types: postmenopausal osteoporosis (OSTEOPOROSIS, POSTMENOPAUSAL) and age-related or senile osteoporosis.
Definition (CSP) loss of bone mass and strength due to nutritional, metabolic, or other factors, usually resulting in deformity or fracture; a major public health problem of the elderly, especially women.
Concepts Disease or Syndrome (T047)
MSH D010024
ICD9 733.00, 733.0
ICD10 M81.9, M81.0, M81.99
SnomedCT 203428004, 156825006, 203440004, 64859006
LNC MTHU020796, LA10527-2
English Osteoporoses, Osteoporosis NOS, Osteoporosis, unspecified, osteoporosis, osteoporosis (diagnosis), OSTEOPOROSIS, Osteoporosis [Disease/Finding], Unspecified osteoporosis, site unspecified, Unspecified osteoporosis, Osteoporosis, unspecified (disorder), Osteoporosis NOS (disorder), Bone rarefaction, OP - Osteoporosis, Osteoporosis (disorder), rarefaction; bone, Osteoporosis, NOS, Osteoporosis
French OSTEOPOROSE, Ostéoporose, non précisée, Ostéoporose SAI, Ostéoporose
Portuguese OSTEOPOROSE, Osteoporose NE, Osteoporose
Spanish OSTEOPOROSIS, Osteoporosis NEOM, Osteoporosis no especificada, osteoporosis, no especificada, osteoporosis, SAI (trastorno), osteoporosis, SAI, osteoporosis, no especificada (trastorno), osteoporosis (trastorno), osteoporosis, Osteoporosis
German OSTEOPOROSE, Osteoporose, unspezifisch, Osteoporose NNB, Osteoporose, nicht naeher bezeichnet, Osteoporose
Dutch osteoporose NAO, niet-gespecificeerde osteoporose, rarefactio; bot, Osteoporose, niet gespecificeerd, osteoporose, Osteoporose, Porose, osteo-
Italian Osteoporosi non specificata, Osteoporosi NAS, Osteoporosi
Japanese 骨粗鬆症NOS, 骨粗鬆症、詳細不明, コツソショウショウNOS, コツソショウショウ, コツソショウショウショウサイフメイ, 骨多孔症-老人性, 年齢関連骨消失, 年令関連骨消失, 老人性骨粗鬆症, 老年性骨粗鬆症, 外傷後骨粗鬆症, 骨消失-年齢関連, 骨多孔症-年齢関連, 骨多孔症, オステオポロシス, 骨粗しょう症, 年齢関連骨減少, 年齢関連骨多孔症, 老年性骨多孔症, 骨粗鬆症-外傷後, 年齢関連骨粗鬆症, 年令関連骨多孔症, 老人性骨粗しょう症, 年令関連骨粗しょう症, 骨減少-年齢関連, 老人性骨多孔症, 老年性骨粗しょう症, 骨粗鬆症, オステオポローシス
Swedish Benskörhet
Czech osteoporóza, Osteoporóza NOS, Osteoporóza, Osteoporóza, blíže neurčená, řídnutí kostí
Finnish Osteoporoosi
Russian OSTEOPOROZ, KLIMAKTERICHESKII OSTEOPOROZ, RAREFIKATSIIA KOSTI, OSTEOPOROZ KLIMAKTERICHESKII, OSTEOPOROZ STARCHESKII, КЛИМАКТЕРИЧЕСКИЙ ОСТЕОПОРОЗ, ОСТЕОПОРОЗ, ОСТЕОПОРОЗ КЛИМАКТЕРИЧЕСКИЙ, ОСТЕОПОРОЗ СТАРЧЕСКИЙ, РАРЕФИКАЦИЯ КОСТИ
Korean 상세불명의 골다공증
Croatian OSTEOPOROZA
Polish Osteoporoza pourazowa, Osteoporoza starcza, Osteoporoza, Osteoporoza związana z wiekiem, Zrzeszotnienie kości
Hungarian Osteoporosis k.m.n., Osteoporosis, nem meghatározott, Osteoporosis
Norwegian Osteoporose, Benskjørhet, Beinskjørhet
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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