Osteoporosis is a chronic and often disabling condition characterized by a combination of low bone mass and distorted bone architecture. It is a very common bone disease among post-menopausal women, especially the elderly. The disease is a burden on the health care system (fracture care estimated at $17 billion in 2005) as it relates to the common factor of fractures. The disease and care issues and cost relate directly to:
- Costs and complications of medical care including long term care (nursing homes)
- Kyphosis and other activity limitations
- Restrictive lung disease
- Slow healing
- Often, the first fracture is followed by another within a year
- Increased morbidity and mortality
What is the disease process?
Older bone is continually replaced with new bone. Bone loss occurs when this balance is altered. Loss of bone tissue leads to disorders in the skeletal system and increases the risk of fracture.
- Low calcium intake Vitamin D insufficiency Excess vitamin A
- High caffeine intake High salt intake Aluminum (in antacids)
- Alcohol (3 or more drinks/d)
- Inadequate physical activity
- Smoking (active or passive)
- Genetic disorders
- Cystic fibrosis
- Endocrine disorders
The diagnosis of osteoporosis is established by measurement of bone minerals using various techniques, generally referred to as densitometry technology and absorptiometry (pCXA). Bone Mineral Density Measurement and Classification (BMD), Central DXA. Dual-energy x-ray absorptiometry (DXA) measurement of the hip and spine is the technology used to diagnose osteoporosis, predict future fracture risk, and monitor patients by performing serial assessments. Areal BMD is expressed in absolute terms of grams of mineral per square centimeter scanned (g/cm2) and as a relationship to two norms: compared to the expected BMD for the patient’s age and sex. You will hear or see T and Z-scores.
CT-based absorptiometry. Quantitative computed tomography (QCT) measures volumetric trabecular and cortical bone density at the spine and hip, whereas peripheral QCT (pQCT) measures the same at the forearm or tibia. In postmenopausal women, QCT measurement of spine trabecular BMD can predict vertebral fractures whereas pQCT of the forearm at the ultra distal radius predicts hip, but not spine fractures.
Quantitative ultrasound densitometry (QUS) uses the speed of sound (SOS) and or broadband ultrasound attenuation (BUA) at the heel, tibia, patella, and other peripheral skeletal sites.
Who Sould Be Tested?
The decision to perform bone density assessment is based on an individual’s fracture risk profile and skeletal health assessment, with authorities recommending testing of all women age 65 and older for men age 70 and older.
Several interventions to reduce fracture risk are recommended:
- adequate intake of calcium and vitamin D (1200 to 1500 mg/daily)
- participation in regular weight-bearing and muscle-strengthening exercise
- avoidance of tobacco and alcohol
- treatment of other risk factors for fracture such as impaired vision
Current FDA-approved pharmacologic options for the prevention and/or treatment of postmenopausal osteoporosis include (brand names in parentheses):
- bisphosphonates (alendronate, alendronate plus D, ibandronate, (brand name Boniva), risedronate (Actonel), and risedronate (Reclast) with 500 mg of calcium carbonate, zoledronate), calcitonin (Miacalcin, Calcimar, Fortical)
- Estrogen/Hormone Therapy (brand names: Climara, Estrace, Estraderm, Estratab, Ogen, Ortho-Est, Premarin, Vivelle); HT brand names: e.g. Activella, Femhrt, Premphase, Prempro). Estrogen Agonist/Antagonist Raloxifene (Evista)
- Parathyroid Hormone – teriparatide (Forteo), is an anabolic (bone-building) agent
DISCLAIMER: The information provided here is for general informational purposes only, and is provided as a supplement for students enrolled in Meditec’s medical career training courses. The information should NOT be used for actual diagnostic or treatment purposes or in lieu of diagnosis or treatment by a licensed physician.