Osteoporosis Prevention and Management

Abstract

Osteoporosis, defined by BMD at the hip or lumbar spine that is less than or equal to 2.5 standard deviations below the mean BMD of a young-adult reference population, is the most common bone disease in humans affecting both sexes and all races. It's a silent killer affecting the quality of life due to fractures and postural changes. In osteoporosis there is an imbalance between bone formation and bone resorption in favor of latter. Preventive measures and treatments are available to combat this evil. Counseling is the integral part of prevention as well as treatment of osteoporosis. Preventive strategy includes life style changes, exercise, intake of calcium and vitamin D, avoiding alcohol, smoking and excessive intake of salt. Estrogen therapy/estrogen+progesterone therapy (ET/EPT) is no longer recommended as a first-line therapy for the prevention of osteoporosis. They may be used in the therapy for osteoporosis in women under 60. Diagnosis and classification are made by assessment of BMD using DEXA or ultrasound and laboratory investigations. Management includes estimation of 10-year fracture risk using FRAX, life style and diet modification and pharmacological therapy. The drugs used in osteoporosis may be those that inhibit bone resorption-bisphosphonates, denosumab, calcitonin, SERMs, estrogen and progesterone-or that stimulate bone formation-PTH, Teriparatide. Combination therapies are not recommended as they do not have proven additional BMD/fracture benefits. No therapy should be indefinite in duration. There are no uniform recommendations to all patients. Duration decisions need to be individualized. While on treatment monitoring should be done with BMD assessment by DEXA/ultrasound and bone turnover markers.

Incidence and Economic Burden of Intertrochanteric Fracture

“…Our study further corroborates the decline as the estimated incidence rates of hip fracture of 223 and 555 per 100,000 in males and females were 40% and 30% lower, respectively, compared with the rates of 369 and 793.5 per 100,000 that were previously reported on the basis of 2005 Medicare data 8 . Increased awareness of the risk factors for hip fracture and preventative measures (such as fall-prevention strategies and lifestyle modification, including increased exercise and dietary intake of calcium and vitamin D) are possible explanations for the observed decrease in hip fracture incidence rates 12 .…”

Assessment of the Level of Satisfaction with Medical Care of Patients Treated in Osteoporosis Clinics as an Indicator of the Quality of Medical Care

“…The issue of assessing the quality of medical services, especially in the context of civilization diseases, is important to many institutions, e.g., healthcare providers and recipients, local governments, managers of medical entities, politicians and taxpayers [ 12 , 13 ]. Based on epidemiological data and cost analyses related to its prevention, diagnosis and treatment, osteoporosis, a metabolic bone tissue disease, is considered a social and economic problem [ 14 , 15 , 16 ]. Osteoporosis is recognized by the World Health Organization as a civilization disease and an epidemic of the 21st century [ 17 , 18 , 19 ].…”

Underlying Signaling Pathways and Therapeutic Applications of Pulsed Electromagnetic Fields in Bone Repair

“…Osteoporosis is a worldwide health problem with high morbidity, especially in postmenopausal women [88-90]. It is generally defined as a systemic skeletal disease characterized by low bone mineral density (BMD) and compromised bone strength, leading to enhanced bone fragility, increased fracture risk, and resultant disability, which strikingly affects patients' quality of life [91, 92].…”