Wednesday, January 18, 2012

Osteoporosis

Osteoporosis, a chronic progressive disease of multifactorial etiology (see Etiology), is the most common metabolic bone disease in the United States. It has been most frequently recognized in elderly white women, although it does occur in both sexes, all races, and all age groups.

This disease is considered a "silent thief" that generally does not become clinically apparent until a fracture occurs (see Clinical Presentation). Screening at-risk populations is, therefore, essential (see Workup).

Osteoporosis can affect almost the entire skeleton. It is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of bone tissue, with a consequent increase in bone fragility.[1] The disease often does not become clinically apparent until a fracture occurs.

Osteoporosis represents an increasingly serious problem in the United States and around the world. Many individuals, male and female, experience pain, disability, and diminished quality of life as a result of having this condition. The economic burden the disease imposes is already considerable and will only grow as the population ages.[2]

Despite the adverse effects of osteoporosis, it is a condition that is often overlooked and undertreated, in large part because it is so often clinically silent before manifesting in the form of fracture. For example, a Gallup survey performed by the National Osteoporosis Foundation revealed that 75% of all women aged 45-75 years have never discussed osteoporosis with their physicians. Failure to identify at-risk patients, to educate them, and to implement preventive measures may lead to tragic consequences.

Medical care includes calcium, vitamin D, and antiosteoporotic medication such as bisphosphonates and parathyroid hormone. Antiresorptive agents currently available for osteoporosis treatment include bisphosphonates, the selective estrogen-receptor modulator (SERM) raloxifene, calcitonin, and denosumab. One anabolic agent, teriparatide (see Medication), is available as well. Surgical care includes vertebroplasty and kyphoplasty. (See Treatment and Management.)

Osteoporosis is a preventable disease that can result in devastating physical, psychosocial, and economic consequences. Prevention and recognition of the secondary causes of osteoporosis are first-line measures to lessen the impact of the disease (see the images below).

Osteoporosis of the spine. Observe the considerablOsteoporosis of the spine. Observe the considerable reduction in overall vertebral bone density and note the lateral wedge fracture of L2.Osteoporosis of the spine. Note the lateral wedge Osteoporosis of the spine. Note the lateral wedge fracture in L3 and the central burst fracture in L5. The patient had suffered a recent fall.

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