Unit
- Definition: Osteoporosis is a systemic skeletal disorder characterized by low bone mass and microarchitectural deterioration of bone tissue, leading to increased bone fragility and fracture risk. It is often called a silent disease because bone loss occurs without symptoms until a fracture happens.
- Epidemiology: Worldwide, osteoporosis causes more than 8.9 million fractures annually, with one in three women and one in five men over age 50 experiencing an osteoporotic fracture. The condition is more common in postmenopausal women due to estrogen decline.
- Fracture sites: The most common osteoporotic fractures occur at the hip, spine, and wrist. Hip fractures are particularly serious, leading to increased mortality, loss of independence, and high healthcare costs. Vertebral fractures can cause chronic pain and kyphosis.
- Healthcare burden: The economic impact of osteoporosis-related fractures is substantial, with direct costs related to hospitalizations, surgeries, rehabilitation, and long-term care. Indirect costs include lost productivity and caregiver burden.
- Demographics: Prevalence increases with age and is higher in Caucasian and Asian populations. However, osteoporosis affects all racial and ethnic groups. Men are often underdiagnosed and undertreated despite significant burden.
- Global trends: As the population ages worldwide, the prevalence of osteoporosis is expected to rise dramatically. By 2050, the global incidence of hip fractures could increase by 240% in women and 310% in men compared to 1990 rates.
- Public health response: Many countries have developed clinical practice guidelines for screening and treatment. Initiatives such as Fracture Liaison Services aim to identify and manage patients after a fragility fracture to prevent subsequent fractures.
- Secondary osteoporosis: In some cases, osteoporosis results from underlying medical conditions (e.g., hyperparathyroidism, rheumatoid arthritis) or medications (e.g., glucocorticoids, proton pump inhibitors). Identifying secondary causes is crucial for appropriate management.
- Risk factors: Major risk factors include advanced age, female sex, low body weight, family history of hip fracture, prior fragility fracture, smoking, excessive alcohol intake, and prolonged immobilization. Early recognition of these factors helps target screening and prevention efforts.
- Diagnosis: Osteoporosis is diagnosed by dual-energy X-ray absorptiometry (DXA) scanning, which measures bone mineral density at the hip and spine. A T-score of -2.5 or lower indicates osteoporosis. Screening is recommended for women 65 and older, and for younger postmenopausal women with risk factors.
- Treatment options: Pharmacologic therapies include bisphosphonates (e.g., alendronate, zoledronic acid), denosumab, selective estrogen receptor modulators, and parathyroid hormone analogs. All patients should also receive adequate calcium and vitamin D supplementation along with weight-bearing exercise.
Terminology
- Osteoporosis
- A bone disease where bone density decreases, increasing fracture risk.
- Fragility fracture
- A fracture resulting from a low-energy trauma, such as a fall from standing height or less.
- Bone mineral density (BMD)
- A measure of the amount of minerals (mainly calcium) in bone, used to diagnose osteoporosis.
- Osteopenia
- Bone density that is lower than normal but not low enough to be classified as osteoporosis.
Regulatory Note
Regulation: The U.S. Preventive Services Task Force recommends screening for osteoporosis in women aged 65 years and older and in younger women with increased risk factors. Similar guidelines exist from the World Health Organization and national bodies.
Source: WHO Scientific Group on the Assessment of Osteoporosis at Primary Health Care Level (2007).
Quick Revision
- Osteoporosis is a silent bone disease leading to increased fracture risk.
- It affects millions globally, with hip and spine fractures being most serious.
- Prevalence rises with age and is higher in postmenopausal women.
- Secondary osteoporosis due to other conditions or medications must be ruled out.
- Screening guidelines target older adults and those with risk factors.