Epidemiology and management of osteoporosis in the People’s Republic of China: current perspectives

Figures & data

Table 1 World Health Organization criteria for the diagnosis of osteoporosis

Diagnosis categories	Definitions
Normal	BMD within 1 SD of the young adult mean value (T-score ≥ −1.0)
Osteopenia	BMD >1 SD below the young adult mean, but <2.5 SD below this value (−2.5 < T-score < −1.0)
Osteoporosis	BMD ≥2.5 SD below the young adult mean value (T-score ≤ −2.5)
Severe (established) osteoporosis	BMD ≥2.5 SD below the young adult mean value (T-score ≤ −2.5) and in the presence of ≥1 fragility fractures

Note: Data from World Health Organization Study Group,¹⁰ and Kanis et al.¹⁴

Abbreviations: BMD, bone mineral density; SD, standard deviation.

Table 2 Risk factors for osteoporosis

Categories	Risk factors
General factors	Female
	Age
	Height
	Body mass index
	History of fragility fracture
Body composition	Fat mass
	Lean mass
Dietary factors	Vitamin D
	Calcium
Lifestyle	Sedentary or lack of exercise
	Cigarette smoking
	Alcohol drinking
	Caffeine
Genetic factors	OPG, RANK, RANKL
	ESR1, LRP4, LRP5, BTB40, SOST
	A family history of fracture
Medications	Glucocorticoids
	Immunosuppressants
	Heparin
	Anticonvulsants
	Thiazolidenediones
	Proton pump inhibitors
Diseases	Endocrine disorders
	Gastrointestinal diseases
	Hematologic diseases
	Other disorders

Table 3 Medications for the prevention/treatment of OP

Categories	Agents	Indications	Dosage and method	Effects on BMD	Effects on risk of fractures	Side effects	Prevention or treatment
Antiabsorptive	Alendronate Residronate	PMOP, men’s OP, and GIOP^Citation38,Citation156 PMOP, men’s OP, and GIOP^Citation38,Citation156	Oral 10 mg/day, 70 mg/week^Citation157 Oral 5 mg/day, 35 mg/week^Citation161	↑Lumbar spine and hip^Citation158	↓Vertebral, nonvertebral, and hip^Citation159	Bone, joint or muscle pain, inflammation of the eye, dyspepsia, esophagitis, and osteonecrosis of the jaw^Citation160	Prevention and treatment^Citation38,Citation156
	Zoledronic acid	PMOP^Citation38	IV 5 mg/year,^Citation162
	Ibandronate	PMOP^Citation38	IV 3 mg/3 months^Citation163		↓Vertebral^Citation163
	Calcitonin	PMOP^Citation38	Nasal 200 IU/day or IM 50 IU/day^Citation164	↑Spine^Citation38	↓Vertebral, nonvertebral^Citation38	Facial or hand flushing, rash, nausea, urinary frequency, rhinitis, epistaxis, headache, and back or joint pain^Citation79	Treatment, but not prevention
	HRT	PMOP^Citation38	Individualized dose	↑Spine and hip^Citation38	↓Vertebral, nonvertebral^Citation38	Increasing fracture risk, cardiovascular, uterine cancer, breast cancer, stroke, and thromboembolic event risk^Citation165,Citation166	Prevention and treatment
	SERMs	PMOP	60 mg/day^Citation167	↑Spine and femoral neck	↓Vertebral^Citation168	Hot flushes, leg cramps, swelling, a flu-like syndrome, peripheral edema and vasomotor symptoms, and deep vein thrombosis^Citation169	Prevention and treatment
	Denosumab	PMOP	Subcutaneous injection 60 mg/6 months^Citation170	↑Lumbar spine and hip^Citation170	↓Vertebral, nonvertebral, and hip^Citation171	Hypocalcemia, skin infections, osteonecrosis of the jaw, and atypical femoral fractures^Citation172	Treatment
Anabolic	PTH and teriparatide	PMOP and men’s OP	Subcutaneous injection 20 μg/day, less than 2 years^Citation172	↑Spine and hip^Citation173	↓Vertebral, nonvertebral^Citation173	Leg cramps, vertigo, pain, nausea, orthostatic hypotension, and a modest rise in serum and urine calcium^Citation174	Treatment
Combined Antiresorption with stimulated bone formation	Strontium ranelate	PMOP	Oral 2 g/day^Citation38	↑Lumbar spine, femoral neck, and total hip^Citation175	↓Vertebral, nonvertebral^Citation176	Headache, nausea, diarrhea and skin reaction syndrome, Stevens–Johnson syndrome, and toxic epidermal necrolysis^Citation79	Prevention

Abbreviations: OP, osteoporosis; BMD, bone mineral density; PMOP, postmenopausal osteoporosis; GIOP, glucocorticoid-induced osteoporosis; IV, intravenous; IM, intramuscular; HRT, hormone replacement therapy; SERMs, selective estrogen receptor modulators; PTH, parathyroid hormone.

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