Abstract
The economic, social and personal burdens of osteoporosis carry a heavy toll. Despite this, it is significantly under-recognized and under-treated. Complete evaluation includes work-up and recognition of secondary causes of osteoporosis in addition to biochemical marker and bone densitometry testing. Recognition of factors contributing to falls is a critical part of prevention of fragility fractures in the elderly. Nutraceutical treatments include calcium and vitamin D. Pharmacologic treatments include bisphosphonates, raloxifene, estrogen, testosterone, strontium ranelate, calcitonin and parathyroid hormone (recombinant 1–34 and 1–84). Although bisphosphonates are generally considered first-line therapy, therapies such as raloxifene and zoledronate have unique benefits. Nonpharmacologic interventions include weight-bearing exercise and behavioral counseling for modification of risk factors such as smoking and alcohol use. Fall and fracture prevention with hip protectors and balance training have also been used. The ideal duration of therapy is not well established. Treatment failure should raise concerns about compliance and secondary causes of fractures/osteoporosis.
Financial & competing interests disclosure
The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.
No writing assistance was utilized in the production of this manuscript.
Notes
*Strong evidence support older age, weight below 70 kg and not taking estrogen as risk factors for osteoporosis and related fractures. There is less evidence for smoking, weight loss, family history, decreased physical activity, alcohol or caffeine use, or low calcium and vitamin D intake as risk factors. At any given age, African–American women have, on average, a higher BMD than white women and, thus, are likely to benefit from screening.
‡Predictors of low BMD include female gender, increased age, estrogen deficiency, white race, low weight and body mass index, family history of osteoporosis, smoking and history of prior fracture. Late menarche, early menopause and low endogenous estrogen levels are also associated with low BMD in several studies.
§Several (too numerous to list) clinical factors are listed on the National Osteoporosis Foundation website, including lifestyle factors, genetic disorders, hypogonadal states, endocrine, gastrointestinal and hematologic disorders and medications.
BMD: Bone mineral density.
Adapted from Citation[81].