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LEARNING OBJECTIVES

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LEARNING OBJECTIVES

Upon completion of the chapter, the reader will be able to:

  1. Explain the association between osteoporosis and morbidity and mortality.

  2. Identify risk factors that predispose patients to osteoporosis.

  3. Describe the pathogenesis of fractures.

  4. List the criteria for diagnosis of osteoporosis.

  5. Recommend appropriate lifestyle modifications to prevent bone loss.

  6. Compare and contrast the effect of available treatment options on reduction of fracture risk.

  7. Recommend an appropriate treatment regimen for a patient with osteoporosis and develop a monitoring plan for the selected regimen.

  8. Educate patients on osteoporosis and drug treatment, including appropriate use, administration, and adverse effects.

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KEY CONCEPTS

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  • Image not available. Major risk factors for osteoporotic fracture as defined by the World Health Organization (WHO) are low bone mineral density (BMD), personal history of adult fracture, age, family history of osteoporotic fracture, current cigarette smoking, low body mass index, excessive alcohol use, and chronic glucocorticoid use.

  • Image not available. A standardized approach for diagnosing osteoporosis is recommended using central dual-energy x-ray absorptiometry (DXA) measurements.

  • Image not available. Both pharmacologic and nonpharmacologic therapies for osteoporosis are aimed at preventing fractures and their complications, maintaining or increasing BMD, preventing secondary causes of bone loss, and improving morbidity and mortality.

  • Image not available. All men and women over age 50 should be considered for pharmacologic treatment if they meet any of the following criteria: (a) history of hip or vertebral fracture, (b) T-score less than or equal to –2.5 at femoral neck or spine, or (c) osteopenia and at least a 3% 10-year probability of hip fracture or at least a 20% 10-year probability of major osteoporosis-related fracture as determined by FRAX.

  • Image not available. Adequate calcium and vitamin D intake is essential in prevention and treatment of osteoporosis. Calcium and vitamin D supplements to meet requirements should be added to all drug therapy regimens for osteoporosis.

  • Image not available. Bisphosphonates are first-line therapy for postmenopausal and male osteoporosis due to established efficacy in preventing hip and vertebral fractures.

  • Image not available. The American College of Rheumatology (ACR) recommends bisphosphonate therapy with alendronate or risedronate for all patients who are starting treatment with glucocorticoids (prednisone 5 mg or more daily or equivalent) that will continue for 3 months or longer.

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INTRODUCTION

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Osteoporosis is a common and often silent disorder causing significant morbidity and mortality and reduced quality of life. It is associated with increased risk and rate of bone fracture and is responsible for more than 1.5 million fractures in the United States annually resulting in direct healthcare costs of more than $17 billion.1 As the population ages, these numbers are expected to increase by two- to threefold. It is estimated that postmenopausal white women have a 50% lifetime chance of developing an osteoporosis-related fracture, whereas men have a 20% lifetime chance.1 Common sites of fracture include the spine, hip, and wrist, although almost all sites can be affected. Only a fraction of patients with osteoporosis receive optimal treatment.

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The fractures associated with osteoporosis ...

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