Upon completion of the chapter, the reader will be able to:
Explain the association between osteoporosis and morbidity and mortality.
Identify risk factors that predispose patients to osteoporosis.
Describe the pathogenesis of fractures.
List the criteria for diagnosis of osteoporosis.
Recommend appropriate lifestyle modifications to prevent bone loss.
Compare and contrast the effect of available treatment options on reduction of fracture risk.
Recommend an appropriate treatment regimen for a patient with osteoporosis and develop a monitoring plan for the selected regimen.
Educate patients on osteoporosis and drug treatment, including appropriate use, administration, and adverse effects.
Osteoporosis is a common and often silent disorder causing significant morbidity and mortality and reduced quality of life. It is characterized by low bone density and loss of strength in bone tissue resulting in an increased risk and rate of bone fracture. Osteoporosis is responsible for more than 2 million fractures in the United States annually. Almost 10 million Americans have osteoporosis, and an additional 43 million are classified as having low bone density.1,2 The cost of care is expected to rise to $25.3 billion by 2025. 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.
The fractures associated with osteoporosis have an enormous impact on individual patients, not only causing initial pain, but also chronic pain, loss of mobility, depression, nursing home placement, and death. Patients with vertebral fractures may also experience height loss, kyphosis, and decreased mobility due to limitations in bending and reaching. These patients are also at greater risk of having a future vertebral fracture. Multiple vertebral fractures may lead to restrictive lung disease and altered abdominal anatomy, while patients with hip fractures have added risks associated with surgical intervention to repair the fracture. More than 50% of patients never fully recover or regain preinjury independence. Death is common in the year after a hip fracture.1
EPIDEMIOLOGY AND ETIOLOGY
Osteoporosis is the most common skeletal disorder, but only one in three patients with osteoporosis are diagnosed, and only one in seven receives treatment.2 Osteoporosis can be classified as either primary (no known cause) or secondary (caused by drugs or other diseases). Primary osteoporosis is most often found in postmenopausal women and aging men, but it can occur in other age groups as well.1,2
The prevalence of osteoporosis varies by age, gender, and race/ethnicity and increases exponentially after age 50.3 Most hip fractures occur in postmenopausal white women, who also have the highest incidence of fracture when adjusted for age. The frequency of fracture in African American and Hispanic women trail far behind that of Caucasians, although ...