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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 in patients with osteoporosis.

  4. List the criteria for diagnosis and screening of osteoporosis.

  5. Recommend appropriate lifestyle modifications to prevent bone loss.

  6. Compare and contrast the effect of available treatment options on reducing 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 about 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. Approximately 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. The risk of developing an osteoporosis-related fracture varies according to age, sex, and race/ethnicity.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, and death may occur in up to 20% of patients within 2 years after fracture.2


Osteoporosis is the most common skeletal disorder, but only a fraction of patients are evaluated and diagnosed, and less than one in four receives treatment after a fracture.2,3 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, sex, and race/ethnicity and increases exponentially after age 50.4 As a group, African Americans have the highest BMD, while Asian Americans have the lowest.4 In the United States most hip fractures occur in postmenopausal White women, ...

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