What is first Osteoporosis treatment Osteoporosis overview Postmenopausal osteoporosis Osteoporosis postmenopausal National osteoporosis Foundation

Which of the following is most likely the best initial first line therapy for a postmenopausal woman with osteoporosis?

Average 4.5 of 89 Ratings

Topic

Images

  • Summary

    • Osteopenia & Osteoporosis represent a continuum of conditions that present with a decrease in bone mass and disrupted bone microarchitecture most commonly as a result of increased age, menopause, and metabolic abnormalities.

    • Diagnosis is made with a lumbar-based DEXA scan with osteopenia having a T-score of 1 to 2.5 standard deviations below the peak bone mass of a 25-year-old individual, and osteoporosis having a T-score >2.5 standard of deviations below the peak bone mass of a 25-year-old individual.

    • Treatment involves a multidisciplinary approach with medical management and physical activity to increase bone mineral density and to help prevent fractures.

  • Epidemiology

    • Incidence

      • 10 million Americans and 200 million people worldwide have osteoporosis

      • 34 million Americans have osteopenia

      • 1.5 million osteoporotic fractures occur each year

        • 700,000 are vertebral fractures

        • 300,000 are hip fractures

        • 200,000 are wrist fractures

    • Demographics

      • male: female ratio is 1:4

        • men have a higher prevalence of secondary osteoporosis [60%] including

          • hypogonadism

          • glucocorticoid excess

          • alcoholism

      • age bracket

        • osteoporosis

          • postmenopausal osteoporosis is highest in women aged 50-70 years

          • senile osteoporosis begins after 70 years

          • secondary osteoporosis begins at any age

        • fractures

          • wrist fractures occur most commonly at age 50-60 years

          • vertebral fractures occur most commonly at age 60-70 years

          • hip fractures occur most commonly at age 70-80 years

    • Anatomic location

      • vertebral body > peritrochanter femur > distal radius

    • Risk factors

      • table of risk factors

  • Etiology

    • Pathophysiology

      • quantitative, not qualitative, disorder of bone mineralization

      • factors

        • failure to build peak bone mass as a young adult

        • bone loss in later life

    • Genetics

      • Polymorphisms in the genes for the calcitonin receptor, estrogen receptor-1, type I collagen alpha-1 chain, or the vitamin D receptor have been shown to be associated with osteoporosis

    • Associated conditions

      • fragility fractures

        • direct relationship between degree of bone loss and fractures

        • kyphotic deformity can arise from vertebral body fractures

        • pelvic ring insufficiency fractures most often treated with bed rest and analgesia

        • total hip arthroplasty with constrained components are a risk factor for fragility fractures

    • Associated with 20% increase in mortality

      • men have higher mortality rates following hip fractures than women

    • Associated with increased morbidity

      • reduced quality of life

      • only one-third of patients with hip fractures return to their previous level of function

    • History of 1 hip fracture results in up to 10 fold increased risk of 2nd hip fracture

  • Classification

      • Type I vs. Type II Osteoporosis

      • Type I

      • [Post menopausal]

      • Type II

      • [Senile]

      • Age group

      • Postmenopausal [highest incidence in 50-70 years old]

      • >70 years old

      • Bone affected

      • Almost exclusively trabecular

      • Trabecular > cortical

      • Bones fractured

      • Distal radius and vertebral

      • Hip and pelvis

      • Effect on calcium

      • Net negative change in calcium levels because of decreased intestinal absorption and increased urinary excretion of calcium.

      • Poor calcium absorption

      • Effect on Vit D

      • Reduced circulating levels of total [but not free] 1,25 dihydroxyvitamin D.