{"id":4422535,"date":"2025-01-11T23:01:17","date_gmt":"2025-01-12T05:01:17","guid":{"rendered":"https:\/\/myendoconsult.com\/learn\/topics\/osteoporosis\/"},"modified":"2025-01-13T06:28:02","modified_gmt":"2025-01-13T12:28:02","slug":"osteoporosis","status":"publish","type":"oen_topic","link":"https:\/\/myendoconsult.com\/learn\/topics\/osteoporosis\/","title":{"rendered":"Osteoporosis"},"content":{"rendered":"\n<h2 class=\"wp-block-heading\">PATHOGENESIS OF OSTEOPOROSIS<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Definition &amp; Key Features<\/strong>\n<ul class=\"wp-block-list\">\n<li>Osteoporosis: a structural skeletal disorder with <strong>low bone mass<\/strong> and <strong>bone fragility<\/strong>, leading to increased fracture risk.<\/li>\n\n\n\n<li>Microarchitectural disruption includes <strong>perforated trabecular plates<\/strong> and <strong>discontinuous trabecular struts<\/strong>.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Mechanisms of Low Bone Mass<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Low peak bone mass<\/strong><\/li>\n\n\n\n<li><strong>Increased bone resorption<\/strong><\/li>\n\n\n\n<li><strong>Decreased bone formation<\/strong><\/li>\n\n\n\n<li>High-turnover osteoporosis = <strong>dominant bone resorption<\/strong><\/li>\n\n\n\n<li>Low-turnover osteoporosis = <strong>dominant decrease in bone formation<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Determinants of Peak Bone Mass<\/strong>\n<ul class=\"wp-block-list\">\n<li>~50% is <strong>genetically<\/strong> determined.<\/li>\n\n\n\n<li>~50% is <strong>environmental<\/strong> (e.g., physical activity, calcium intake, etc.).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Role of Sex Hormones<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Estrogen deficiency<\/strong>: major contributor in postmenopausal women.\n<ul class=\"wp-block-list\">\n<li>Estrogen normally inhibits bone resorption.<\/li>\n\n\n\n<li>Prolonged estrogen deficiency \u2192 decreased bone density (includes premenopausal estrogen-deficient states).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Testosterone deficiency<\/strong> in men \u2192 predisposes to osteoporosis; some men also need estrogen (via aromatization) for normal bone.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Risk Factors<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Advancing age<\/strong><\/li>\n\n\n\n<li><strong>Fragility fracture<\/strong> history<\/li>\n\n\n\n<li><strong>Glucocorticoid therapy<\/strong><\/li>\n\n\n\n<li><strong>Low body mass index<\/strong><\/li>\n\n\n\n<li><strong>Family history<\/strong> of hip fracture<\/li>\n\n\n\n<li><strong>Smoking<\/strong><\/li>\n\n\n\n<li><strong>Excess alcohol use<\/strong><\/li>\n\n\n\n<li><strong>Low bone mineral density (BMD)<\/strong><\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Other Contributing Factors<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Low dietary calcium\/vitamin D<\/strong><\/li>\n\n\n\n<li><strong>Certain medications<\/strong> (e.g., anticonvulsants, heparin, methotrexate)<\/li>\n\n\n\n<li><strong>Immobility\/bed rest<\/strong><\/li>\n\n\n\n<li><strong>Neurologic disorders<\/strong> \u2192 limited mobility<\/li>\n\n\n\n<li><strong>Glucocorticoid excess<\/strong> (most commonly iatrogenic) \u2192 inhibited osteoblast differentiation<\/li>\n\n\n\n<li><strong>Hyperparathyroidism<\/strong> (primary\/secondary) \u2192 increased bone resorption<\/li>\n\n\n\n<li>Chronic <strong>inflammatory<\/strong> disorders (e.g., rheumatoid arthritis, IBD), <strong>malabsorption<\/strong> (celiac), <strong>thyroid hormone excess<\/strong>, <strong>multiple myeloma<\/strong>, etc.<\/li>\n\n\n\n<li><strong>Anorexia nervosa<\/strong> \u2192 dietary deficiency + estrogen deficiency<\/li>\n\n\n\n<li><strong>Genetic disorders<\/strong> \u2192 osteogenesis imperfecta, homocystinuria<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Overview<\/strong>\n<ul class=\"wp-block-list\">\n<li>Markedly low bone mass, often tied to <strong>estrogen deficiency<\/strong> and <strong>aging<\/strong>.<\/li>\n\n\n\n<li>Clinically silent until <strong>fracture<\/strong> occurs (spine, hip, rib, distal radius most common).<\/li>\n\n\n\n<li>Multiple vertebral fractures \u2192 <strong>thoracic kyphosis<\/strong> (dowager\u2019s hump), height loss, abdominal protrusion.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Bone Strength<\/strong>\n<ul class=\"wp-block-list\">\n<li>Depends on <strong>bone mass<\/strong> (size, shape, microarchitecture) and <strong>bone turnover<\/strong> (formation vs. resorption).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Bone Mineral Density (BMD)<\/strong>\n<ul class=\"wp-block-list\">\n<li>Measured by <strong>dual energy\u2013x-ray absorptiometry (DXA)<\/strong> at hip and lumbar spine.<\/li>\n\n\n\n<li><strong>Inverse<\/strong> relationship between BMD and fracture risk.<\/li>\n\n\n\n<li><strong>T score<\/strong> = SD difference from a young adult reference.\n<ul class=\"wp-block-list\">\n<li>Normal: \u2265\u22121.0 SD.<\/li>\n\n\n\n<li>Osteopenia: between \u22121.0 and \u22122.5.<\/li>\n\n\n\n<li>Osteoporosis: \u2264\u22122.5.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Z score<\/strong> = SD difference from an age-matched reference (Z &lt; \u22122.0 considered low).<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Causes of Low BMD<\/strong>\n<ul class=\"wp-block-list\">\n<li>Low peak bone mass in youth\/adolescence.<\/li>\n\n\n\n<li><strong>Decreased bone formation<\/strong> and\/or <strong>increased bone resorption<\/strong>.<\/li>\n\n\n\n<li>Excess resorption often pivotal in postmenopausal women.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Secondary Osteoporosis Considerations<\/strong>\n<ul class=\"wp-block-list\">\n<li>Conditions: <strong>vitamin D deficiency, osteomalacia, hyperthyroidism, hyperparathyroidism, celiac disease, mast cell disease, hypercortisolism, etc.<\/strong><\/li>\n\n\n\n<li>Initial labs: CBC, serum Ca, phosphorus, liver enzymes, creatinine, TSH, 25(OH)D.<\/li>\n\n\n\n<li>Additional tests guided by clinical suspicion.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Treatment<\/strong>\n<ol class=\"wp-block-list\">\n<li><strong>Lifestyle<\/strong>: Diet, exercise, smoking cessation, limiting steroids.\n<ul class=\"wp-block-list\">\n<li>Daily <strong>calcium 1500 mg<\/strong> and <strong>vitamin D 800 IU<\/strong> recommended.<\/li>\n\n\n\n<li>Weight-bearing exercise (e.g., walking) beneficial.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Pharmacologic<\/strong>:\n<ul class=\"wp-block-list\">\n<li><strong>Antiresorptive agents<\/strong>: estrogen, selective estrogen receptor modulators, bisphosphonates, calcitonin.<\/li>\n\n\n\n<li><strong>Anabolic agents<\/strong>: parathyroid hormone 1-34 (teriparatide).<\/li>\n\n\n\n<li>Future potential therapies: RANKL antibodies, sclerostin inhibitors, integrin inhibitors, cathepsin K inhibitors.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Monitoring<\/strong>:\n<ul class=\"wp-block-list\">\n<li><strong>Bone turnover markers<\/strong> at baseline, then 3\u20136 months.<\/li>\n\n\n\n<li><strong>DXA<\/strong> at 1 year, then every 2\u20133 years.<\/li>\n<\/ul>\n<\/li>\n<\/ol>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">OSTEOPOROSIS IN MEN<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Overview<\/strong>\n<ul class=\"wp-block-list\">\n<li>Frequently underdiagnosed; often recognized after <strong>low-impact fractures<\/strong> or noted osteopenia on radiographs.<\/li>\n\n\n\n<li>Typical fracture sites: <strong>spine, hip, ribs<\/strong>.<\/li>\n\n\n\n<li>Multiple vertebral fractures \u2192 height loss, thoracic kyphosis, restricted pulmonary function.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Evaluation<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>DXA<\/strong> at lumbar spine and hip if:\n<ul class=\"wp-block-list\">\n<li>Low-trauma fracture, incidental osteopenia on radiograph, &gt;4 cm height loss, or clinical risk factors.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li>T score \u2264\u22122.5 indicates osteoporosis.<\/li>\n\n\n\n<li>T score \u22121.0 to \u22122.5 indicates osteopenia.<\/li>\n\n\n\n<li><strong>Secondary Osteoporosis<\/strong>: consider malabsorption (celiac), hypogonadism, Cushing syndrome, chronic renal\/liver disease, hypercalciuria, hyperparathyroidism, etc.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Laboratory<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Initial<\/strong>: CBC, total protein (SPEP), testosterone, Ca, phosphorus, PTH, 25(OH)D, alkaline phosphatase, liver enzymes, creatinine, TSH, 24-hour urine cortisol, calcium, creatinine.<\/li>\n\n\n\n<li>Additional testing guided by results.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Treatment<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Lifestyle<\/strong>: adequate calcium\/vitamin D, exercise, smoking cessation, alcohol moderation.<\/li>\n\n\n\n<li><strong>Underlying Cause<\/strong>: e.g., testosterone replacement if hypogonadism.<\/li>\n\n\n\n<li><strong>Pharmacologic<\/strong>: indicated for:\n<ul class=\"wp-block-list\">\n<li>Men \u226550 years with vertebral\/hip fracture or T score \u2264\u22122.5.<\/li>\n\n\n\n<li>Men with FRAX risk of \u22653% hip fracture or \u226520% combined osteoporotic fractures.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Options<\/strong>: primarily <strong>bisphosphonates<\/strong>; teriparatide (PTH 1-34) reserved for severe\/refractory cases.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h2 class=\"wp-block-heading\">CLINICAL MANIFESTATIONS OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES<\/h2>\n\n\n\n<ul class=\"wp-block-list\">\n<li><strong>Prevalence &amp; Presentation<\/strong>\n<ul class=\"wp-block-list\">\n<li>Thoracic and lumbar <strong>vertebral bodies<\/strong> are most commonly fractured.<\/li>\n\n\n\n<li>Often at thoracolumbar junction (T11\u2013L2).<\/li>\n\n\n\n<li>May be <strong>asymptomatic<\/strong> and found incidentally on radiographs.<\/li>\n\n\n\n<li><strong>Acute<\/strong> fractures \u2192 local or radiating back pain, worsened by movement.<\/li>\n\n\n\n<li><strong>Pain<\/strong> typically improves over 4\u20138 weeks; but chronic discomfort can persist.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Kyphosis &amp; Height Loss<\/strong>\n<ul class=\"wp-block-list\">\n<li>Multiple compression fractures \u2192 <strong>thoracic kyphosis<\/strong> (\u201cdowager\u2019s hump\u201d) and reduced stature.<\/li>\n\n\n\n<li>Neck hyperextension to maintain head position \u2192 neck discomfort.<\/li>\n\n\n\n<li>Abdominal protrusion from decreased thoracic space.<\/li>\n\n\n\n<li>Lowest rib may contact iliac crest \u2192 fl ank\/abdominal pain.<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Fracture Patterns<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Anterior wedge<\/strong> fractures<\/li>\n\n\n\n<li><strong>Biconcave (codfi sh) deformities<\/strong><\/li>\n\n\n\n<li><strong>Compression<\/strong> fractures.<\/li>\n\n\n\n<li>Grading severity by vertebral height loss:\n<ul class=\"wp-block-list\">\n<li>Grade 1: 20\u201325%<\/li>\n\n\n\n<li>Grade 2: 26\u201340%<\/li>\n\n\n\n<li>Grade 3: &gt;40%<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n\n\n\n<li><strong>Evaluation &amp; Treatment<\/strong>\n<ul class=\"wp-block-list\">\n<li><strong>Plain spine radiographs<\/strong> if new vertebral fracture suspected.<\/li>\n\n\n\n<li><strong>MRI<\/strong> if radicular symptoms or concern for other pathology.<\/li>\n\n\n\n<li><strong>BMD assessment<\/strong> by DXA to confirm osteoporosis.<\/li>\n\n\n\n<li><strong>Underlying cause<\/strong> (e.g., postmenopausal osteoporosis, steroid-induced) determines therapies.<\/li>\n\n\n\n<li><strong>Pain management<\/strong> with NSAIDs or analgesics.<\/li>\n\n\n\n<li><strong>Vertebroplasty\/kyphoplasty<\/strong> for severe or persistent pain, restores vertebral height and reduces pain.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n\n\n\n<p><a href=\"https:\/\/myendoconsult.com\/learn\/management-of-osteoporosis\/\" data-type=\"link\" data-id=\"https:\/\/myendoconsult.com\/learn\/management-of-osteoporosis\/\">Learn more about the Treatment of osteoporosis.<\/a><\/p>\n\n\n\n<p><\/p>\n","protected":false},"excerpt":{"rendered":"<p>PATHOGENESIS OF OSTEOPOROSIS OSTEOPOROSIS IN POSTMENOPAUSAL WOMEN OSTEOPOROSIS IN MEN CLINICAL MANIFESTATIONS OF OSTEOPOROTIC VERTEBRAL COMPRESSION FRACTURES Learn more about the Treatment of osteoporosis.<\/p>\n","protected":false},"featured_media":0,"template":"","oen_topic_chapter":[687],"class_list":["post-4422535","oen_topic","type-oen_topic","status-publish","hentry","oen_topic_chapter-parathyroid-gland","post-wrapper","thrv_wrapper"],"_links":{"self":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422535","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic"}],"about":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/types\/oen_topic"}],"version-history":[{"count":4,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422535\/revisions"}],"predecessor-version":[{"id":4422866,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic\/4422535\/revisions\/4422866"}],"wp:attachment":[{"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/media?parent=4422535"}],"wp:term":[{"taxonomy":"oen_topic_chapter","embeddable":true,"href":"https:\/\/myendoconsult.com\/learn\/wp-json\/wp\/v2\/oen_topic_chapter?post=4422535"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}