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For further information, see CMDT Part 26-18: Osteoporosis

Key Features

Essentials of Diagnosis

  • Fracture propensity of spine, hip, pelvis, and wrist

  • Asymptomatic until a fracture has occurred

  • Serum PTH, calcium, phosphorus, and alkaline phosphatase usually normal

  • Serum 25-hydroxyvitamin D levels often low as a comorbid condition

General Considerations

  • Causes over 1.5 million fractures annually in the United States

  • Most common causes

    • Aging

    • Sex hormone deficiency

    • Alcoholism

    • Smoking

    • Long-term proton pump inhibitor therapy

    • High-dose glucocorticoid administration

    • See Table 26–9

Table 26–9.Causes of osteoporosis.1
Table 26–10.Causes of osteomalacia.1


  • Clinically evident in middle life and beyond

  • Develops frequently in hypogonadal men

  • White women aged ≥ 50 years (who do not receive estrogen replacement) have a 46% risk of sustaining an osteoporotic fracture during their lives

Clinical Findings

Symptoms and Signs

  • Usually asymptomatic until fractures occur

  • May present as back pain of varying degrees of severity or as spontaneous fracture or collapse of a vertebra

  • Loss of height common

  • Fractures of femoral neck and distal radius also common

  • Once osteoporosis is identified, careful history and physical examination are required to determine its cause

Differential Diagnosis


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