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For further information, see CMDT Part 26-19: Osteoporosis

Key Features

Essentials of Diagnosis

  • Fracture propensity of spine, hip, pelvis, and wrist from depletion of bone matrix with subsequent demineralization

  • 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

  • Most common causes

    • Aging

    • Sex hormone deficiency

    • Alcohol use disorder

    • Cigarette smoking

    • Long-term proton pump inhibitor therapy

    • High-dose glucocorticoid administration

    • See Table 26–10

  • Vertebral fractures are the most common fracture; they are usually diagnosed incidentally on radiographs or CT scanning

  • Largely due to a reduction in smoking, the age-adjusted risk for hip fracture has declined in the United States in recent years

  • However, the risk for fragility fractures remains high and varies with ethnicity, sex, and age

Table 26–10.Causes of osteoporosis.1
Table 26–11.Causes of osteomalacia.1


  • Causes over 1.5 million fractures annually in the United States, most commonly vertebral fractures, followed by hip fractures (300,000 annually) and pelvic fractures

  • Prevalence of vertebral fractures in women older than 65 years is

    • 70% for White women

    • 68% for Japanese women

    • 55% for Mexican women

    • 50% ...

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