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Essentials of Diagnosis

  • Osteoporosis is a systemic skeletal disease characterized by low bone mass and microarchitectural deterioration of the bone tissue, with a consequent increase in bone fragility and susceptibility to fracture.

  • Osteoporosis is more common in women than in men, although the incidence among men is increasing.

  • The prevalence of osteoporosis and osteoporotic fractures increases with age.

General Principles in Older Adults

Osteoporosis is a skeletal disorder characterized by compromised bone strength, resulting in bone fragility and susceptibility to fractures. Bone strength is a function of bone mineral density (BMD) and bone quality. Bone quality refers to the architecture, bone turnover, damage accumulation, and mineralization occurring at the bony matrix. Bone mass is assessed with the use of bone density measurements; ie, dual x-ray absorptiometry (DXA), but currently there is no way to measure bone quality in a quantitative and comparable way.

Osteoporosis is a disease with its origin in childhood. Although genetic factors primarily account for peak bone mass, environmental factors such as nutrition and exercise can alter the genetically determined pattern of skeletal growth. At present, not enough is known about the genetics of osteoporosis to influence clinical decision making. However, it is known that illness and medications during a person’s lifetime can impact the accrual of peak mass such that individuals start at a lower peak bone mass. Modulation of peak bone mass can even occur during intrauterine life and is affected by maternal nutrition, smoking, and level of exercise. During adulthood, bone tends to have a steady state of formation and resorption with a stable bone mass. For women, menopause marks the start of increased bone resorption. For most older adults bone resorption exceeds bone formation, with acceleration of the process caused by medical illness and medications.

Older adults are particularly susceptible to the adverse outcomes attributed to osteoporosis. Comorobidities, such as cognitive and gait impairments, which are more prevalent as a patient gets older, predisposes the individual to falls and the development of fragility fractures.

According to the National Osteoporosis Foundation, the United States has some 52 million individuals with low bone mass: 9 million with osteoporosis and 43 million with osteopenia. The prevalence of osteoporosis and osteopenia increases with age for both men and women. With the growth in the geriatric population as a consequence of the coming of age of the baby boomers, the prevalence of osteoporosis and fractures is expected to increase exponentially.

An estimated 1.5 million fragility fractures occur in the United States each year. Approximately 50% of women and 20% of men older than age 50 years will have a fragility fracture in their remaining lifetime, with potentially devastating results. In general, osteoporotic fragility fractures involve the hip, vertebral, and wrist fractures. However, the effect of osteoporosis on the skeleton is systemic and there is an increased risk of almost all types of ...

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