Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
Other diagnostic factors
- back pain
- kyphosis
- vertebral tenderness
Risk factors
- prior fragility fracture
- female sex
- white ancestry
- older age (>50 years for women and >65 years for men)
- low BMI
- loss of height
- family history of maternal hip fracture
- postmenopause
- secondary amenorrhea
- primary hypogonadism
- tobacco use
- excessive alcohol use
- prolonged immobilization
- low calcium intake
- vitamin D deficiency
- glucocorticoid excess
- corticosteroid use
- proton-pump inhibitors
- hyperthyroidism
- heparin use
- anticonvulsant use
- androgen deprivation treatment (men)
- aromatase inhibitor treatment (women)
Diagnostic tests
1st tests to order
- dual-energy x-ray absorptiometry (DXA)
Tests to consider
- Fracture Risk Assessment Tool (FRAX)
- quantitative ultrasound (QUS) of the heel
- x-ray (wrist, heel, spine, and hip)
- quantitative CT
- biochemical markers of bone resorption and bone formation
- serum alkaline phosphatase
- serum calcium
- serum albumin
- serum creatinine
- serum phosphate
- serum 25-hydroxy vitamin D
- serum parathyroid hormone
- thyroid function tests
- urinary free cortisol
- serum testosterone (men)
- urine protein electrophoresis
- serum protein electrophoresis
Treatment algorithm
not glucocorticoid-induced: women
not glucocorticoid-induced: men
glucocorticoid-induced
Contributors
Authors
Khashayar Sakhaee, MD
Professor in Internal Medicine
Division Chief of Mineral Metabolism
Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center at Dallas
Dallas
TX
Disclosures
KS declares that he has no competing interests.
Acknowledgements
Dr Khashayar Sakhaee would like to gratefully acknowledge Dr Alberto V Cabo-Chan Jr and Dr Lisa Leinau, the previous contributors to this topic. AVCC and LL declare that they have no competing interests.
Disclosures
LL declares that she has no competing interests.
Peer reviewers
Kimberly Olson, MD
Internist
Veterans Administration Hospital
Minneapolis
MN
Disclosures
KO declares that she has no competing interests.
David Reid, MBBS
Head of Division of Applied Medicine & Professor of Rheumatology
School of Medicine & Dentistry
University of Aberdeen
Aberdeen
UK
Disclosures
DMR has attended meetings sponsored by or been paid speaker fees by Amgen, Merck, Novartis, Procter & Gamble, Roche, and Servier. He has been a paid advisor to Amgen, Merck, Novartis, Procter & Gamble, Roche, Servier, and Shire Pharmaceuticals. He has undertaken research studies funded by Amgen, Merck, Novartis, Procter & Gamble, and Roche.
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