Resumen
Definición
Anamnesis y examen
Principales factores de diagnóstico
- asymptomatic
Otros factores de diagnóstico
- back pain
- kyphosis
- height loss
- vertebral tenderness
Factores de riesgo
- 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
- diabetes
- rheumatoid arthritis
- sarcopenia
- glucocorticoid excess
- corticosteroid use
- proton-pump inhibitor use
- hyperthyroidism
- heparin use
- anticonvulsant use
- androgen deprivation treatment (men)
- aromatase inhibitor treatment (women)
- use of drugs associated with an increased risk of falls
Pruebas diagnósticas
Primeras pruebas diagnósticas para solicitar
- dual-energy x-ray absorptiometry (DXA)-bone mineral density (BMD)
Pruebas diagnósticas que deben considerarse
- Fracture Risk Assessment Tool (FRAX)
- vertebral fracture assessment (DXA-VFA)
- trabecular bone score
- 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
Algoritmo de tratamiento
not glucocorticoid-induced: women
not glucocorticoid-induced: men
glucocorticoid-induced
Colaboradores
Autores
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
Divulgaciones
KS declares that he has no competing interests.
Alireza Zomorodian, MD
Research Associate
Charles and Jane Pak Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center
Dallas
TX
Divulgaciones
AZ declares that he has no competing interests.
Agradecimientos
Dr Khashayar Sakhaee and Dr Alireza Zomorodian 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.
Divulgaciones
AVCC declares that he has no competing interests. LL declares that she has no competing interests.
Revisores por pares
Kimberly Olson, MD
Internist
Veterans Administration Hospital
Minneapolis
MN
Divulgaciones
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
Divulgaciones
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.
Agradecimiento de los revisores por pares
Los temas de BMJ Best Practice se actualizan de forma continua de acuerdo con los desarrollos en la evidencia y en las guías. Los revisores por pares listados aquí han revisado el contenido al menos una vez durante la historia del tema.
Divulgaciones
Las afiliaciones y divulgaciones de los revisores por pares se refieren al momento de la revisión.
Referencias
Artículos principales
ACOG Committee on Clinical Practice Guidelines–Gynecology. Osteoporosis prevention, screening, and diagnosis: ACOG clinical practice guideline no. 1. Obstet Gynecol. 2021 Sep 1;138(3):494-506. Resumen
LeBoff MS, Greenspan SL, Insogna KL, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102.Texto completo Resumen
ACOG Committee on Clinical Practice Guidelines–Gynecology. Management of postmenopausal osteoporosis: ACOG clinical practice guideline no. 2. Obstet Gynecol. 2022 Apr 1;139(4):698-717. Resumen
Humphrey MB, Russell L, Danila MI, et al. 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis. Arthritis Rheumatol. 2023 Dec;75(12):2088-102.Texto completo Resumen
Eastell R, Rosen CJ, Black DM, et al. Pharmacological management of osteoporosis in postmenopausal women: an Endocrine Society* clinical practice guideline. J Clin Endocrinol Metab. 2019 May 1;104(5):1595-622.Texto completo Resumen
Artículos de referencia
Una lista completa de las fuentes a las que se hace referencia en este tema está disponible para los usuarios con acceso a todo BMJ Best Practice.
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Más DiferencialesGuías de práctica clínica
- Screening for osteoporosis to prevent fractures
- Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults
Más Guías de práctica clínicaFolletos para el paciente
Osteoporosis: what is it?
Osteoporosis: what are the treatment options?
Más Folletos para el paciente
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