Summary
Definition
History and exam
Key diagnostic factors
- asymptomatic
Other diagnostic factors
- back pain
- kyphosis
- height loss
- 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
- 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
Diagnostic tests
1st tests to order
- dual-energy x-ray absorptiometry (DXA)-bone mineral density (BMD)
Tests to consider
- 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
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
Declarações
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
Declarações
AZ declares that he has no competing interests.
Agradecimentos
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.
Declarações
AVCC declares that he has no competing interests. LL declares that she has no competing interests.
Revisores
Kimberly Olson, MD
Internist
Veterans Administration Hospital
Minneapolis
MN
Declarações
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
Declarações
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.
Créditos aos pareceristas
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Declarações
As afiliações e declarações dos pareceristas referem--se ao momento da revisão.
Referências
Principais artigos
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. Resumo
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 Resumo
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. Resumo
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 Resumo
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 Resumo
Artigos de referência
Uma lista completa das fontes referenciadas neste tópico está disponível para os usuários com acesso total ao BMJ Best Practice.
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