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Osteoporosis

Last reviewed: 10 Oct 2024
Last updated: 19 Sep 2024

Summary

Definition

History and exam

Key diagnostic factors

  • asymptomatic
Full details

Other diagnostic factors

  • back pain
  • kyphosis
  • vertebral tenderness
Full details

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)
Full details

Diagnostic tests

1st tests to order

  • dual-energy x-ray absorptiometry (DXA)
Full details

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
Full details

Treatment algorithm

ONGOING

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.

  • Osteoporosis images
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  • Guidelines

    • Pharmacologic treatment of primary osteoporosis or low bone mass to prevent fractures in adults
    • 2022 American College of Rheumatology guideline for the prevention and treatment of glucocorticoid-induced osteoporosis​
    More Guidelines
  • Patient information

    Osteoporosis: what is it?

    Osteoporosis: what treatments work?

    More Patient information
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