Resumo
Definição
História e exame físico
Principais fatores diagnósticos
- presencia de factores de riesgo
- asintomático
Outros fatores diagnósticos
- dolor de espalda
- cifosis
- pérdida de altura
- sensibilidad vertebral
Fatores de risco
- fractura por fragilidad previa
- sexo femenino
- linaje de raza blanca
- edad avanzada (>50 años en mujeres y >65 años en hombres)
- índice de masa corporal (IMC) bajo
- pérdida de peso
- antecedentes familiares maternos de fractura de cadera
- posmenopausia
- amenorrea secundaria
- hipogonadismo primario
- tabaquismo
- consumo excesivo de alcohol
- inmovilización prolongada
- ingesta de calcio reducida
- deficiencia de vitamina D
- diabetes
- artritis reumatoide
- sarcopenia
- exceso de glucocorticoides
- uso de corticosteroides
- uso de inhibidores de la bomba de protones
- hipertiroidismo
- uso de heparina
- uso de anticonvulsivos
- tratamiento de privación de andrógenos (hombres)
- tratamiento inhibidor de la aromatasa (mujeres)
- uso de fármacos asociados con un mayor riesgo de caídas
Investigações diagnósticas
Primeiras investigações a serem solicitadas
- exploración por radioabsorciometría de doble energía (DEXA) de la densidad mineral ósea (DMO)
Investigações a serem consideradas
- Fracture Risk Assessment Tool (FRAX)
- evaluación de fracturas vertebrales (DEXA-EFV)
- puntaje óseo trabecular
- ultrasonido cuantitativo (QUS) de calcáneo
- radiografía (muñeca, calcáneo, columna y cadera)
- tomografía computarizada (TC) cuantitativa
- marcadores bioquímicos de resorción ósea y formación ósea
- fosfatasa alcalina en suero
- calcio sérico
- albúmina sérica
- creatinina sérica
- fosfato sérico
- 25-hidroxivitamina D sérica
- hormona paratiroidea sérica
- pruebas de función tiroidea
- cortisol libre urinario
- testosterona en suero (hombres)
- electroforesis de proteínas en orina
- electroforesis de proteínas séricas
Algoritmo de tratamento
no inducida por glucocorticoides: mujeres
no inducida por glucocorticoides: hombres
inducida por glucocorticoides
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
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
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.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
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. Abstract
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.Full text Abstract
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. Abstract
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.Full text Abstract
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.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
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