Summary
Definition
History and exam
Key diagnostic factors
- presença de fatores de risco
- assintomático
Other diagnostic factors
- dorsalgia
- cifose
- perda de altura
- dor à palpação vertebral
Risk factors
- fratura prévia por fragilidade
- sexo feminino
- ascendência branca
- idade avançada (>50 anos para as mulheres e >65 anos para os homens)
- baixo índice de massa corporal (IMC)
- perda de altura
- história familiar de fratura do quadril maternal
- pós-menopausa
- amenorreia secundária
- hipogonadismo primário
- tabagismo
- uso excessivo de bebidas alcoólicas
- imobilização prolongada
- baixa ingestão de cálcio
- deficiência de vitamina D
- diabetes
- artrite reumatoide
- sarcopenia
- excesso de glicocorticoides
- uso de corticosteroide
- uso de inibidor da bomba de prótons
- hipertireoidismo
- uso de heparina
- uso de anticonvulsivante
- tratamento de privação de androgênio (homens)
- tratamento com inibidor da aromatase (mulheres)
- uso de medicamentos associados ao aumento do risco de quedas
Diagnostic tests
1st tests to order
- densidade mineral óssea (DMO) por absorciometria por dupla emissão de raios X (DEXA)
Tests to consider
- Ferramenta de Avaliação do Risco de Fraturas (FRAX)
- avaliação da fratura vertebral (DEXA-AFV)
- escore ósseo trabecular
- ultrassonografia quantitativa (USQ) do calcanhar
- raio-X (punho, calcanhar, coluna e quadril)
- tomografia computadorizada (TC) quantitativa
- marcadores bioquímicos de reabsorção e formação óssea
- fosfatase alcalina sérica
- cálcio sérico
- albumina sérica
- creatinina sérica
- fosfato sérico
- níveis séricos de 25-hidroxivitamina D
- paratormônio sérico
- testes da função tireoidiana
- cortisol livre urinário
- testosterona sérica (homens)
- eletroforese de proteínas urinárias
- eletroforese de proteínas séricas
Treatment algorithm
não induzida por glicocorticoides: mulheres
não induzida por glicocorticoides: homens
induzida por glicocorticoides
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.
Alireza Zomorodian, MD
Research Associate
Charles and Jane Pak Center for Mineral Metabolism and Clinical Research
UT Southwestern Medical Center
Dallas
TX
Disclosures
AZ declares that he has no competing interests.
Acknowledgements
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.
Disclosures
AVCC declares that he has no competing interests. 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.
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.
Differentials
- Mieloma múltiplo
- Osteomalácia
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