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Osteoporose

  • 概述
  • 理论
  • 诊断
  • 治疗
  • 随访
  • 资源
最后审阅： 30 May 2025
最后更新： 15 Apr 2025

小结

定义

病史和体格检查

关键诊断因素

  • presença de fatores de risco
  • assintomático
完整详情

其他诊断因素

  • dorsalgia
  • cifose
  • perda de altura
  • dor à palpação vertebral
完整详情

危险因素

  • 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
完整详情

诊断性检查

首要检查

  • densidade mineral óssea (DMO) por absorciometria por dupla emissão de raios X (DEXA)
完整详情

需考虑的检查

  • 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
完整详情

治疗流程

持续性治疗

não induzida por glicocorticoides: mulheres

não induzida por glicocorticoides: homens

induzida por glicocorticoides

撰稿人

作者

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

利益声明

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

利益声明

AZ declares that he has no competing interests.

鸣谢

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.

利益声明

AVCC declares that he has no competing interests. LL declares that she has no competing interests.

同行评议者

Kimberly Olson, MD

Internist

Veterans Administration Hospital

Minneapolis

MN

利益声明

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

利益声明

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.

参考文献

Our in-house evidence and editorial teams collaborate with international expert contributors and peer reviewers to ensure that we provide access to the most clinically relevant information possible.

关键文献

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. 摘要

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.全文  摘要

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. 摘要

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.全文  摘要

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.全文  摘要

参考文献

A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
  • Osteoporose images

  • Differentials

    • Mieloma múltiplo
    • Osteomalácia
    • Doença renal crônica - distúrbio ósseo e mineral
    更多 Differentials

  • Guidelines

    • Screening for osteoporosis to prevent fractures
    • Evidence-based guideline for the management of osteoporosis in men
    更多 Guidelines

  • Patient information

    Dor no calcanhar (fasciite plantar)

    Osteoporose: o que é?

    More Patient information
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