eMedicine Specialties > Physical Medicine and Rehabilitation > Medical Diseases

Osteoporosis (Primary)

Author: Srinivas R Nalamachu, MD, Clinical Assistant Professor, Department of Internal Medicine, Kansas City University of Medicine and Biosciences; President and Medical Director, Internation Clinical Research Institute, Inc; Medical Director, Pain Management Institute
Coauthor(s): Shireesha Nalamasu, MD, Consulting Staff, Methodist Hospital, Indianapolis; Hospitalist, Respiratory and Critical Care Consultants, PC
Contributor Information and Disclosures

Updated: Sep 25, 2008

Introduction

Background

Osteoporosis is a systemic skeletal disease characterized by low bone mass and micro-architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to bone fracture.

Related Medscape topic:
Resource Center Osteoporosis

Related eMedicine topics:
Osteoporosis [Orthopedic Surgery]
Osteoporosis [Pediatrics: General Medicine]
Osteoporosis, Involutional
Osteoporosis (Secondary)

Pathophysiology

Bone tissue undergoes constant remodeling. Under the physiologic conditions, bone formation and resorption are in a fair balance. After the third decade of life, bone resorption exceeds bone formation and leads to osteopenia and, in severe situations, osteoporosis. Women lose 30-40% of their cortical bone and 50% of their trabecular bone over their lifetime, as opposed to men, who lose 15-20% of their cortical bone and 25-30% of trabecular bone.

Frequency

United States

According to the National Institutes of Health (NIH), more than 25 million people in the United States are affected by osteoporosis. Women make up 80% of this group.1

International

Osteoporosis is by far the most common metabolic bone disease in the world.

Mortality/Morbidity

  • Osteoporosis is the leading cause of fractures in the elderly. Women aged 50 years have a 40% lifetime fracture rate as a result of osteoporosis. Osteoporosis is associated with 80% of all the fractures in people aged 50 years or older.
  • More than 250,000 hip fractures are attributed to osteoporosis each year.2 Approximately 50% of patients who have had a hip fracture never recover fully, and data support an excess mortality rate of 20% within a year of the hip fracture.
  • According to a 2004 Surgeon General's report, osteoporosis and other bone diseases are responsible for about 1.5 million fractures per year. Osteoporosis-related fractures result in annual direct care expenditures of $12.2-$17.9 billion (in 2002 dollars).3

Race

White persons are at higher risk for osteoporosis than are people of other races.

Sex

Women are at a significantly higher risk for osteoporosis. In primary osteoporosis, the female-to-male ratio is 5:1.

Age

Although bone loss in women begins slowly, it speeds up around the time of menopause, typically at about or after age 50 years.

Clinical

History

A complete medical history should be obtained, including the patient's age and information on medical problems, medications, family history of osteoporosis, menarche and menopause, smoking history, and any recent fractures.4

  • Social factors
  • People who smoke are at a higher risk for osteoporosis.
  • A definite correlation has been observed between an increased risk of developing osteoporosis and a family history of the condition.
  • Sex
  • Postmenopausal women are at a high risk for osteoporosis. Women who have undergone a hysterectomy and an oophorectomy are at a higher risk for osteoporosis. They are also at risk of developing the disease earlier in life.
  • Men with hypogonadism secondary to any genetic or other conditions are at a higher risk for osteoporosis.
  • Medications
  • Glucocorticoids, heparin, cyclosporine, high-dose methotrexate, and high-dose medroxyprogesterone acetate can increase bone resorption, contributing to osteoporosis.
  • Certain studies have found an association between excess ingestion of vitamin A and an increased incidence of fractures.
  • Individuals taking systemic steroids for various diseases, such as chronic obstructive pulmonary disease (COPD), lupus, or rheumatoid arthritis, are at an increased risk for osteoporosis.
  • Persons taking selected anticonvulsants for a long duration are at an increased risk for osteoporosis.
  • Evidence suggests that there is an increased incidence of osteoporosis in people who are receiving thyroid supplements or heparin.
  • Patients with the following diseases are at an increased risk for osteopenia and osteoporosis:
    • Hyperthyroidism
    • Hyperparathyroidism
    • Inflammatory bowel disease
    • Celiac disease
    • Cystic fibrosis
    • Malnutrition
    • Chronic liver disease
  • Evidence suggests that cancer patients who have undergone chemotherapy are at a higher risk for osteoporosis.
  • European studies have shown that, compared with the general population, individuals with diabetes who are receiving long-term insulin therapy are at a higher risk for osteoporosis.
  • Immobility increases the risk for osteoporosis.5
    • Spinal cord injury and stroke cause physical impairment and are common causes of immobility.

Related Medscape topic:
Resource Center Menopause

Related eMedicine topic:
Osteoporosis and Spinal Cord Injury

Physical

The physical examination should focus on any loss of height, kyphosis, and the patient's overall stature.

Causes

Risk factors for osteoporosis include the following6,7,8 :

  • Race - Higher incidence in white persons
  • Age of 50 years or older
  • Early menopause and late menarche
  • Amenorrhea
  • Postmenopausal state
  • Thin build or small stature
  • Use of drugs
    • Anticonvulsants
    • Systemic steroids
    • Thyroid supplements
    • Heparin
    • Chemotherapeutic agents
    • Insulin
  • Genetic factors, such as a family history of osteoporosis
  • Environmental factors
    • Smoking
    • Immobilization5

More on Osteoporosis (Primary)

Overview: Osteoporosis (Primary)
Differential Diagnoses & Workup: Osteoporosis (Primary)
Treatment & Medication: Osteoporosis (Primary)
Follow-up: Osteoporosis (Primary)
References
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References

  1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. Jun 1993;94(6):646-50. [Medline].

  2. Cummings SR, Nevitt MC, Browner WS, et al. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. Mar 23 1995;332(12):767-73. [Medline]. [Full Text].

  3. Bone Health and Osteoporosis: A Report of the Surgeon General. Washington, DC: Department of Health and Human Services; 2004. [Full Text].

  4. Geusens P, Dumitrescu B, van Geel T, et al. Impact of systematic implementation of a clinical case finding strategy on diagnosis and therapy of postmenopausal osteoporosis. J Bone Miner Res. Feb 5 2008;[Medline].

  5. Sinaki M. Exercise and osteoporosis. Arch Phys Med Rehabil. Mar 1989;70(3):220-9. [Medline].

  6. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1-129. [Medline].

  7. Lyles KW, Schenck AP, Colón-Emeric CS. Hip and other osteoporotic fractures increase the risk of subsequent fractures in nursing home residents. Osteoporos Int. Feb 27 2008;[Medline].

  8. Fink HA, Kuskowski MA, Taylor BC, et al. Association of Parkinson's disease with accelerated bone loss, fractures and mortality in older men: the Osteoporotic Fractures in Men (MrOS) study. Osteoporos Int. Feb 27 2008;[Medline].

  9. Liu JM, Zhao HY, Ning G, et al. IGF-1 as an early marker for low bone mass or osteoporosis in premenopausal and postmenopausal women. J Bone Miner Metab. 2008;26(2):159-64. [Medline].

  10. Gosfield E 3rd, Bonner FJ Jr. Evaluating bone mineral density in osteoporosis. Am J Phys Med Rehabil. May-Jun 2000;79(3):283-91. [Medline].

  11. Clinician's Guide to Prevention and Treatment of Osteoporosis. Washington, DC: National Osteoporosis Foundation; 2008. [Full Text].

  12. Curtis J, Carbone L, Cheng H, et al. Longitudinal trends in use of bone mass measurement among older Americans, 1999-2005. J Bone Miner Res. Feb 26 2008;[Medline].

  13. Sinaki M. Postmenopausal spinal osteoporosis: physical therapy and rehabilitation principles. Mayo Clin Proc. Nov 1982;57(11):699-703. [Medline].

  14. Tinetti ME, Speechley M. Prevention of falls among the elderly. N Engl J Med. Apr 20 1989;320(16):1055-9. [Medline].

  15. Sinaki M, Mikkelsen BA. Postmenopausal spinal osteoporosis: flexion versus extension exercises. Arch Phys Med Rehabil. Oct 1984;65(10):593-6. [Medline].

  16. Cook DJ, Guyatt GH, Adachi JD, et al. Quality of life issues in women with vertebral fractures due to osteoporosis. Arthritis Rheum. Jun 1993;36(6):750-6. [Medline].

  17. Canalis E. New treatments in osteoporosis. Bone. Sep 2001;29(3):296.

  18. NIH consensus conference. Optimal calcium intake. NIH Consensus Development Panel on Optimal Calcium Intake. JAMA. Dec 28 1994;272(24):1942-8. [Medline].

  19. Hulley SB, Grady D. The WHI estrogen-alone trial--do things look any better?. JAMA. Apr 14 2004;291(14):1769-71. [Medline]. [Full Text].

  20. Kirshblum SC. Spinal and upper extremity orthotics. In: DeLisa JA, Gans BM, eds. Rehabilitation Medicine: Principles and Practice. 3rd ed. Philadelphia, Pa: Lippincott-Raven; 1998:635-50.

  21. Stillo JV. Low back orthoses. Phys Med Rehab Clin North Am. 1992;3:57-94.

  22. Riggs BL, Melton LJ 3rd. The prevention and treatment of osteoporosis. N Engl J Med. Aug 27 1992;327(9):620-7. [Medline].

  23. Iwamoto J, Sato Y, Uzawa M, et al. Comparison of effects of alendronate and raloxifene on lumbar bone mineral density, bone turnover, and lipid metabolism in elderly women with osteoporosis. Yonsei Med J. Feb 2008;49(1):119-28. [Medline].

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Further Reading

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Keywords

osteoporosis, primary osteoporosis, bone density, bone loss, bone density test, secondary osteoporosis, osteoporosis treatment, osteoporosis therapy, metabolic bone disorder, metabolic bone disease, bone mass, osteopenia, bisphosphonates, vitamin D, calcium, calcium carbonate, calcium supplement, calcitonin, osteoporosis calcium, osteoporosis medication, osteoporosis exercises, osteoporosis vitamin, densitometry

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Contributor Information and Disclosures

Author

Srinivas R Nalamachu, MD, Clinical Assistant Professor, Department of Internal Medicine, Kansas City University of Medicine and Biosciences; President and Medical Director, Internation Clinical Research Institute, Inc; Medical Director, Pain Management Institute
Srinivas R Nalamachu, MD is a member of the following medical societies: American Academy of Pain Management, American Pain Society, and International Association for the Study of Pain
Disclosure: Nothing to disclose.

Coauthor(s)

Shireesha Nalamasu, MD, Consulting Staff, Methodist Hospital, Indianapolis; Hospitalist, Respiratory and Critical Care Consultants, PC
Shireesha Nalamasu, MD is a member of the following medical societies: American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Robert J Kaplan, MD, Associate Professor, Department of Physical Medicine and Rehabilitation, University of Kansas School of Medicine and Medical Center
Robert J Kaplan, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, International Spine Intervention Society, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Richard Salcido, MD, Chairman, Erdman Professor of Rehabilitation, Department of Physical Medicine and Rehabilitation, University of Pennsylvania School of Medicine
Richard Salcido, MD is a member of the following medical societies: American Academy of Pain Medicine, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Medical Association, and American Paraplegia Society
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Regional Medical Director, IMX-Medical Management Services
Disclosure: Nothing to disclose.

Chief Editor

Denise I Campagnolo, MD, MS, Director of Multiple Sclerosis Clinical Research and Staff Physiatrist, Barrow Neurology Clinics, St. Joseph's Hospital and Medical Center; Investigator for Barrow Neurology Clinics; Director, NARCOMS Project for Consortium of MS Centers, Phoenix
Denise I Campagnolo, MD, MS is a member of the following medical societies: Alpha Omega Alpha, American Association of Neuromuscular and Electrodiagnostic Medicine, American Paraplegia Society, Association of Academic Physiatrists, and Consortium of Multiple Sclerosis Centers
Disclosure: Teva Neuroscience Honoraria Speaking and teaching; Serono-Pfizer Honoraria Speaking and teaching

 
 
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