eMedicine Specialties > Rheumatology > Metabolic and Bone Disease

Osteoporosis: Follow-up

Author: Dana Jacobs-Kosmin, MD, Attending Physician, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center; Clinical Assistant Professor of Medicine, Jefferson Medical College
Coauthor(s): Coburn Hobar, MD, Clinician in Rheumatology, Hobar Health and Wellness, and Anti-Aging & Wellness Center of Sarasota; Sucharitha Shanmugam, MD, Consulting Physician, PMA Medical Specialists, Limerick, PA
Contributor Information and Disclosures

Updated: Sep 30, 2009

Follow-up

Further Outpatient Care

DXA should be repeated every 2-3 years if the baseline test results are normal. DXA should be performed every 1-2 years in patients who are undergoing osteoporosis treatment.

Deterrence/Prevention

Primary prevention of osteoporosis starts in childhood. Patients require adequate calcium intake, vitamin D intake, and weight-bearing exercise. Patients should be counseled on smoking cessation and moderated alcohol intake. Patients who have disorders or who take medications that can cause or accelerate bone loss should receive calcium and vitamin D supplementation (see Causes).

Complications

The most serious consequences of osteoporosis include fractures and, in some patients, death due to postfracture complications.

Respiratory compromise can occur in patients with multiple vertebral fractures that result in severe kyphosis.

Prognosis

If full recovery is not achieved, osteoporotic fractures may lead to chronic pain, disability, and, in some cases, death.

Patient Education

Miscellaneous

Medicolegal Pitfalls

Osteoporosis is a preventable disease with potentially devastating consequences. Failure to identify at-risk patients, to educate them, and to implement preventive measures may lead to tragic consequences.

Special Concerns

  • Recognize the increased mortality and morbidity associated with osteoporotic fractures.
  • Many patients have a coexisting cause of bone loss. This should be investigated and treated.
  • WHO criteria for T-scores should not be applied to premenopausal women, men younger than 50 years old, and children. Z-scores should be used for these individuals, and, in these cases, a diagnosis of osteoporosis should not be based on densitometric criteria alone.
 


More on Osteoporosis

Overview: Osteoporosis
Differential Diagnoses & Workup: Osteoporosis
Treatment & Medication: Osteoporosis
Follow-up: Osteoporosis
Multimedia: Osteoporosis
References
Further Reading
[ CLOSE WINDOW ]

References

  1. Bono CM, Einhorn TA. Overview of osteoporosis: pathophysiology and determinants of bone strength. Eur Spine J. Oct 2003;12 Suppl 2:S90-6. [Medline].

  2. Raisz LG. Pathogenesis of osteoporosis: concepts, conflicts, and prospects. J Clin Invest. Dec 2005;115(12):3318-25. [Medline].

  3. Seeman E, Delmas PD. Bone quality--the material and structural basis of bone strength and fragility. N Engl J Med. May 25 2006;354(21):2250-61. [Medline].

  4. Mora S, Gilsanz V. Establishment of peak bone mass. Endocrinol Metab Clin North Am. Mar 2003;32(1):39-63. [Medline].

  5. Ringe JD, Farahmand P. Advances in the management of corticosteroid-induced osteoporosis with bisphosphonates. Clin Rheumatol. Apr 2007;26(4):474-84. [Medline].

  6. Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures. Lancet. May 18 2002;359(9319):1761-7. [Medline].

  7. National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. Available at http://www.nof.org/professionals/Clinicians_Guide.htm. Accessed May 5, 2008.

  8. Cooper C, Campion G, Melton LJ 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. Nov 1992;2(6):285-9. [Medline].

  9. Who are candidates for prevention and treatment for osteoporosis?. Osteoporos Int. 1997;7(1):1-6. [Medline].

  10. International Osteoporosis Foundation. Facts and statistics about osteoporosis and its impact. I. Available at http://www.iofbonehealth.org/facts-and-statistics.html. Accessed May 5, 2008.

  11. Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-13. [Medline].

  12. Burge R, Dawson-Hughes B, Solomon DH, et al. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005-2025. J Bone Miner Res. Mar 2007;22(3):465-75. [Medline].

  13. Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. May 1 1993;137(9):1001-5. [Medline].

  14. Vestergaard P, Rejnmark L, Mosekilde L. Increased mortality in patients with a hip fracture-effect of pre-morbid conditions and post-fracture complications. Osteoporos Int. Dec 2007;18(12):1583-93. [Medline].

  15. Michel JP, Hoffmeyer P, Klopfenstein C, et al. Prognosis of functional recovery 1 year after hip fracture: typical patient profiles through cluster analysis. J Gerontol A Biol Sci Med Sci. Sep 2000;55(9):M508-15. [Medline].

  16. Klotzbuecher CM, Ross PD, Landsman PB, et al. Patients with prior fractures have an increased risk of future fractures: a summary of the literature and statistical synthesis. J Bone Miner Res. Apr 2000;15(4):721-39. [Medline].

  17. Cooper C, Atkinson EJ, Jacobsen SJ, et al. Population-based study of survival after osteoporotic fractures. Am J Epidemiol. May 1 1993;137(9):1001-5. [Medline].

  18. Cooper C, Atkinson EJ, O'Fallon WM, et al. Incidence of clinically diagnosed vertebral fractures: a population-based study in Rochester, Minnesota, 1985-1989. J Bone Miner Res. Feb 1992;7(2):221-7. [Medline].

  19. Lindsay R, Silverman SL, Cooper C, et al. Risk of new vertebral fracture in the year following a fracture. JAMA. Jan 17 2001;285(3):320-3. [Medline].

  20. Smith R, Wordsworth P. Osteoporosis. In: Clinical and Biochemical Disorders of the Skeleton. 2005:123.

  21. [Guideline] American Association of Clinical Endocrinologists medical guidelines for clinical practice for the prevention and treatment of postmenopausal osteoporosis: 2001 edition, with selected updates for 2003. Endocr Pract. Nov-Dec 2003;9(6):544-64. [Medline].

  22. Kelman A, Lane NE. The management of secondary osteoporosis. Best Pract Res Clin Rheumatol. Dec 2005;19(6):1021-37. [Medline].

  23. van Staa TP, Leufkens HG, Cooper C. The epidemiology of corticosteroid-induced osteoporosis: a meta-analysis. Osteoporos Int. Oct 2002;13(10):777-87. [Medline].

  24. The World Health Organization Fracture Risk Assessment Tool. Available at http://www.shef.ac.uk/FRAX/. Accessed May 5, 2008.

  25. The International Society for Clinical Densitometry. 2007 ISCD Official Positions Brochure. Available at http://www.iscd.org/Visitors/positions/OfficialPositionsText.cfm. Accessed May 5, 2008.

  26. Resnick D, Kransdorf M. Osteoporosis. In: Bone and Joint Imaging. Third Edition. 2005:551.

  27. [Best Evidence] Bischoff-Ferrari HA, Willett WC, Wong JB, Stuck AE, Staehelin HB, Orav EJ, et al. Prevention of nonvertebral fractures with oral vitamin D and dose dependency: a meta-analysis of randomized controlled trials. Arch Intern Med. Mar 23 2009;169(6):551-61. [Medline].

  28. [Best Evidence] Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. Aug 25 2007;370(9588):657-66. [Medline].

  29. [Guideline] Qaseem A, Snow V, Shekelle P, Hopkins R Jr, Forciea MA, Owens DK. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med. Sep 16 2008;149(6):404-15. [Medline].

  30. Rossouw JE, Anderson GL, Prentice RL, et al. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: principal results From the Women's Health Initiative randomized controlled trial. JAMA. Jul 17 2002;288(3):321-33. [Medline].

  31. [Best Evidence] Bouxsein ML, Chen P, Glass EV, Kallmes DF, Delmas PD, Mitlak BH. Teriparatide and raloxifene reduce the risk of new adjacent vertebral fractures in postmenopausal women with osteoporosis. Results from two randomized controlled trials. J Bone Joint Surg Am. Jun 2009;91(6):1329-38. [Medline].

  32. Keen R. Osteoporosis: strategies for prevention and management. Best Pract Res Clin Rheumatol. Feb 2007;21(1):109-22. [Medline].

  33. [Best Evidence] Black DM, Delmas PD, Eastell R, et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med. May 3 2007;356(18):1809-22. [Medline].

  34. Chaiamnuay S, Saag KG. Postmenopausal osteoporosis. What have we learned since the introduction of bisphosphonates?. Rev Endocr Metab Disord. Jun 2006;7(1-2):101-12. [Medline].

  35. Finkelstein JS, Klibanski A, Arnold AL, et al. Prevention of estrogen deficiency-related bone loss with human parathyroid hormone-(1-34): a randomized controlled trial. JAMA. Sep 23-30 1998;280(12):1067-73. [Medline].

  36. Holick MF. Vitamin D deficiency. N Engl J Med. Jul 19 2007;357(3):266-81. [Medline].

  37. Kenny AM, Prestwood KM. Osteoporosis. Pathogenesis, diagnosis, and treatment in older adults. Rheum Dis Clin North Am. Aug 2000;26(3):569-91. [Medline].

  38. Lane NE. An update on glucocorticoid-induced osteoporosis. Rheum Dis Clin North Am. Feb 2001;27(1):235-53. [Medline].

  39. Lim PA, Brander VA, Kaelin DL, et al. Rehabilitation of orthopedic and rheumatologic disorders. 1. Osteoporosis. Arch Phys Med Rehabil. Mar 2000;81(3 Suppl 1):S55-9; quiz S78-86. [Medline].

  40. Mulder JE, Kolatkar NS, LeBoff MS. Drug insight: Existing and emerging therapies for osteoporosis. Nat Clin Pract Endocrinol Metab. Dec 2006;2(12):670-80. [Medline].

  41. Sambrook PN, Dequeker J, Rasp HH. Osteoporosis. In: Klipper JH, Dieppe PA, eds. Rheumatology. 2nd ed. London, UK: Mosby-Year Book; 1998:8.

  42. Schwarz EM, Ritchlin CT. Clinical development of anti-RANKL therapy. Arthritis Res Ther. 2007;9 Suppl 1:S7. [Medline].

  43. Strampel W, Emkey R, Civitelli R. Safety considerations with bisphosphonates for the treatment of osteoporosis. Drug Saf. 2007;30(9):755-63. [Medline].

  44. Watts NB. Treatment of osteoporosis with bisphosphonates. Rheum Dis Clin North Am. Feb 2001;27(1):197-214. [Medline].

  45. [Best Evidence] Cummings SR, San Martin J, McClung MR, Siris ES, Eastell R, Reid IR, et al. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med. Aug 20 2009;361(8):756-65. [Medline].

  46. [Best Evidence] Smith MR, Egerdie B, Hernández Toriz N, Feldman R, Tammela TL, Saad F, et al. Denosumab in men receiving androgen-deprivation therapy for prostate cancer. N Engl J Med. Aug 20 2009;361(8):745-55. [Medline].

[ CLOSE WINDOW ]

Keywords

osteoporosis, type 1 osteoporosis, type 2 osteoporosis, postmenopausal osteoporosis, senile osteoporosis, primary osteoporosis, secondary osteoporosis, osteoporotic fracture, hip fracture, PMO, male osteoporosis, bisphosphonates, bone loss, brittle bones, dowager hump, dual-energy x-ray absorptiometry, DXA, estrogen deficiency, fragile bones, fragility fracture, hormone replacement therapy, HRT, hypogonadism, low bone mass, osteoblasts, osteoclasts, osteocytes, osteopenia, raloxifene, receptor activator nuclear factor-kappa B ligand, RANK, RANKL, secondary hyperparathyroidism, thin bones, vertebral compression fracture, vertebral fracture assessment, VFA, vitamin D deficiency

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Dana Jacobs-Kosmin, MD, Attending Physician, Department of Medicine, Division of Rheumatology, Albert Einstein Medical Center; Clinical Assistant Professor of Medicine, Jefferson Medical College
Dana Jacobs-Kosmin, MD is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Coauthor(s)

Coburn Hobar, MD, Clinician in Rheumatology, Hobar Health and Wellness, and Anti-Aging & Wellness Center of Sarasota
Coburn Hobar, MD is a member of the following medical societies: American Academy of Anti-Aging Medicine and American College of Rheumatology
Disclosure: Nothing to disclose.

Sucharitha Shanmugam, MD, Consulting Physician, PMA Medical Specialists, Limerick, PA
Sucharitha Shanmugam, MD is a member of the following medical societies: American College of Rheumatology
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Elliot Goldberg, MD, Dean of the Western Pennsylvania Clinical Campus, Professor, Department of Medicine, Temple University School of Medicine
Elliot Goldberg, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, and American College of Rheumatology
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Associate Dean for Undergraduate Medical Education, Associate Professor of Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Herbert S Diamond, MD, Professor of Medicine, Temple University School of Medicine; Chairman Emeritus, Department of Internal Medicine, Western Pennsylvania Hospital
Herbert S Diamond, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, American College of Rheumatology, American Medical Association, and Phi Beta Kappa
Disclosure: medifocus Honoraria Review panel membership; health dialogs Honoraria Consulting; West Penn Allegheny Health System None Board membership

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.