Osteoporosis Questions & Answers

Updated: Jun 27, 2019
  • Author: Monique Bethel, MD; Chief Editor: Herbert S Diamond, MD  more...
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Questions & Answers

Overview

What is osteoporosis?

What are the signs and symptoms of vertebral fractures due to osteoporosis?

What are the signs and symptoms of hip fracture due to osteoporosis?

What are the physical findings of vertebral compression fractures due to osteoporosis?

What are physical findings of hip fractures in patients with osteoporosis?

What are signs of Colles fractures in patients with osteoporosis?

What are the signs of pubic and sacral fractures in patients with osteoporosis?

Which lab studies are included in the workup of osteoporosis?

When is bone mineral density (BMD) measurement indicated for screening and diagnosis of osteoporosis?

What is a dual-energy x-ray absorptiometry (DXA) T-score and how is it defined?

What is the role of dual-energy x-ray absorptiometry (DXA) Z-scores in the diagnosis of osteoporosis?

What are the benefits of performing quantitative calcaneal ultrasonography during the workup of osteoporosis?

What are the NOF recommendations for vertebral imaging for osteoporosis?

What is the role of radiography in the diagnosis of osteoporosis?

Which lifestyle modifications prevent osteoporotic fractures?

What are the NOF recommendations for pharmacologic therapy in the treatment of osteoporosis?

What are the AACE recommendations for drug selection in the treatment of osteoporosis?

What are the American College of Rheumatology (ACR) guidelines for the treatment of glucocorticoid-induced osteoporosis?

How are the underlying causes of osteoporosis treated?

How does the WHO define osteoporosis?

How common is osteoporosis and who is at highest risk?

What causes osteoporosis?

What is the effect of osteoporosis on quality of life?

Why is osteoporosis often overlooked and undertreated?

What are the treatment options for osteoporosis?

What steps can be taken to lessen the impact of osteoporosis?

What is bone mineral density (BMD)?

What is known regarding the pathophysiology of osteoporosis?

How does bone remodeling and formation normally occur?

What is the difference between dense cortical bone and spongy trabecular or cancellous bone?

What is the role of osteoclasts in the pathogenesis of osteoporosis?

Why does rapid bone remodeling result in an increased risk of osteoporosis and fracture?

What is the role of receptor activator of nuclear factor-kappa B ligand (RANKL) and receptor activator of nuclear factor-kappa B (RANK) in the pathogenesis of osteoporosis?

Which factors affect bone mass and bone strength?

What is the pathogenesis of osteoporosis?

What is the role of estrogen deficiency in the pathogenesis of osteoporosis?

What is the role of aging in age the pathogenesis of osteoporosis?

What is the role of calcium and vitamin D deficiency in the pathogenesis of osteoporosis?

How do osteoporotic fractures occur?

How does osteoporosis affect vertebral bodies?

What causes trabecular fracture in patients with osteoporosis?

What is the difference between osteoporosis and osteomalacia?

What is the role of Wnt signaling in the pathogenesis of osteoporosis?

Which endocrinologic conditions or medications may cause osteoporosis?

What are lesser known factors in the pathogenesis of osteoporosis?

Which prenatal and postnatal factors increase the risk for osteoporosis in older adults?

How is osteoporosis classified?

What are the types of primary osteoporosis?

What causes secondary osteoporosis?

What are the risk factors for osteoporosis?

What is the mnemonic for osteoporotic risk factors?

What is the prevalence of osteoporosis in the US?

What is the global prevalence of osteoporosis?

How does the incidence of osteoporosis differ among age groups?

How does the prevalence of osteoporosis differ between males and females?

How does the incidence of osteoporosis differ among racial groups?

What is the prognosis for osteoporosis?

What is the prognosis for osteoporosis-related fractures?

What is the prognosis for vertebral compression fractures caused by osteoporosis?

What is the prognosis for hip fractures caused by osteoporosis?

Which factor increases the risk for multiple fractures in patients with osteoporosis?

What is the WHO fracture-risk algorithm (FRAX)?

How is the WHO fracture-risk algorithm (FRAX) used in the treatment of osteoporosis?

What is the effect of type 2 diabetes mellitus on the prognosis for osteoporosis?

What is the sensitivity of the WHO fracture-risk algorithm (FRAX) for perimenopausal and early-menopausal women?

What are the possible complications of osteoporosis?

How should patients be educated about osteoporosis?

Presentation

Screening for osteoporosis is indicated in patients with a history of which disorders?

What are the modifiable and nonmodifiable risk factors for osteoporosis identified by the NOF?

Which risk factors for osteoporosis and osteoporotic fractures should be identified in the patient history?

What is the effect of risk prediction instruments on patient outcomes for osteoporosis?

What is the Fracture Risk Assessment (FRAX) tool for osteoporosis?

Which individuals are at highest risk for osteoporotic fractures?

Which history suggests osteoporotic fractures?

Which history suggests a sustained vertebral compression fracture due to osteoporosis?

How is pain characterized in vertebral fractures caused by osteoporosis?

What are the signs and symptoms of hip fracture in a patient with osteoporosis?

Which GI disorders may be reported in the history of patients with osteoporosis report?

Which physical exams are indicated in suspected osteoporosis?

Which physical findings should raise concern in patients with suspected osteoporosis?

What is the Timed Up and Go (TUG) test?

Which physical findings suggest vertebral compression fractures caused by osteoporosis?

Which are physical findings suggestive of acute vertebral fractures caused by osteoporosis?

Which physical findings suggest hip fractures caused by osteoporosis?

Which physical findings suggest pubic and sacral fractures caused by osteoporosis?

Which physical findings suggest osteoporotic fractures?

Which physical findings are signs of collagen defects in osteoporosis?

Which findings of balance difficulties suggest osteoporosis?

What is the most common and serious complication of osteoporosis?

What is the USPSTF guideline for routine screening of men for osteoporosis?

What should be considered when weighing the risk versus benefit of screening men for osteoporosis?

What are the ACP recommendations for screening men for osteoporosis?

DDX

What role does reduced bone density have in the differential diagnosis of osteoporosis?

Which disorders should be considered in the differential diagnoses of an atraumatic osteoporotic compression fracture?

How is osteoporosis differentiated from osteomalacia?

What does the presence of a fracture indicate in patients with osteoporosis?

Which conditions should be included in the differential diagnoses of osteoporosis?

What are the differential diagnoses for Osteoporosis?

Workup

Which tests should be performed in the workup of osteoporosis?

What is the role of radiography in the workup of osteoporosis?

How should bone mineral density (BMD) be measured in the workup of osteoporosis?

What are the ISCD recommendations for diagnosing osteoporosis in children and adolescents?

What is the role of lab studies in the workup of osteoporosis?

What is the role of biochemical markers of bone turnover in the workup of osteoporosis?

Which serum markers of bone formation are used in the diagnosis of osteoporosis?

Which urinary markers of bone resorption are used in the diagnosis of osteoporosis?

Which serum markers of bone resorption are used in the diagnosis of osteoporosis?

What do high elevations of bone-specific alkaline phosphatase (BSAP) suggest in the workup of osteoporosis?

What is the role of biochemical markers in the treatment of osteoporosis?

When is plain radiography indicated in the workup of osteoporosis?

When is lateral spine radiography indicated in the workup of osteoporosis?

Which radiographic findings suggest osteoporosis?

What is the accuracy of plain radiography for the diagnosis of osteoporosis?

Which test results best indicate the risk of osteoporotic fractures?

What is the criterion standard for the evaluation of bone mineral density (BMD) in the workup of osteoporosis?

What is the role of dual-energy x-ray absorptiometry (DXA) in the workup of osteoporosis?

Which factors may result in a falsely high bone mineral density (BMD) in the workup of osteoporosis?

How are bone density data from dual-energy x-ray absorptiometry (DXA) reported in the workup of osteoporosis?

What are the WHO criteria for diagnosing osteoporosis?

How much is the risk of fracture increased for each standard deviation (SD) reduction in bone mineral density (BMD) in patients with osteoporosis?

What are the ISCD guidelines for use of peripheral dual-energy x-ray absorptiometry (pDXA) in the workup of osteoporosis?

Which techniques for measurement of bone strength are used in the workup of osteoporosis?

What is the role of hip structural analysis (HSA) in the workup of osteoporosis?

What is the role of trabecular bone scores (TBS) in the workup of osteoporosis?

What is the role of finite element analysis (FEA) in the workup of osteoporosis?

What is the role of quantitative CT (QCT) in the workup of osteoporosis?

When is quantitative CT (QCT) scanning indicated in the workup of osteoporosis?

How does dual-energy x-ray absorptiometry (DXA) scanning compare to quantitative CT (QCT) in the diagnosis of osteoporosis?

What are the ISCD recommendations for quantitative CT (QCT) in the workup of osteoporosis?

What are the ISCD guidelines on the use of peripheral quantitative CT (pQCT) in the workup of osteoporosis?

What is the role of SPECT scanning in the workup of osteoporosis?

What is the role of quantitative ultrasonography (QUS) in the workup of osteoporosis?

What are the ISCD recommendations on quantitative ultrasonography (QUS) in the workup of osteoporosis?

What is the role of MRI in the workup of osteoporosis?

What is the role of bone scanning in the workup of osteoporosis?

What is the role of bone biopsy in the workup of osteoporosis?

What is the role of tetracycline double labeling in the workup of osteoporosis?

When is vertebral body bone biopsy performed in the workup of osteoporosis?

What are the histologic findings of osteoporotic bone?

Treatment

What are the ACP guidelines for prevention of fractures in patients with osteoporosis?

Which lifestyle modifications may prevent osteoporosis?

What is the surgical treatment of osteoporosis?

Which measures may lead to a reduction in fractures and an increase in osteoporosis therapy?

What are the goals of rehabilitation in osteoporotic fracture?

How can progression of osteoporosis be halted?

What are preventive measures for patients at risk for osteoporosis?

What protective measures should be taken for patients taking glucocorticoids who are at risk for osteoporosis?

What are the most commonly used agents for treatment and prevention of osteoporosis?

What is the role of alendronate (Fosamax) in the treatment of osteoporosis?

What is the dosage regimen for alendronate (Fosamax) in the treatment of osteoporosis?

Which bisphosphonates are used for the treatment of osteoporosis?

What is the role of zoledronic acid (Reclast) in the treatment of osteoporosis?

What are the possible risks of zoledronic acid (Reclast) for the treatment of osteoporosis?

What warnings have been issued by the FDA regarding the use of zoledronic acid (Reclast) for the treatment of osteoporosis?

How does bisphosphonate therapy affect bone turnover in patients with osteoporosis?

What is the optimal length of treatment with bisphosphonates for osteoporosis?

Which risk factors should be considered in determining the duration of bisphosphonate therapy for osteoporosis?

What are the recommendations for pharmacologic therapy if osteoporosis is mild or if fracture risk is high?

What are the AACE recommendations for long-term bisphosphonate therapy for osteoporosis?

What is the role of selective estrogen receptor modulators (SERMs) in the treatment of osteoporosis?

What is the role of raloxifene (Evista) in the treatment of osteoporosis?

Which combination therapy has been approved for prevention of osteoporosis?

What is the role of teriparatide (Forteo) in the treatment of osteoporosis?

What are the contraindications for use of teriparatide (Forteo) in the treatment of osteoporosis?

What are the possible complications of parathyroid hormone (PTH) for the treatment of osteoporosis?

What is the role of parathyroid hormone (PTH) in the treatment of osteoporosis?

Is parathyroid hormone (PTH) effective in the treatment of osteoporosis?

Is combination therapy with parathyroid hormone (PTH) and bisphosphonate effective in the treatment of osteoporosis?

When is teriparatide (Forteo) indicated in the treatment of osteoporosis?

What is the role of abaloparatide (Tymlos) in the treatment of osteoporosis?

What is the role of calcitonin-salmon (Fortical, Miacalcin) in the treatment of osteoporosis?

What is the efficacy of calcitonin-salmon (Fortical, Miacalcin) in the treatment of osteoporosis?

Does calcitonin-salmon (Fortical, Miacalcin) increase the risk of malignancy in patients with osteoporosis?

When is calcitonin-salmon (Fortical, Miacalcin) indicated in the treatment of osteoporosis?

What is the role of denosumab (Prolia) in the treatment of osteoporosis?

Is denosumab (Prolia) effective in the treatment of osteoporosis?

In which patients should denosumab (Prolia) be considered as first-line therapy for osteoporosis?

Which combination therapy increases bone mineral density (BMD) in patients with osteoporosis?

What is the role of hormone replacement therapy (HRT) in the treatment of osteoporosis?

What is the role of romosozumab in the treatment of osteoporosis?

What is the role of strontium ranelate in the treatment of osteoporosis?

What are the goals of surgical treatment of osteoporotic fractures?

When are vertebroplasty and balloon kyphoplasty indicated for the treatment of osteoporosis?

Which dietary measures are important for the prevention of osteoporosis?

Which dietary sources of calcium and vitamin D should be considered for the prevention of osteoporosis?

What are the AACE recommendations for daily calcium intake for the prevention of osteoporosis?

What are the Institute of Medicine (IOM) (Health and Medicine Division) recommendations for calcium and vitamin D daily intake in older adults for the prevention of osteoporosis?

Which factors may interfere with nutrition and what is their effect on the risk for developing osteoporosis?

Which calcium supplements are used for the prevention of osteoporosis?

Which vitamin D supplements are used for the prevention of osteoporosis?

What is the efficacy of calcium and vitamin D supplements in reducing the risk of fracture in patients with osteoporosis?

What is the focus of physical therapy for osteoporosis?

What is the focus of occupational therapy for osteoporosis?

What exercises are recommended for patients with osteoporosis?

What does exercise therapy for osteoporosis include?

Are impact exercises an effective treatment of osteoporosis?

What is the efficacy of swimming for osteoporosis?

What is the role of balance training in the treatment of osteoporosis?

How is osteoporosis prevented?

What are the NOF recommendations for lifestyle modifications to reduce the risk of developing osteoporosis?

Which pharmacologic agents are used in the prevention of osteoporosis?

What is the role of estrogen-progestin therapy in the treatment of osteoporosis?

What monitoring should be performed for prevention of osteoporosis?

Which specialist consultations are needed for a patient with osteoporosis?

What should be considered in consultations for osteoporosis?

What are USPSTF recommendations for repeated screening of osteoporosis?

What is the role of osteopenia in the development of osteoporosis in older, postmenopausal women during rescreening intervals?

What is the role of orthotics in the treatment of osteoporosis?

Guidelines

What are the guidelines for screening patients for osteoporosis with bone mineral density (BMD) measurement?

What are the NOF recommendations for pharmacologic therapy of osteoporosis?

What are the ACP recommendations for pharmacologic treatment of osteoporosis?

According to ACP guidelines, which agents are contraindicated for the treatment of osteoporosis?

What are the AACE recommendations on choosing medications to treat osteoporosis?

What are the AACE recommendations for combination therapy for osteoporosis?

What are the NOGG recommendations for the diagnosis and management of osteoporosis?

Medications

Which agents are used to treat osteoporosis?

Which medications in the drug class Estrogens/Progestins-HRT are used in the treatment of Osteoporosis?

Which medications in the drug class Estrogens/Progestins are used in the treatment of Osteoporosis?

Which medications in the drug class Vitamins, Fat-Soluble are used in the treatment of Osteoporosis?

Which medications in the drug class Estrogen Derivatives are used in the treatment of Osteoporosis?

Which medications in the drug class Calcium Salts are used in the treatment of Osteoporosis?

Which medications in the drug class Monoclonal Antibodies, Endocrine are used in the treatment of Osteoporosis?

Which medications in the drug class Selective Estrogen Receptor Modulator are used in the treatment of Osteoporosis?

Which medications in the drug class Parathyroid Hormone Analogs are used in the treatment of Osteoporosis?

Which medications in the drug class Calcium Metabolism Modifiers are used in the treatment of Osteoporosis?