A systematic search of the medical literature was conducted between
March 7, 2007, and March 20, 2007. A search update was conducted
between February 13, 2008, and March 11, 2008. The search, limited
to human subjects and English language journals, included the National
Guideline Clearinghouse, PubMed, and the Cochrane database. The
National Osteoporosis Foundation can be found at www.nof.org and
the Clinician’s Guide to Prevention
and Treatment of Osteoporosis can be found at http://www.nof.org/professionals/clinicians_Guide.htm.
Osteoporosis is the most common human bone disease that is often
recognized only after a patient experiences a fracture. Characterized
by low bone mass and increased bone porosity, osteoporosis leads
to reduced bone strength and an increased risk of bone fracture.
Although the disease can affect any bone, most typical fracture
sites include the hip, spine, wrist, and ribs. Osteoporosis is prevalent
in the United States and considered a major public health threat,
particularly as our population ages. U.S. Census data estimated
that in 2002, more than 10 million women and men aged 50 and older
had osteoporosis, and this number is projected to rise by 30% in
2020.1 Approximately 44 million Americans have osteoporosis
and osteopenia (low bone mass) and by 2020, more than 61 million
are expected to be affected by these disorders. Osteoporosis most commonly
occurs in Caucasian and Asian postmenopausal women, and 50% will
experience an osteoporosis-related fracture during their lifetime.
Table 33-1 describes other risk factors for developing osteoporosis
and fractures. Osteoporotic fractures result in significant financial
and individual costs. The United States spends approximately $18
billion annually treating fractures secondary to osteoporosis.2 Adults
who incur one fracture are 50% to 100% likely
to sustain another. Moreover, the one year posthip fracture mortality
rate for patients 50 years and older is approximately 24%.
Table 33-1. Risk Factors
for Developing Osteoporosis and Fractures |Favorite Table|Download (.pdf)
Table 33-1. Risk Factors
for Developing Osteoporosis and Fractures
|Nonmodifiable Risk Factors||Potentially Modifiable Risk Factors|
|• Advanced age||• Low BMD|
|• Gender: Women >> Men (approximately
4:1 ratio, especially postmenopausal women)||• Falling|
|• Race: Caucasian
or Asian > Hispanic or African American ||• Decreased gonadal
steroid levels (estrogen in women and testosterone in men)|
|• Genetics: First-degree family
history of osteoporosis or nontraumatic fracture, or personal history
of low body weight or small body frame, cystic fibrosis, homocystinuria,
osteogenesis imperfecta, Ehlers-Danlos, glycogen storage diseases, Gaucher’s disease, hemochromatosis, hypo-phosphatasia, idiopathic hypercalciuria,
Marfan syndrome, Riley-Day syndrome, Menkes steely hair syndrome, porphyria||• Lifestyle choices: sedentary (inadequate physical activity
or immobilization), smoking (active or passive), low dietary intake
of calcium and vitamin D (or inadequate sunlight exposure), excessive alcohol
consumption (>2 drinks per day), excessive vitamin
A, salt, and caffeine intake|
|• Gonadal steroids:
late menarche, early menopause or oophorectomy without hormone replacement (especially
premenopausal), amenorrhea, nulliparity, gonadal failure or loss (androgen
insensitivity, anorexia nervosa or bulimia, Turner’s & Klinefelter’s
syndromes, hyperprolactinemia, panhypopituitarism, athletic amenorrhea)...|
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