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  • Image not available. Perimenopausal and postmenopausal women, men older than age 50 years, and those with potential disease- or medication-induced bone loss should be assessed for osteoporosis. Patients with early-onset or severe osteoporosis should be evaluated for secondary causes of bone loss.
  • Image not available. Inadequate vitamin D concentrations, which sometimes cause osteomalacia, can be insidious and coexist with osteoporosis. A serum 25(OH) vitamin D concentration should be obtained in patients with osteoporosis, at high risk for low vitamin D concentrations, or with symptoms suggestive of inadequate vitamin D such as unexplained muscle weakness, falls, or pain.
  • Image not available. Osteoporosis in men is often secondary to certain diseases and medications and responds well to a bone-healthy lifestyle, bisphosphonate or teriparatide therapy, and in some cases, testosterone replacement.
  • Image not available.Estimation of an adult person's 10-year probability of developing an osteoporotic fracture can be estimated with the FRAX tool. Central bone densitometry can determine bone mass, predict fracture risk, and influence patient and provider treatment decisions. Portable equipment can be used for screening in the community to determine the need for further testing.
  • Image not available. All people, regardless of age, should incorporate a bone-healthy lifestyle beginning at birth and continuing throughout life, that emphasizes regular exercise, nutritious diet, tobacco avoidance, minimal alcohol use, and fall prevention to prevent and treat osteoporosis.
  • Image not available. The adequate intake for calcium in American adults is 1,000 to 1,200 mg of elemental calcium daily in divided doses from diet or supplements. The adequate intake for American adults is 400 to 1,000 units (seniors 800–1,000 units) of vitamin D daily, mainly from supplements, with some experts recommending higher doses.
  • Image not available. Bisphosphonates decrease vertebral, hip, and nonvertebral fractures and are considered the medication of choice for osteoporosis treatment. Adherence with bisphosphonates is frequently suboptimal, which has been associated with less fracture prevention. Assessment of correct administration should be frequently conducted with repeat patient education as needed.
  • Image not available.Raloxifene is an alternative treatment option to prevent vertebral fractures, particularly in women who cannot tolerate, should not, or will not take bisphosphonates. Raloxifene also decreases invasive breast cancer risk. Postmenopausal women at high risk for breast cancer might choose this medication to obtain dual benefits.
  • Image not available. Healthcare providers can have an important role in prevention and treatment of osteoporosis by conducting osteoporosis assessments at health fairs and community pharmacies, identifying and resolving disease and medication-induced bone loss/osteoporosis, ensuring medications are taken accurately, identifying and resolving medication-related problems resulting in suboptimal adherence, and encouraging secondary fracture prevention in patients with past hip or vertebral fractures.
  • Image not available. Patients taking long-term oral glucocorticoids need to be identified and started on a bone-healthy lifestyle with higher intakes of calcium and vitamin D and usually bisphosphonate therapy to prevent or treat osteoporosis.

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Upon completion of the chapter, the reader will be able to:

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  • 1. Compare osteopenia and osteoporosisprevalence and fracture risk between ethnic and gender groups.
  • 2. Explain the major steps in bone remodeling.
  • 3. Determine the impact of calcium, vitamin D, or parathyroid hormone concentration changes on bone resorption.
  • 4. ...

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