After reading this chapter, the pharmacy student, community practice resident, or pharmacist should be able to:
Utilize the current osteoporosis clinical guidelines to differentiate normal bone health, osteoporosis, and osteopenia.
Evaluate benefits and barriers of available bone densitometry devices and methods.
Develop osteoporosis screening services within a community pharmacy practice setting including marketing, primary care provider collaboration, and follow-up.
Recommend patient-specific over-the-counter (OTC) and prescription medication treatment regimens and lifestyle modifications.
Osteoporosis is a silent disease that is characterized by low bone mass, deterioration of bone architecture, and increase risk of fracture. According to the National Osteoporosis Foundation (NOF), osteoporosis is estimated to be a major health threat for Americans with 55% of people 50 years and older at risk.1 Of the 43 million people at risk, 10 million have osteoporosis while the other 33 million suffer from low bone density of the hip, putting them at increased risk of osteoporosis.1
Osteoporosis exerts a large financial burden on the health system. In 2005, it was estimated that osteoporosis-related complications (such as fractures) cost an imposing $17 billion in the United States. With the aging population, this financial burden is expected to double or triple by the year 2040.1 Not only is osteoporosis a costly disease, it is also a debilitating disease. Over 430,000 hospital admissions, 2.5 million physician visits, and 180,000 nursing home admissions each year can be attributed to fractures from osteoporosis.2 Hip fractures are among the most common and debilitating of osteoporosis-related complications.3 It is estimated that 50% of Caucasian women will experience a fracture related to osteoporosis at some point in their lifetime.4 As a result of osteoporosis-related fractures, patients may experience a decreased quality of life because of acute and chronic back pain, disability, limited mobility, and loss of height that can all be deleterious results of a fracture.5Table 13-1 details nonmodifiable and modifiable risk factors for osteoporosis.
Table 13-1. Risk Factors for Osteoporosis ||Download (.pdf)
Table 13-1. Risk Factors for Osteoporosis
Nonmodifiable Risk Factors
Modifiable Risk Factors
- Caucasian or Asian race
- Advanced age
- Female gender
- Family history of fracture in a first-degree relative
- Personal history of an adult aged fracture
- Certain diseases (such as rheumatoid arthritis or anorexia nervosa)
- Low body weight
- Low calcium intake/poor diet
- Alcohol abuse (3 or more drinks per day)
- Cigarette smoking
- Inactive lifestyle
- Low levels of sex hormones
Currently the NOF, American Association of Clinical Endocrinologists (AACE), and International Society of Clinical Densitometry (ISCD) recommend bone mineral density (BMD) screening for all women aged 65 and greater regardless of risk factors, all postmenopausal women with a fracture, postmenopausal women younger than 65 years with one or more risk factors (other than fracture or low sex hormones), and any women who are considering therapy for osteoporosis.1,6–8 The AACE also recommends testing women with ...