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Singapore Medical Journal Apr 2021Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early...
Screening for osteoporosis in women can be based on age and weight, using the Osteoporosis Screening Tool for Asians and assessment for other risk factors such as early menopause, Chinese ethnicity and other secondary factors. Based on the resulting risk profile, women can be triaged to dual-energy X-ray absorptiometry (DEXA) scanning for definite diagnosis of osteoporosis. Treatment should be considered in women with previous fragility fractures, DEXA-diagnosed osteoporosis and high risk of fracture. Exercise improves muscle function, can help prevent falls and has moderate effects on improvements in bone mass. Women should ensure adequate calcium intake and vitamin D. Menopausal hormone therapy (MHT) effectively prevents osteoporosis and fractures, and should be encouraged in those aged < 50 years. For women aged < 60 years, MHT or tibolone can be considered, especially if they have vasomotor or genitourinary symptoms. Risedronate or bisphosphonates may then be reserved for those aged over 60 years.
Topics: Bone Density; Diphosphonates; Female; Humans; Menopause; Osteoporosis; Osteoporosis, Postmenopausal
PubMed: 33948669
DOI: 10.11622/smedj.2021036 -
Clinical Obstetrics and Gynecology Dec 2020Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have... (Review)
Review
Postmenopausal osteoporosis is a common condition and is associated with increased risk of fracture, including hip and vertebral fractures that in turn can have devastating consequences on morbidity and mortality. In this article, we review the pathogenesis and diagnostic approach to postmenopausal osteoporosis. We review available nonpharmacologic and pharmacologic therapies and we discuss their clinical efficacy and complications, with a detailed discussion of atypical femur fractures and osteonecrosis of the jaw.
Topics: Bone Density; Bone Density Conservation Agents; Female; Fractures, Bone; Humans; Osteoporosis, Postmenopausal; Treatment Outcome
PubMed: 33017332
DOI: 10.1097/GRF.0000000000000572 -
The Medical Clinics of North America Sep 2020Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to... (Review)
Review
Osteoporosis and osteoporosis-related fractures are common causes of morbidity and mortality in older adults. Healthy adults should be counseled about measures to prevent osteoporosis. Women should be screened for osteoporosis beginning at age 65. Screening for osteoporosis in men should be considered when risk factors are present. Appropriate screening intervals are controversial. Women and men with osteoporosis should be offered pharmacologic therapy. Choice of therapy should be based on safety, cost, convenience, and other patient-related factors. Bisphosphonates are a first-line therapy for many patients with osteoporosis. Other treatments for osteoporosis include denosumab, teriparatide, abaloparatide, romosozumab, and selective estrogen receptor modulators.
Topics: Aged; Bone Density Conservation Agents; Female; Geriatric Assessment; Humans; Male; Osteoporosis; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Risk Factors
PubMed: 32773051
DOI: 10.1016/j.mcna.2020.06.004 -
Sub-cellular Biochemistry 2019Osteoporosis is a "skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture" which, in light of demographic... (Review)
Review
Osteoporosis is a "skeletal disorder characterized by compromised bone strength predisposing a person to an increased risk of fracture" which, in light of demographic change, is becoming an increasing burden on health care worldwide. Increasing age and female gender are associated with the condition, although a wider range of clinical risk factors are being used increasingly to identify those at risk of osteoporosis and its most important sequelae, fracture.While osteoporosis and fracture have long been associated with women in the post-menopausal age, fracture incidence increases because of the ageing of our population. Interventions to abate the progression of osteoporosis and to prevent fractures must focus on the old and the very old. Evidence associating nutritional factors, particularly calcium and vitamin D are reviewed as are the association of falls risk with fracture and the potential for interventions to prevent falls. Finally, the assessment of frailty in the oldest old, associated sarcopenia and multi-morbidity are considered in the evaluation of fall and fracture risk and the management of osteoporosis in the ninth decade of life and beyond.
Topics: Accidental Falls; Aging; Bone Density; Calcium; Female; Fractures, Bone; Humans; Osteoporosis, Postmenopausal; Risk Factors; Vitamin D
PubMed: 30888662
DOI: 10.1007/978-981-13-3681-2_16 -
Endocrine Practice : Official Journal... May 2020The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of...
AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS/AMERICAN COLLEGE OF ENDOCRINOLOGY CLINICAL PRACTICE GUIDELINES FOR THE DIAGNOSIS AND TREATMENT OF POSTMENOPAUSAL OSTEOPOROSIS-2020 UPDATE.
The development of these guidelines is sponsored by the American Association of Clinical Endocrinologists (AACE) Board of Directors and American College of Endocrinology (ACE) Board of Trustees and adheres with published AACE protocols for the standardized production of clinical practice guidelines (CPGs). Recommendations are based on diligent reviews of the clinical evidence with transparent incorporation of subjective factors, according to established AACE/ACE guidelines for guidelines protocols. The Executive Summary of this 2020 updated guideline contains 52 recommendations: 21 Grade A (40%), 24 Grade B (46%), 7 Grade C (14%), and no Grade D (0%). These detailed, evidence-based recommendations allow for nuance-based clinical decision-making that addresses multiple aspects of real-world care of patients. The evidence base presented in the subsequent Appendix provides relevant supporting information for the Executive Summary recommendations. This update contains 368 citations: 123 (33.5%) evidence level (EL) 1 (highest), 132 (36%) EL 2 (intermediate), 20 (5.5%) EL 3 (weak), and 93 (25%) EL 4 (lowest). New or updated topics in this CPG include: clarification of the diagnosis of osteoporosis, stratification of the patient according to high-risk and very-high-risk features, a new dual-action therapy option, and transitions from therapeutic options. This guideline is a practical tool for endocrinologists, physicians in general, regulatory bodies, health-related organizations, and interested laypersons regarding the diagnosis, evaluation, and treatment of post-menopausal osteoporosis. = 25-hydroxyvitamin D; = American Association of Clinical Endocrinologists; = American College of Endocrinology; = atypical femoral fracture; = American Society for Bone and Mineral Research; = best evidence level; = bone mineral density; = bone turnover marker; = confidence interval; = clinical practice guideline; = C-terminal telopeptide type-I collagen; = dual-energy X-ray absorptiometry; = evidence level; = U.S. Food and Drug Administration; = Fracture Risk Assessment Tool; = gastrointestinal; = Health Outcomes and Reduced Incidence with Zoledronic acid ONce yearly Pivotal Fracture Trial (zoledronic acid and zoledronate are equivalent terms); = International Society for Clinical Densitometry; = international units; = intravenous; = least significant change; = National Osteoporosis Foundation; = osteonecrosis of the jaw; = serum amino-terminal propeptide of type-I collagen; = parathyroid hormone; = recommendation; = region of interest; = relative risk; = standard deviation; = trabecular bone score; = vertebral fracture assessment; = World Health Organization.
Topics: Absorptiometry, Photon; Aged; Bone Density; Endocrinologists; Female; Humans; Middle Aged; Osteoporosis, Postmenopausal; United States
PubMed: 32427503
DOI: 10.4158/GL-2020-0524SUPPL -
Endocrinology and Metabolism Clinics of... Jun 2021Significant development has occurred in the treatment of postmenopausal osteoporosis. We review the most recent guidelines from the American Association of Clinical... (Review)
Review
Significant development has occurred in the treatment of postmenopausal osteoporosis. We review the most recent guidelines from the American Association of Clinical Endocrinologists/American College of Endocrinology, Endocrine Society, and the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis/International Osteoporosis Foundation Guidelines.
Topics: Bone Density; Endocrinologists; Endocrinology; Female; Humans; Osteoporosis; Osteoporosis, Postmenopausal; Risk Assessment; United States
PubMed: 34023036
DOI: 10.1016/j.ecl.2021.03.009 -
Periodontology 2000 Jun 2022Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both... (Review)
Review
Periodontitis and osteoporosis are prevalent inflammation-associated skeletal disorders that pose significant public health challenges to our aging population. Both periodontitis and osteoporosis are bone disorders closely associated with inflammation and aging. There has been consistent intrigue on whether a systemic skeletal disease such as osteoporosis will amplify the alveolar bone loss in periodontitis. A survey of the literature published in the past 25 years indicates that systemic low bone mineral density (BMD) is associated with alveolar bone loss, while recent evidence also suggests a correlation between clinical attachment loss and other parameters of periodontitis. Inflammation and its influence on bone remodeling play critical roles in the pathogenesis of both osteoporosis and periodontitis and could serve as the central mechanistic link between these disorders. Enhanced cytokine production and elevated inflammatory response exacerbate osteoclastic bone resorption while inhibiting osteoblastic bone formation, resulting in a net bone loss. With aging, accumulation of oxidative stress and cellular senescence drive the progression of osteoporosis and exacerbation of periodontitis. Vitamin D deficiency and smoking are shared risk factors and may mediate the connection between osteoporosis and periodontitis, through increasing oxidative stress and impairing host response to inflammation. With the connection between systemic and localized bone loss in mind, routine dental exams and intraoral radiographs may serve as a low-cost screening tool for low systemic BMD and increased fracture risk. Conversely, patients with fracture risk beyond the intervention threshold are at greater risk for developing severe periodontitis and undergo tooth loss. Various Food and Drug Administration-approved therapies for osteoporosis have shown promising results for treating periodontitis. Understanding the molecular mechanisms underlying their connection sheds light on potential therapeutic strategies that may facilitate co-management of systemic and localized bone loss.
Topics: Aged; Alveolar Bone Loss; Bone Density; Female; Humans; Inflammation; Osteoporosis; Osteoporosis, Postmenopausal; Periodontal Diseases; Periodontitis
PubMed: 35244945
DOI: 10.1111/prd.12422 -
Endocrinology and Metabolism (Seoul,... Jun 2021Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension. A large gap currently exists in the primary prevention of fractures, and...
Osteoporosis is an incurable chronic condition, like heart disease, diabetes, or hypertension. A large gap currently exists in the primary prevention of fractures, and studies show that an estimated 80% to 90% of adults do not receive appropriate osteoporosis management even in the secondary prevention setting. Case finding strategies have been developed and effective pharmacological interventions are available. This publication addresses how best to use the pharmacological options available for postmenopausal osteoporosis to provide lifelong fracture protection in patients at high and very high risk of fracture. The benefit of osteoporosis therapies far outweighs the rare risks.
Topics: Bone Density Conservation Agents; Diphosphonates; Female; Humans; Osteoporosis; Osteoporosis, Postmenopausal
PubMed: 34154042
DOI: 10.3803/EnM.2021.301 -
Annals of Internal Medicine Aug 2017Osteoporosis is a common systemic skeletal disorder resulting in bone fragility and increased fracture risk. However, management of osteoporosis and fracture prevention... (Review)
Review
Osteoporosis is a common systemic skeletal disorder resulting in bone fragility and increased fracture risk. However, management of osteoporosis and fracture prevention strategies are often not addressed by primary care clinicians, even in older patients with recent fractures. Evidence-based screening strategies will improve identification of patients who are most likely to benefit from drug treatment to prevent fracture. In addition, careful consideration of when pharmacotherapy should be started and choice of medication and duration of treatment will maximize the benefits of fracture prevention while minimizing potential harms of long-term drug exposure.
Topics: Absorptiometry, Photon; Bone Density; Bone Density Conservation Agents; Calcium, Dietary; Female; Humans; Male; Mass Screening; Osteoporosis; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Risk Assessment; Risk Factors; Vitamin D
PubMed: 28761958
DOI: 10.7326/AITC201708010 -
Osteoporosis International : a Journal... Jan 2019Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis.
UNLABELLED
Guidance is provided in a European setting on the assessment and treatment of postmenopausal women at risk from fractures due to osteoporosis.
INTRODUCTION
The International Osteoporosis Foundation and European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis published guidance for the diagnosis and management of osteoporosis in 2013. This manuscript updates these in a European setting.
METHODS
Systematic reviews were updated.
RESULTS
The following areas are reviewed: the role of bone mineral density measurement for the diagnosis of osteoporosis and assessment of fracture risk; general and pharmacological management of osteoporosis; monitoring of treatment; assessment of fracture risk; case-finding strategies; investigation of patients; health economics of treatment. The update includes new information on the evaluation of bone microstructure evaluation in facture risk assessment, the role of FRAX® and Fracture Liaison Services in secondary fracture prevention, long-term effects on fracture risk of dietary intakes, and increased fracture risk on stopping drug treatment.
CONCLUSIONS
A platform is provided on which specific guidelines can be developed for national use.
Topics: Absorptiometry, Photon; Bone Density; Bone Density Conservation Agents; Europe; Female; Humans; Life Style; Osteoporosis, Postmenopausal; Osteoporotic Fractures; Risk Assessment; Risk Factors
PubMed: 30324412
DOI: 10.1007/s00198-018-4704-5