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Osteoporosis - Highlights

Description

An in-depth report on the causes, diagnosis, treatment, and prevention of osteoporosis.

Highlights:

Drug Approvals

In 2008, the Food and Drug Administration (FDA) approved a generic version of the osteoporosis drug alendronate (Fosamax).
In 2008, the FDA broadened the use of once-yearly zoledronic acid (Reclast) to include the prevention of new fractures in patients who have had previously had a hip fracture. Reclast was previously approved as the first once-yearly injectable drug for treatment of postmenopausal osteoporosis.
In 2008, the FDA approved a new once-a-month dose of risedronate (Actonel).

Osteoporosis Screening

Bone density testing is recommended for:

All women over age 65
Postmenopausal women under age 65 with one or more risk factors for osteoporosis
All men over age 70
Men ages 50 - 70 with one or more risk factors for osteoporosis.
Any man or women over age 50 who has suffered a fracture.
People with specific risk factors for osteoporosis. These risk factors include long-term use of medications such as corticosteroids, history of certain medical conditions (diabetes, thyroid imbalances), history of breast or prostate cancer treatment, significant loss of height or recent weight loss.

Osteoporosis Risk Factors

Age is the main risk factor for osteoporosis. Aging causes bones to thin and weaken. Although osteoporosis affects mostly postmenopausal women, older men are also at risk.
Osteoporosis is more common in people who have a small, thin body frame and bone structure.
Dietary calcium and vitamin D deficiencies are important factors in the risk for osteoporosis.
Women who smoke, particularly after menopause, have a significantly greater risk of spine and hip fractures than those who do not smoke. Men who smoke also have lower bone density.

Resources

www.nof.org -- National Osteoporosis Foundation
www.niams.nih.gov/Health_Info/Bone -- National Institute of Arthritis and Musculoskeletal and Skin Diseases
www.iofbonehealth.org -- International Osteoporosis Foundation
www.healthywomen.org -- National Women's Health Resource Center
www.menopause.org -- North American Menopause Society

References

Ebeling PR. Clinical practice. Osteoporosis in men. N Engl J Med. 2008; 358(14): 1474-82.

Greenspan SL, Bone HG, Ettinger MP, Hanley DA, Lindsay R, Zanchetta JR, et al. Effect of recombinant human parathyroid hormone (1-84) on vertebral fracture and bone mineral density in postmenopausal women with osteoporosis: a randomized trial. Ann Intern Med. 2007;146(5): 326-39.

Greenspan SL, Nelson JB, Trump DL and Resnick NM. Effect of once-weekly oral alendronate on bone loss in men receiving androgen deprivation therapy for prostate cancer: a randomized trial. Ann Intern Med. 2007;146(6): 416-24.

Heckbert SR, Li G, Cummings SR, Smith NL, Psaty BM. Use of alendronate and risk of incident atrial fibrillation in women. Arch Intern Med. 2008;168(8):826-31.

Kothawala P, Badamgarav E, Ryu S, Miller RM and Halbert RJ. Systematic review and meta-analysis of real-world adherence to drug therapy for osteoporosis. Mayo Clin Proc. 2007;82(12): 1493-501.

MacLean C, Newberry S, Maglione M, McMahon M, Ranganath V, Suttorp M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148(3): 197-213.

National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis -- 2008. Washington, DC.

Qaseem A, Snow V, Shekelle P, Hopkins R Jr., Forciea MA and Owens DK. Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2008;149(6): 404-15.

Tang BM, Eslick GD, Nowson C, Smith C, Bensoussan A. Use of calcium or calcium in combination with vitamin D supplementation to prevent fractures and bone loss in people aged 50 years and older: a meta-analysis. Lancet. 2007 Aug 25;370(9588):657-66.

Reviewed last on: 11/18/2008
Harvey Simon, MD, Editor-in-Chief, Associate Professor of Medicine, Harvard Medical School; Physician, Massachusetts General Hospital. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

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