Osteoporosis
The chapter provides an overview of the screening recommendations, evaluation and diagnosis, and treatment options for osteoporosis. Lifestyle factors, family history, medical conditions, and medications increase the risk for the development of osteoporosis. Physical examination findings and clinical assessments can also identify individuals at risk for osteoporosis and falls. Workup for osteoporosis should include laboratory tests to assess for secondary causes of bone loss. Bone mineral density (BMD) screening with dual-energy x-ray absorptiometry (DXA) is recommended for women and men based on age or additional risk factors. The fracture risk assessment tool (FRAX), and similar tools, can quantify the risk of fracture and provide guidance on initiation of therapy for individuals at predicted high-risk for a fragility fracture. Individuals should strive to meet the recommended daily dietary intake of calcium and vitamin D to reach peak bone mass. Supplementation with calcium and vitamin D may not be beneficial for the primary prevention of fractures in a healthy, noninstitutionalized adult population, but may benefit individuals with osteoporosis or vitamin D deficiency. Several US Food and Drug Administration-approved drugs for the treatment of osteoporosis are available with antiresorptive and anabolic mechanisms of action. Monitoring for response to therapy is most commonly assessed by the onset of new fragility fractures and changes in BMD on serial DXA measurements. Duration of pharmacological therapy for osteoporosis varies based upon the mechanism of action of the drug and the patient’s fracture risk profile.
