Osteoporosis

The fractures that result from osteoporosis are a major public health problem. The physician needs to be aware of the major risk factors for osteoporosis and refer appropriately for bone densitometry. These risk factors include prior fracture, a family history of fracture, slender habitus, early menopause, treatment with drugs known to affect bone (glucocorticoids) and diseases known to affect bone (rheumatoid arthritis). The diagnosis of osteoporosis can be made if the bone density T-score is −2.5 or below. This information can be used with other risk factors to estimate the 10-year risk of fractures. Patients at the highest risk for fracture benefit from the many licensed treatments for this common disorder. These may be given orally (alendronate, etidronate, risedronate, ibandronate, strontium, calcitriol, raloxifene, hormone replacement therapy), intranasally (calcitonin), subcutaneously (calcitonin, parathyroid hormone) or intravenously (ibandronate, zoledronic acid). These treatments usually result in an increase in bone mineral density and a reduction in fracture risk.