Table of Contents
Overview
Definition and Significance
Osteoporosis is a disease characterized by low bone mass, deterioration of bone tissue, and disruption of bone microarchitecture, which ultimately compromises bone strength and increases the risk of fractures.[5.1] This condition leads to weak and brittle bones, making individuals more susceptible to fractures, particularly in the hip, spine, and wrist.[4.1] Osteoporotic fractures significantly decrease quality of life and are associated with increased morbidity, mortality, and disability.[6.1] Osteoporosis is a disease that weakens bones and increases the risk of fractures, particularly affecting postmenopausal women, with over 50% of this demographic expected to experience an osteoporotic-related fracture during their lifetime.[6.1] The condition is characterized by low bone mineral density and altered bone microstructure, which predisposes individuals to low-impact, fragility fractures.[6.1] Osteoporotic fractures can lead to a significant decrease in quality of life, increasing morbidity, mortality, and disability among affected individuals.[6.1] Understanding osteoporosis is crucial for recognizing its risk factors, signs, diagnosis, treatment, and prevention strategies, as it represents a significant public health challenge due to its widespread impact on older adults.[4.1] In addition to its clinical implications, osteoporosis highlights the importance of maintaining bone health through adequate nutrition, including essential vitamins such as vitamin K, which plays a vital role in bone metabolism.[49.1] Overall, osteoporosis is a major health concern that necessitates awareness and proactive management to mitigate its effects on individuals and healthcare systems.Symptoms and Risk Factors
History
Osteoporosis is marked by a significant reduction in bone density, leading to an increased risk of fractures, particularly in the vertebrae, hips, and wrists, even with minimal trauma. This condition is especially prevalent among postmenopausal women due to hormonal changes, notably the decline in estrogen levels, which accelerate bone loss. During menopause, women can experience up to 20% of bone loss, significantly increasing their risk of developing osteoporosis, with approximately 1 in 10 women over the age of 60 affected globally.[12.1] The rate of bone loss begins to accelerate approximately one year before the final menstrual period and remains elevated for about two years thereafter.[13.1] To address these risks, effective strategies include hormone therapy, increased calcium intake, and regular exercise, which can help protect bone health.[16.1] Engaging in bone-loading exercises can slow age-related bone loss, further contributing to the maintenance of bone density during this vulnerable period.[15.1] Hormonal treatments, such as Menopausal Hormone Therapy (MHT) and Hormone Replacement Therapy (HRT), have been shown to be effective in preventing menopause-related bone loss and decreasing fracture risk.[14.1] Additionally, lifestyle interventions, including weight-bearing exercises and adequate calcium intake, are essential for maintaining bone health during and after menopause.[16.1] These combined approaches can significantly reduce the risk of osteoporosis and its associated complications in postmenopausal women.Early Discoveries and Definitions
Early diagnostic methods for osteoporosis and other bone diseases have evolved significantly over time. Blood tests, X-rays, scans, and other diagnostic tools are essential in detecting both acute and chronic bone diseases, including osteoporosis, osteopenia, rheumatoid arthritis, osteoarthritis, and fractures. It is particularly important for women to be aware of these diagnostic methods, as they are at a higher risk for developing bone and joint disorders.[57.1] Among the various diagnostic tools, radioisotope scans are utilized to determine if broken bones may be attributed to other medical conditions, such as cancer or infections. Additionally, CT scans provide detailed information regarding bone density and structure, which is crucial for accurate diagnosis. Bone markers, which are blood or urine tests measuring the rate of bone turnover, are also significant for monitoring the effectiveness of osteoporosis treatment.[58.1] Bone mineral density (BMD) testing is a critical component in the diagnosis of osteoporosis. It is recommended for any patient whose risk factor analysis indicates a strong potential for the disease. Formal guidelines suggest that BMD testing should be performed on specific populations, including postmenopausal women over the age of 65, younger women with multiple risk factors, and both men and women who have experienced fragility fractures or have other diseases that may affect bone health.[59.1]Evolution of Understanding and Treatment
The understanding of osteoporosis has evolved significantly since its initial description in the early 19th century. The term 'osteoporosis' was likely first introduced by the French pathologist Jean Lobstein in 1830, derived from Greek words meaning "porous bone," to describe the cavities observed in bones during autopsies.[51.1] This marked a pivotal moment in the medical lexicon, although the concept of bone density loss had been recognized earlier, with John Hunter identifying osteoporosis in the 1800s.[74.1] In the late 19th century, advancements in diagnostic techniques began to shape the understanding of osteoporosis. Pommer's work in 1885 distinguished osteoporosis from conditions like rickets and osteomalacia, clarifying that osteoporosis involved a reduction in bone mass rather than a loss of calcium from existing bone.[55.1] This differentiation laid the groundwork for future research and treatment approaches. The evolution of the understanding and treatment of osteoporosis has a rich history that dates back to the late 19th century. Measurements of bone opacity using dental X-rays were first described during this period, and plain radiographs were utilized to assess bone quality for much of the first half of the 20th century.[72.1] In the 1800s, John Hunter, a British surgeon, identified osteoporosis, and the term itself was coined by French pathologist Jean Lobstein in the 1830s.[74.1] By the 1940s, significant advancements were made with the recognition of postmenopausal osteoporosis, which was treated with estrogen as defined by American endocrinologist Fuller Albright.[74.1] The development of bone densitometers in the 1950s and the discovery of bisphosphonates in the 1960s further marked major milestones in both the diagnosis and treatment of osteoporosis.[74.1] The late 20th century marked a turning point in public awareness and medical practice regarding osteoporosis. The National Institute of Health (NIH) publicized osteoporosis in 1984, which helped to elevate its status as a significant health concern.[74.1] The World Health Organization (WHO) introduced the T-score in 1994 to classify and define bone mineral density (BMD), further standardizing the diagnosis of osteoporosis.[74.1] Recent advancements in the treatment of osteoporosis have led to the approval of two osteoanabolic agents, abaloparatide and romosozumab, specifically for patients at high risk of fractures, including postmenopausal women who have not responded to other treatments.[51.1] The U.S. Food and Drug Administration (FDA) has approved romosozumab (Evenity) for this demographic, noting that it not only halts bone loss but also promotes new bone formation, distinguishing it from traditional bisphosphonates that primarily focus on preventing bone loss.[51.1] Additionally, research into Chinese herbal medicine has shown significant efficacy in treating osteoporosis, with advantages such as minimal toxic side effects and suitability for long-term use, thus offering a promising complementary approach to conventional therapies.[50.1]Recent Advancements
Current Treatment Options
Current treatment options for osteoporosis encompass a range of medications that vary in their mechanisms of action and administration methods. These treatments can be categorized into two main types: anti-resorptive agents and anabolic drugs. Anti-resorptive agents, which include bisphosphonates, selective estrogen receptor modulators (SERMs), estrogen replacement therapy, denosumab, and calcitonin, primarily work by inhibiting bone resorption. Bisphosphonates, for instance, are the first-line drugs that induce apoptosis in osteoclasts, thereby reducing bone loss.[109.1] Denosumab functions by inhibiting receptor activator of NF-κB ligand (RANKL), a key factor in osteoclastogenesis, which is crucial for bone remodeling and homeostasis.[109.1] Current treatment options for osteoporosis include a variety of both well-established and newly developed drugs, which differ based on the characteristics of the disease. These treatments can be categorized into two primary groups: anti-resorptive agents and anabolic drugs. Anti-resorptive agents, such as bisphosphonates and selective estrogen receptor modulators (SERMs), are designed to inhibit bone resorption, while anabolic drugs, including parathyroid hormone (PTH) analogues, promote bone formation.[105.1] Bisphosphonates are recognized as first-line therapies, primarily functioning by inducing apoptosis in osteoclasts, which are responsible for bone resorption.[106.1] SERMs are specifically developed to minimize the adverse effects associated with estrogen therapy.[106.1] Denosumab, another anti-resorptive agent, works by inhibiting receptor activator of NF-κB ligand (RANKL), thereby reducing osteoclast activity.[106.1] The anabolic effects of PTH enhance the differentiation and growth of osteoblasts, leading to increased bone formation; however, PTH also has a catabolic effect that indirectly promotes bone resorption through RANKL secretion.[108.1] It is important to note that a single anti-osteoporosis drug may not be sufficient throughout the entire course of the disease, necessitating a long-term treatment strategy that minimizes the concurrent use of drugs with similar mechanisms of action.[106.1] Understanding the mechanisms of action of these medications is crucial for optimizing treatment strategies and tailoring them to individual patient risk factors.[105.1] Recent advancements in osteoporosis treatments have underscored the significance of patient education and support in enhancing quality of life. Individuals with osteoporosis can improve their daily living through lifestyle modifications, including exercise, proper nutrition, and mental health support.[121.1] The psychological impact of osteoporosis, which includes anxiety and fear of falls, highlights the need for effective coping strategies. These strategies may involve participation in support groups, counseling, and mindfulness practices, all of which contribute to improved mental well-being.[120.1] Furthermore, online communities, such as the Osteoporosis Online Support Community, serve as valuable platforms for individuals affected by osteoporosis to share experiences and provide mutual support, fostering a sense of community that is essential for managing the condition.[138.1]Emerging Therapies and Research
Recent advancements in the treatment of osteoporosis have led to the development of a variety of therapeutic agents that significantly improve patient management and fracture prevention. The landscape of osteoporosis therapy now includes both antiresorptive and osteoanabolic agents, allowing for targeted treatment based on individual fracture risk profiles. Antiresorptive options such as estrogens, raloxifene, bisphosphonates, and denosumab are widely used, while osteoanabolic agents like teriparatide and romosozumab have shown promising efficacy in enhancing bone formation and reducing fracture risk.[99.1] Research has identified the critical role of Wnt signaling pathways in bone health, particularly concerning osteoporosis, which is characterized by decreased bone mass, reduced bone mineral density, and an increased risk of fractures.[103.1] The Wnt signaling pathways are essential for bone development, osteoblast differentiation, and the maintenance of normal bone homeostasis.[103.1] Specifically, the non-canonical Wnt pathways, including the Wnt-planar cell polarity pathway and the Wnt-calcium pathway, have been shown to influence these processes significantly. Understanding how these pathways affect bone remodeling is vital for developing new therapeutic strategies for osteoporosis.[103.1] In addition to traditional therapies, novel small-molecule drugs are being investigated for their potential to improve bone health. These include miRNA inhibitors and cathepsin K inhibitors, which aim to modulate bone resorption and remodeling processes more effectively than existing treatments.[111.1] Furthermore, the sclerostin inhibitor romosozumab has received FDA approval and has demonstrated significant therapeutic effects in postmenopausal osteoporosis, marking a significant advancement in the management of this condition.[113.1] Emerging research highlights significant advancements in the treatment of osteoporosis, which is increasingly recognized as a preventable and treatable chronic disease rather than an inevitable consequence of aging.[116.1] Notably, new therapeutic strategies are being explored, including the senolytic compound ABT263, which has shown promise in selectively eliminating senescent bone cells and addressing osteoporosis related to Vitamin D insufficiency.[114.1] Despite these advancements, there remains a growing treatment gap for patients at high fracture risk, underscoring the need for continued innovation in this field.[117.1] The evolving understanding of osteoporosis emphasizes the importance of characterizing its pathophysiology and integrating new biomarkers for improved diagnosis and management.[97.1] Overall, these developments reflect a paradigm shift in the perception of osteoporosis, highlighting its impact on individuals and healthcare systems alike.[116.1]In this section:
Causes Of Osteoporosis
Biological Mechanisms
Osteoporosis is influenced by a complex interplay of genetic and biological mechanisms that affect bone density and strength. Research has identified numerous genetic markers associated with bone mineral density (BMD) and osteoporosis, with polymorphisms in the vitamin D receptor (VDR) gene being particularly significant as they influence the body's utilization of vitamin D, a critical nutrient for bone health.[144.1] A retrospective study involving nearly 400,000 individuals suggests that a new genetic screening method may predict low BMD, osteoporosis, and fracture risk before clinical symptoms manifest.[145.1] The heritability of bone traits is substantial, with genetic factors accounting for approximately 50% to 80% of the biological variation in bone density and other related phenotypes.[146.1] However, these genetic factors alone do not fully explain fracture risk, indicating that osteoporosis is a multifactorial disorder influenced by both genetic and environmental factors.[147.1] Genetic variations can also affect the regulation of bone remodeling, a process that involves the continuous turnover of bone tissue, and are linked to hormonal regulation, including hormones such as estrogen and testosterone that are vital for maintaining bone health.[148.1] In addition to genetic influences, aging significantly alters bone metabolism and density, increasing the risk of osteoporosis. Age-related hormonal changes, particularly the decline in estrogen levels during menopause, contribute to decreased bone mineral density and mass, making individuals more susceptible to osteoporosis.[167.1] The aging process leads to deterioration in bone composition, structure, and function, which predisposes individuals to fragility fractures.[169.1] Furthermore, age-onset osteoporosis is multifactorial, with intrinsic factors such as hormonal changes and extrinsic factors like certain medical conditions and medications playing a role.[168.1]Modifiable and Non-modifiable Risk Factors
Osteoporosis is a condition that can develop at any age, although the risk of developing the disease increases with advancing age. Several risk factors contribute to the likelihood of developing osteoporosis, including a body weight of under 128 pounds, smoking, a family history of the disease, and being of Caucasian or Asian descent. Additionally, individuals with a small body frame or those who have low dietary intake of calcium or vitamin D are at greater risk.[142.1] Women, particularly slender or thin-boned women, are especially vulnerable due to having less bone mass to lose compared to larger-boned individuals.[141.1] Other factors that may increase the risk include early menopause, low levels of physical activity, and a personal history of fractures from ground-level falls or minor trauma after the age of forty.[140.1] It is important to note that maintaining bone health can be supported by regular exercise, a diet rich in calcium, adequate vitamin D intake, cessation of smoking, and limiting alcohol consumption.[142.1] Osteoporosis is influenced by both modifiable and non-modifiable risk factors. Modifiable risk factors include lifestyle choices such as body weight, physical activity levels, smoking, and dietary habits. Individuals with a body weight of under 128 pounds, as well as those who engage in low levels of physical activity, are at a heightened risk for developing osteoporosis.[140.1] Smoking has been associated with increased bone loss, although the precise mechanisms remain under investigation.[141.1] Additionally, a diet low in calcium and vitamin D significantly elevates the risk of osteoporosis and broken bones.[139.1] To mitigate these risks, it is essential to engage in weight-bearing exercises, consume a well-balanced diet rich in calcium and vitamin D, and avoid smoking and excessive alcohol consumption.[142.1] Furthermore, slender individuals, particularly women, are at greater risk due to having less bone mass to lose compared to those with larger frames.[141.1] In some cases, healthcare providers may recommend medications to help limit the risk of bone loss and fractures, especially for individuals with a family history of osteoporosis or other significant risk factors.[142.1] Certain medical conditions and medications can also contribute to osteoporosis. For example, individuals with spinal cord injuries may experience rapid deterioration of bone mineral density shortly after their injury.[140.1] Long-term use of specific medications may also increase the likelihood of developing osteoporosis.[139.1] Therefore, understanding both modifiable and non-modifiable risk factors is essential for effective prevention and management of osteoporosis.In this section:
Diagnosis And Assessment
Diagnostic Tools and Techniques
Various diagnostic tools and techniques are employed to assess osteoporosis, with bone mineral density (BMD) measurement being the cornerstone of diagnosis. Dual-energy X-ray absorptiometry (DEXA) is widely recognized as the gold standard for comprehensive osteoporosis diagnosis and long-term monitoring, providing reliable BMD measurements that help classify patients into categories such as normal, osteopenia, or osteoporosis.[195.1] However, quantitative computed tomography (QCT) has emerged as a valuable alternative, particularly in cases where high precision is required. QCT may offer advantages in detecting osteoporosis, especially in patients with spinal degeneration, as it can avoid the overestimation of BMD that sometimes occurs with DEXA.[197.1] Screening guidelines recommend that all women aged 65 years and older, as well as men aged 70 years and older, undergo BMD testing regardless of clinical risk factors.[199.1] Additionally, postmenopausal women younger than 65 years who exhibit risk factors for osteoporosis should also be screened.[201.1] Risk factors include early menopause, chronic use of certain medications, and lifestyle factors such as smoking and excessive alcohol consumption.[182.1] The detection rates for osteoporosis can vary significantly between different imaging techniques. For instance, a study indicated that the detection rate for osteoporosis was 17.1% for DEXA compared to 46.4% for QCT, highlighting the potential for QCT to identify cases that DEXA might miss.[194.1] Furthermore, discrepancies in diagnostic outcomes between DEXA and QCT can lead to different classifications of osteoporosis severity, which may impact treatment decisions.[198.1]Bone Density Measurement
Bone mineral density (BMD) measurement is a crucial diagnostic tool used to assess bone strength and diagnose osteoporosis. The most common method for measuring BMD is dual-energy X-ray absorptiometry (DXA), which provides a reliable estimate of bone mineral content and density, helping to identify individuals at risk of fractures before they occur.[221.1] A bone density test is quick and painless, offering a snapshot of bone strength by examining segments of bone through X-rays.[223.1] The interpretation of BMD results is typically expressed as a T-score, which compares an individual's bone density to that of a healthy young adult. A T-score between -1.0 and -2.5 indicates low bone density, while a score of -2.5 or below signifies osteoporosis.[222.1] Clinicians interpret these scores in conjunction with a patient's medical history, physical examination, and risk factors to provide a comprehensive assessment of bone health.[222.1] Bone mineral density (BMD) is a critical measurement that evaluates the amount of minerals, primarily calcium and phosphorus, in bone tissue, and is essential for diagnosing osteoporosis.[225.1] Several factors can influence BMD results, including age, gender, genetics, lifestyle choices, and nutritional intake.[226.1] Adequate calcium intake is vital for building and maintaining bone density, while vitamin D plays a crucial role in calcium absorption.[224.1] Individuals should undergo a bone mineral density test when they are over age 65, have experienced early menopause, have low body weight, are undergoing long-term corticosteroid therapy, or have chronic disorders such as anorexia nervosa or liver disease.[220.1] Additionally, a history of previous fractures from minimal trauma can adversely affect bone density.[220.1] Understanding these factors is essential for clinicians to make accurate assessments and implement effective prevention strategies for maintaining strong bones.[226.1]In this section:
Prevention Strategies
Lifestyle Modifications
Lifestyle modifications are essential for preventing osteoporosis, particularly among older adults, as they play a significant role in maintaining mobility and quality of life. A well-balanced diet that includes a variety of foods—such as grains, fruits, vegetables, nonfat or low-fat dairy products, and calcium-rich foods like meat or beans—is crucial for bone health.[248.1] Additionally, it is recommended that older adults engage in at least 30 minutes of general physical activity each day, complemented by specific weight-bearing and strength-building exercises two or more times a week to effectively build and maintain bone mass.[248.1] Regular screenings to monitor bone health are also an important strategy in the prevention of osteoporosis.[249.1] By integrating these dietary and physical activity guidelines into their daily routines, older adults can significantly reduce their risk of developing osteoporosis.[249.1] Avoiding negative lifestyle habits is equally important. Smoking and excessive alcohol consumption have been linked to increased bone loss and a higher risk of fractures.[245.1] Therefore, individuals are encouraged to refrain from these behaviors to support their bone health. Additionally, maintaining a healthy weight and managing protein intake can further contribute to bone density and overall skeletal health.[247.1] For older adults, early recognition of osteoporosis and timely management through lifestyle changes can help mitigate the risk of debilitating fractures.[237.1] Incorporating these modifications into daily routines not only aids in the prevention of osteoporosis but also enhances overall quality of life and mobility.[249.1] Regular screenings to monitor bone health are also recommended to ensure that any potential issues are addressed promptly.[249.1]Nutritional Recommendations
Adequate nutrition is crucial for the prevention of osteoporosis, and specific dietary recommendations vary across different life stages. Calcium is a vital nutrient for building strong bones, with 99% of the body's calcium stored in the skeleton, making it essential for maintaining bone health throughout life.[255.1] The recommended dietary allowance (RDA) for adults over 18 years is 1000 mg/day, which increases to 1,200 mg/day for those over 70 years.[257.1] It is recommended that individuals obtain calcium primarily through food sources due to better absorption, although supplementation may be considered if dietary intake is insufficient.[257.1] In addition to calcium, protein intake plays a significant role in bone health. For individuals with osteoporosis or those at risk, a protein intake of at least 1-1.2 g/kg/day is recommended as part of a balanced diet that also includes adequate calories, calcium, and vitamin D.[258.1] High-quality animal proteins should be included in the diet to support bone strength.[258.1] Furthermore, a dietary pattern rich in fruits, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts, and legumes has been shown to positively affect bone health, contributing to better bone mineral density (BMD) and a lower risk of fractures.[259.1] It is important to recognize that misconceptions about bone health can hinder effective prevention strategies. For instance, many believe that osteoporosis is solely a concern for older adults, when in fact, the foundations for strong bones are established much earlier in life.[274.1] Additionally, while calcium is essential, it is a myth that simply increasing calcium intake guarantees bone health; a balanced diet that includes a variety of nutrients is necessary for optimal bone strength.[276.1]Complications And Management
Common Fractures and Their Impact
Common fractures associated with osteoporosis primarily include hip fractures, which are particularly severe and often require hospitalization. The consequences of a hip fracture can be dire, with approximately 20% of cases resulting in fatality. Furthermore, around 50% of individuals who suffer a hip fracture experience permanent disability, and only about 30% achieve a full recovery following the incident.[285.1] In addition to hip fractures, osteoporosis can lead to other complications such as pain, limited mobility, and a decreased quality of life. Conditions like kyphosis and depression may also be linked to osteoporosis, exacerbating the overall impact on an individual's health and well-being.[286.1] The presence of certain medications and health conditions can further elevate the risk of bone loss and the development of osteoporosis, highlighting the multifaceted nature of its complications.[286.1]Long-term Management Strategies
Long-term management of osteoporosis involves a multifaceted approach that includes lifestyle modifications, psychological support, and tailored exercise regimens. A balanced diet rich in calcium and vitamin D is essential for maintaining bone density, with recommendations to include dairy products, leafy greens, and fortified cereals in daily nutrition.[280.1] Regular weight-bearing exercises, such as walking, dancing, and low-impact aerobics, are also crucial, as they help strengthen bones and improve overall physical health.[310.1] Addressing lifestyle risk factors and appropriately treating predisposing conditions can slow the decline in bone density and prevent complications associated with osteoporosis.[282.1] However, managing osteoporosis effectively requires ongoing individualized strategies, as the disease can significantly impact various aspects of a patient's life, including daily activities and self-esteem.[281.1] The psychological impact of osteoporosis is significant, as individuals with this condition often experience elevated levels of anxiety and depression.[300.1] This relationship is complex, with various factors contributing to mental health challenges, including diminished quality of life, fear of falling, and embarrassment about changes in posture.[301.1] Chronic pain resulting from osteoporotic fractures can exacerbate emotional distress, further complicating the mental well-being of these patients.[300.1] Research indicates that focusing on personal coping resources can enhance patients' outlook and reduce the impact of pain in their lives.[298.1] Therefore, implementing evidence-based psychological strategies is essential for helping patients manage their emotional and physical challenges associated with osteoporosis. In terms of exercise, assessing an individual's readiness for specific weight-bearing activities is vital to ensure safety and effectiveness. Factors such as overall health, the extent of bone loss, and previous fracture history should be considered before initiating an exercise program.[308.1] Resistance training, when carefully tailored to the individual's condition, can also be beneficial, with studies indicating that high-intensity loading forces are particularly effective for increasing bone mineral density.[309.1]References
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[106] Osteoporosis treatment: current drugs and future developments — But a single anti-osteoporosis drug cannot be used throughout the entire disease, and a long procedure of consistent treatment should be adhered to, minimizing the combined use of drugs with the same mechanism of action. Understanding and identifying potential biomarkers and therapeutic targets at different stages of osteoporosis.
[108] Osteoporosis therapies and their mechanisms of action (Review) — Keywords: osteoporosis treatment, osteoblast, osteoclast, bone resorption, bone formation, bone remodeling, menopause, fracture Vitamin D activates this signaling pathway through VDR, and VDR signaling acts primarily on osteoblasts rather than osteoclasts, directly acting on the expression of RANKL, which is important for osteoclast production and increased bone resorption (71-73). The anabolic effect of PTH increases the differentiation and growth of osteoblasts, thereby increasing bone formation, while its catabolic effect increases bone resorption indirectly, since osteoclasts are activated by RANKL secreted by osteoblasts (146-148). 16.Dempster D, Cauley J, Bouxsein M, Cosman F (eds.) Lessons from bone histomorphometry on the mechanisms of action of osteoporosis drugs. doi: 10.1016/j.bone.2011.04.022. doi: 10.1016/j.bone.2017.08.003. doi: 10.1016/j.bone.2010.02.018. doi: 10.1016/j.bone.2009.07.082. doi: 10.1016/j.bone.2009.07.091. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. doi: 10.1016/j.bone.2017.09.021.
[109] Osteoporosis: Mechanism, Molecular Target, and Current Status on Drug ... — Anti-resorptive agents, such as bisphosphonates and SERMs, and anabolic drugs that stimulate bone formation, including PTH analogues and sclerostin inhibitors, are current treatments for osteoporosis. Six antiresorptive agents are now in clinical use : 1) bisphosphonates, which are the first line drugs in treating osteoporosis and mainly work by directly inducing osteoclasts apoptosis ; 2) estrogen for estrogen replacement therapy ; 3) selective estrogen receptor modulators (SERM), which are designed to minimize the adverse effects of estrogen ; 4) denosumab, which inhibits receptor activator of NF-κB ligand (RANKL) ; 5) eldecalcitol (1α, 25-dihydroxy-2β-[3-hydroxypropyloxy] vitamin D3), a vitamin D analogue with strong inhibitory effect on bone resorption [33-35]; and 6) calcitonin, a second line method to inhibit osteoclasts .
[111] Novel Osteoporosis Therapeutic Targets Derived from Medical ... — Since the clinical transformation of miRNA inhibitors is less difficult than lentivirus transfection, using them to affect the progress of osteoporosis is more feasible. Cathepsin K inhibitors which are involved in bone resorption in addition to remodeling, have been studied in many trials and are being investigated to find a promising one 8.
[113] Targeting strategies for bone diseases: signaling pathways and clinical ... — Romosozumab (AMG785), the pioneer sclerostin inhibitor with FDA approval, has demonstrated a tremendous therapeutic effect in postmenopausal osteoporosis. 133 Several other promising anti
[114] New developments in osteoporosis, osteoarthritis and soft tissue repair ... — The 2024 November issue of JOT brings an exciting review on biomarkers for osteoporosis development and diagnosis [].New treatment strategies for osteoporosis are emerging, Yang et al. reported the therapeutic potential of a senolytic compound ABT263 in treating osteoporosis related to Vitamin D insufficiency, by selectively eliminating senescent bone cells [].
[116] Recent advances in the pathogenesis and treatment of osteoporosis — Over recent decades, the perception of osteoporosis has changed from that of an inevitable consequence of ageing, to that of a well characterised and treatable chronic non-communicable disease, with major impacts on individuals, healthcare systems and societies. ... Recent advances in the pathogenesis and treatment of osteoporosis Clin Med
[117] Osteoporosis treatment: recent developments and ongoing challenges — Osteoporosis is an enormous and growing public health problem. Once considered an inevitable consequence of ageing, it is now eminently preventable and treatable. Ironically, despite tremendous therapeutic advances, there is an increasing treatment gap for patients at high fracture risk. In this Ser …
[120] Enhancing Quality of Life with Osteoporosis: Strategies for Emotional ... — Discover the often-overlooked psychological impact of osteoporosis, including anxiety and fear of falls. Learn effective coping strategies such as support groups, counselling, mindfulness practices, and safe physical activities to improve mental well-being and overall quality of life. Build a support network, educate yourself, and set realistic goals for managing this condition.
[121] Osteoporosis Impact on Quality of Life: Challenges and Solutions — Discover how osteoporosis impact on quality of life affects daily living and mental health. Explore strategies for better management. ... Understanding these effects and implementing strategies for management can significantly improve life quality. From lifestyle changes and medication to exercise and nutrition, there are numerous ways to cope
[138] Osteoporosis Support Groups: Finding Strength in Community — Introduction. Living with osteoporosis can be a challenging journey, but you don't have to face it alone. Osteoporosis support groups offer invaluable assistance to those dealing with this condition. These groups provide emotional support, practical advice, and a sense of community that can make a significant difference in managing osteoporosis.
[139] Osteoporosis Basics: Overview, Symptoms, and Causes — About NIAMS About NIAMS You can take steps to help prevent osteoporosis and broken bones by doing weight-bearing exercises or lifting weights, eating a well-balanced diet rich in calcium and vitamin D, not drinking too much alcohol, not smoking, and taking your medications, if prescribed. Slender, thin-boned women and men are at greater risk to develop osteoporosis. A diet low in calcium and vitamin D can increase your risk for osteoporosis and broken bones. Dieting too much or getting too little protein may also increase your risk for bone loss and osteoporosis. Long-term use of certain medications may make you more likely to develop bone loss and osteoporosis. Bone Health and Osteoporosis: What it Means to You About NIAMS
[140] Osteoporosis - StatPearls - NCBI Bookshelf — Risk factors for osteoporosis include increasing age, bodyweight of under 128 pounds, smoking, family history of osteoporosis, white or Asian race, early menopause, low levels of physical activity, and a personal history of a fracture from a ground-level fall or minor trauma after the age of forty. Patients afflicted with conditions affecting overall mobility level, such as spinal cord injuries (SCI), can experience rapid deterioration of bone mineral density levels within the first 2 weeks following these debilitating injuries. It is also indicated for patients with osteopenia (t-score between negative 1 and negative 2.5) who score on the osteoporosis risk assessment test as having a 3% or higher risk of hip fracture.
[141] Osteoporosis Causes & Symptoms | NIAMS - National Institute of ... — Osteoporosis can occur at any age, although the risk for developing the disease increases as you get older. Certain risk factors may lead to the development of osteoporosis or can increase the likelihood that you will develop the disease. Over time, your bones can weaken and your risk for osteoporosis increases. Slender, thin-boned women and men are at greater risk to develop osteoporosis because they have less bone to lose compared to larger boned women and men. Researchers are still studying if the impact of smoking on bone health is from tobacco use alone or if people who smoke have more risk factors for osteoporosis. Bone Health and Osteoporosis: What it Means to You
[142] Osteoporosis - Symptoms and causes - Mayo Clinic — Beyond these important factors which you can control, you and your provider may decide it is best to take a medication to limit your risk for bone loss and fractures. There are many other risk factors for osteoporosis, including a family history of osteoporosis, Caucasian or Asian descent, a small body frame or low dietary intake of calcium or vitamin D. The top five things to keep your bones healthy are, being active or exercising, eating calcium rich foods, getting enough vitamin D, stopping smoking and limiting alcohol. Most osteoporosis medications can help stop bone loss. Several studies have shown that calcium, combined with low daily doses of vitamin D reduces fracture risk and increases bone density.
[144] The Role of Genetic Factors in Bone Health - London Osteoporosis Clinic — Keyword: Genetic factors in bone health Research has identified numerous genetic markers associated with bone mineral density (BMD) and osteoporosis. For instance, polymorphisms in the vitamin D receptor (VDR) gene can influence how well the body utilizes vitamin D, a critical nutrient for bone health.
[145] Osteoporosis, fracture risk predicted with genetic screen — A new genetic screen may be able to predict low bone-mineral density, osteoporosis and fracture risk prior to clinical symptoms, according to a retrospective study of nearly 400,000 people by a Stanford researcher.
[146] Genetic Variation in Candidate Osteoporosis Genes, Bone Mineral Density ... — Research into the genetic basis of osteoporosis has been motivated by evidence that bone traits tend to be highly heritable. Whereas genetic factors explain 50% to 80% [ 1 - 4] of the biological variation in bone density and other bone phenotypes, these factors are not sufficient to explain fracture risk [ 5 ].
[147] Genetic Determinants of Osteoporosis: Common Bases to Cardiovascular ... — Today Scientific Community agrees that osteoporosis is a complex multifactorial disorder caused by the interaction between environmental factors and genes that singularly exert modest effects on bone metabolism and fracture risk. Studies on osteoporosis sibs and families demonstrated that genetic factors are responsible for about 60-85% of inter-individual variability of bone mineral density
[148] Understanding the Genetic Factors Behind Osteoporosis and Its Impact on ... — Genetic variations can affect the body's ability to regulate bone remodeling, a process that involves the constant turnover of bone tissue. One of the key genetic factors associated with osteoporosis is the regulation of hormones involved in bone health, including estrogen and testosterone.
[167] Estrogen and Osteoporosis: What's the Connection? - Verywell Health — Lower levels of estrogen in menopause can make you more vulnerable to osteoporosis. This condition causes decreased bone mineral density and bone mass, leading to thin and weak bones that are at risk for fracture. Osteoporosis is believed to affect about one in five women over the age of 50.
[168] Aging and Bone Metabolism - Pignolo - Wiley Online Library — Changes in bone architecture and metabolism with aging increase the likelihood of osteoporosis and fracture. Age-onset osteoporosis is multifactorial, with contributory extrinsic and intrinsic factors including certain medical problems, specific prescription drugs, estrogen loss, secondary hyperparathyroidism, microenvironmental and cellular alterations in bone tissue, and mechanical unloading
[169] Aging and bone loss: new insights for the clinician - PMC — As a result of the aging process, the bone deteriorates in composition, structure and function, which predisposes to osteoporosis. Osteoporosis is defined as deterioration in bone mass and micro-architecture, with increasing risk to fragility fractures [Raisz and Rodan, 2003]. Owing to the close relationship between the aging process of bone
[182] Screening, diagnosis and treatment of osteoporosis: a brief review — Screening and diagnosis of osteoporosis. The presence of osteoporosis should be ascertained in all women aged ≥ 65 years ().Men ≥ 65 years or women aged ≤ 65 years should be screened for the presence of risk factors such as early menopause (≤ 45 years), anorexia, smoking habit or alcohol abuse, chronic use of certain drugs or diseases associated with an increased risk for osteoporosis ().
[194] Comparison of QCT and DXA: Osteoporosis Detection Rates in ... — Results. For the entire 140 patients, the detection rate was 17.1% for DXA and 46.4% for QCT, a significant difference (P < 0.01). Of the 41 patients with conflicting diagnoses, 7 whose diagnosis by QCT was osteoporosis had vertebral fractures even though their DXA findings did not indicate osteoporosis.
[195] DEXA Scan vs. Other Bone Density Tests: Which One Should You Choose? — DEXA Scan: Best for comprehensive osteoporosis diagnosis and long-term monitoring. QCT: Suitable for cases needing high precision, though with higher radiation. pDXA & QUS: Good for initial screening but less reliable for diagnosis. Conclusion. While DEXA remains the gold standard, other tests serve valuable roles in specific situations.
[197] Comparison of QCT and DXA: Osteoporosis Detection Rates in ... — e extent of osteoporosis in these women may have been underestimated by DXA. 5. Conclusions As our study demonstrated, QCT may avoid the overestima-tion of BMD by DXA associated with spinal degeneration, AAC, and other sclerosis lesions, such as bone islands. QCT may be more sensitive for detecting osteoporosis, but this
[198] PDF — often a difference between the spine QCT result and either a previous or subsequent spine PA-DXA result. In most cases, the QCT result was a lower T-score than the DXA result and the concern is that the difference usually means classifying a patient as "osteoporotic" with QCT as opposed to "osteopenia" or even "normal"
[199] Diagnosis and management of osteoporosis in the older senior — While alendronate was most cost effective (due to generic availability), most other therapies for osteoporosis were found to be cost effective in women aged 70 years and older with osteoporosis. While guidelines recommend BMD testing in all women 65 years of age and older and men 70 years of age and older regardless of clinical risk factors
[201] Osteoporosis to Prevent Fractures: Screening - United States Preventive ... — In 2018, the USPSTF recommended screening for osteoporosis with bone measurement testing to prevent osteoporotic fractures in women 65 years or older and in postmenopausal women younger than 65 years who are at increased risk of osteoporosis, as determined by a formal clinical risk assessment tool. 45 For the current recommendation, the USPSTF
[220] Bone Mineral Density Tests: Interpreting the Results - eMedicineHealth — There are several types of bone mineral density tests, which can check the strength and solidness of the bones and diagnose osteoporosis. You should have a bone mineral density test when you are over age 65, had early menopause, low body weight, long-term corticosteroid therapy, chronic disorders (anorexia nervosa or liver disease), previous broken bones with minimal trauma, poor diet, lack of
[221] Bone Density Test, Osteoporosis Screening & T-score Interpretation — A bone density test is a measurement of how much mineral, such as calcium, you have in your bones. The most common and most versatile test is with dual-energy X-ray absorptiometry (DXA). This is used to diagnose osteoporosis BEFORE you break a bone, help to estimate your chances of breaking a bone in the future, and monitor the effectiveness of
[222] Understanding Your Bone Density Scan Results - Healthgrades — A score between -1.0 to -2.5 means you have low bone density . A score of -2.5 or below means you have osteoporosis. Your doctor will interpret your T-score in relation to your physical exam, risks, and medical history, and explain what your bone density scan results mean to you.
[223] Bone Mineral Density Test: Purpose, Procedure, and Results - WebMD — A bone mineral density test examines segments of your bone through X-rays to detect osteoporosis. The test is quick and painless, and it gives you a snapshot of how strong they are.
[224] Key Factors That Influence Bone Density - smartwellness.eu — Maintaining bone density is a balance of building bone mass early in life and minimizing bone loss in later years. Key Factors That Influence Bone Density. 1. Calcium and Vitamin D Intake. Calcium: Calcium is the most abundant mineral in bones, and adequate intake is essential for building and maintaining bone density. When the body lacks
[225] (PDF) Bone Mineral Density and Its Determinants: A ... - ResearchGate — Bone mineral density (BMD) is a measurement of the amount of minerals, primarily calcium and phosphorus, in bone tissue. Factors that can affect BMD include age, gender, genetics, lifestyle
[226] Bone Density Study 101: Everything You Need to Know — A bone density study, also known as a bone mineral density test or DEXA scan, is a diagnostic test that measures the strength and density of your bones. ... Factors That Can Affect Bone Density. Several factors can influence your bone density, both positively and negatively. ... Remember, prevention is key when it comes to maintaining strong
[237] Prevention, screening, and management of osteoporosis: an overview of ... — Measures for osteoporosis prevention should begin at childhood and include balanced nutrition, physical activity, and avoidance of risk factors such as smoking. In adulthood, early recognition of osteoporosis followed by timely and effective management can reduce fracture risk.
[245] Osteoporosis in the Elderly: Risks, Effects, and Prevention — Osteoporosis is a bone disease, meaning it’s not part of your typical aging process. Osteoporosis in older adults is caused by an imbalance in their bone remodeling process. Your bones naturally lose density as you grow older, but osteoporosis isn’t a normal part of aging. Exercising, meeting your nutritional needs, and steering clear of smoking and excessive alcohol use can help reduce your risk of this bone disease later in life. The Surgeon General’s report on bone health and osteoporosis: What it means to you. https://www.niams.nih.gov/health-topics/surgeon-generals-report-bone-health-and-osteoporosis-what-it-means-you Medically reviewed by Gerhard Whitworth, R.N. Osteoporosis is a condition that causes the bones in your body to become weak and porous. Osteoporosis is a progressive disease that affects bone density and quality, leading to a greater risk of bone fractures and reductions in quality of…
[247] Osteoporosis Prevention: 7 Steps to Help Reduce Your Risk — Osteoporosis prevention strategies can help slow down bone loss and reduce your risk of debilitating fractures. How Much Calcium and Vitamin D Do You Need to Prevent Osteoporosis? According to the International Osteoporosis Foundation, higher protein intake is associated with higher bone density, a slower rate of bone loss, and a reduced risk of hip fracture (as long as you get enough calcium). For bone health, eat a diet rich in calcium and vitamin D, do weight-bearing exercises, drink in moderation, and don’t smoke. https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/bone-smoking https://www.bones.nih.gov/health-info/bone/osteoporosis/conditions-behaviors/alcoholism Can Osteoporosis Be Reversed?Osteoporosis is a chronic condition, but certain medications and lifestyle changes can help you prevent and treat bone loss. While bone loss is common during and after menopause, certain exercises can help strengthen bones and prevent osteoporosis.
[248] Lifestyle Approaches to Promote Bone Health - Bone Health and ... — Since many nutrients are important for bone health, it is important to eat a well-balanced diet containing a variety of foods, including grains, fruits and vegetables, nonfat or low-fat dairy products or other calcium-rich foods, and meat or beans each day. In addition to meeting recommended guidelines for physical activity (at least 30 minutes a day for adults and 60 minutes for children), specific strength-and weight-bearing activities are critical to building and maintaining bone mass throughout life. General physical activity every day and some weight-bearing, strength-building, and balance-enhancing activities 2 or more times a week are generally effective for promoting bone health for most persons. Health care providers should consider prescribing a program of physical activity and balance training, with an emphasis on those activities that may help reduce risk of falling.
[249] Essential Strategies for Preventing Osteoporosis in Seniors — Preventing osteoporosis in seniors is crucial for maintaining mobility and quality of life. Essential strategies include a balanced diet rich in calcium and vitamin D, regular weight-bearing exercises, and routine screenings to monitor bone health.
[255] PDF — Nutrition and bone health throughout life Fact Sheet The big 3: key nutrients for building strong bones 1. Calcium • Vital for strong bones, calcium is a major building block of our skeleton; 99% of the 1 kg of calcium found in the average adult body resides in our bones. • Bone acts as a reservoir for maintaining calcium levels
[257] Osteoporosis: Nutrition management and prevention | Dietitians On ... — The recommended dietary allowance (RDA) for adults older than 18 years of age is 1000 mg/day. For adults over age 70, the RDA goes up to 1,200 mg/day. This should be obtained primarily through food, due to improved absorption. If the RDA cannot be met through diet alone, then vitamin supplementation can be considered. Vitamin D
[258] Dietary recommendations in the prevention and treatment of osteoporosis — In patients with osteoporosis or in the prevention of osteoporosis, we recommend a protein intake of at least 1-1.2 g/kg/day as part of a balanced diet with suitably adapted calorie, calcium and vitamin D intakes. Protein intakes should include "high quality" animal proteins.
[259] Nutrients and Dietary Patterns Related to Osteoporosis — In general, a dietary pattern with a high intake of fruit, vegetables, low-fat dairy products, whole grains, poultry, fish, nuts and legumes has been demonstrated to have a positive effect on bone health and directly associated with a better BMD and lower risk of fracture. 24.Wallace T.C., Jun S., Zou P., McCabe G.P., Craig B.A., Cauley J.A., Weaver C.M., Bailey R.L. Dairy intake is not associated with improvements in bone mineral density or risk of fractures across the menopause transition: Data from the Study of Women’s Health Across the Nation. Vitamin C intake in relation to bone mineral density and risk of hip fracture and osteoporosis: A systematic review and meta-analysis of observational studies.
[274] Bone Health Myths Debunked: Common Misconceptions About Bone Health — Debunking the Myth: It's a common misconception that bone health is only a concern for the elderly. While it's true that the risk of bone-related issues such as osteoporosis increases with age, the foundations for strong and healthy bones are laid much earlier in life. Ignoring bone health until old age can have significant consequences.
[276] Top 10 myths about osteoporosis - Better Bones, Better Body — Yes, calcium is important, but it’s a myth that simply taking a high amount of calcium will guarantee bone health and prevent osteoporosis. One of the most dangerous bone health myths is that there is no osteoporosis prevention as we age and that it is inevitable. By knowing these facts about bone health in addition to fracture and osteoporosis prevention, you can take the steps to have better bones now and for life. ← Helping children avoid the future burden of osteoporosis Dr. Susan Brown’s 2020 Predictions For Bone Health → Dr. Susan Brown, PhD, is a medical anthropologist, a New York State Certified Nutritionist, and the author of Better Bones, Better Body — the first comprehensive look at natural bone health.
[280] 10 Serious Complications Associated With Osteoporosis — Prevention and Management Strategies. Preventing complications from osteoporosis starts with lifestyle changes. A balanced diet rich in calcium and vitamin D is crucial. Foods such as dairy products, leafy greens, and fortified cereals can help maintain bone density. Regular weight-bearing exercises, like walking or dancing, also play a vital
[281] Managing Patients With Complications of Osteoporosis — Disability from osteoporosis permeates diverse areas of life ranging from basic activity of daily living to appearance and self-esteem. Only through ongoing individualized management strategies can osteoporosis be controlled. Keeping patients with this disease motivated and compliant is a great challenge, as it is in any degenerative disorder.
[282] Treating osteoporosis: risks and management - PMC — A Z-score less than -2.0 should prompt a more complete search for secondary causes of osteoporosis. Management strategies. Addressing lifestyle risk factors, appropriately treating predisposing conditions and minimising the unnecessary prescription of drugs associated with osteoporosis may slow the decline in bone density and prevent minimal
[285] Complications | Background information | Osteoporosis - NICE — Complications of osteoporosis are fragility fractures and their consequences: Hip fracture Almost always requires hospitalization. Is fatal in approximately 20% of cases. Causes permanent disability in approximately 50% of cases. Is associated with permanent recovery in only 30% of cases. Is associated with an up to 10-fold increased relative mortality risk in the year following fracture
[286] Complications of Osteoporosis and Related Conditions — Summary Osteoporosis-related complications include pain, fractures, limited mobility, and decreased quality of life. Both kyphosis and depression can be associated with osteoporosis. Certain medications and health conditions can raise the risk of bone loss and osteoporosis.
[298] Evidence-based strategies for treating chronic pain - APA Services — Research finds that focusing on the personal coping resources of patients in chronic pain can improve their outlook—and minimize the impact of pain in their lives. ... Evidence-based strategies for treating chronic pain. ... Chronic pain and psychological distress are on the rise in the United States. (CDC, 2019; Case and Deaton, 2015).
[300] 7 Signs Your Osteoporosis Might Be Affecting Your Mental Health — The relationship between osteoporosis and mental health is a complex one. Research indicates that individuals with osteoporosis often experience higher rates of anxiety and depression. Several mechanisms may explain how osteoporosis impacts mental well-being: Chronic Pain: Ongoing pain from bone fractures can lead to emotional distress.
[301] Cause or Effect? The Link Between Psychological Stress and Osteoporosis ... — An osteoporosis diagnosis may affect a patient's mental health because of diminished quality of life, fear of falling, embarrassment about posture changes, or general depression about the diagnosis; however, several recent studies have found that mental health disorders may significantly affect bone loss, contributing to osteoporosis.. Although osteoporosis and psychological stress occur via
[308] Exercising with osteoporosis: Stay active the safe way — Exercising with osteoporosis: Stay active the safe way - Mayo Clinic Exercising if you have osteoporosis means finding the safest, most enjoyable activities for you based on your overall health and amount of bone loss. Consult your health care provider before starting any exercise program for osteoporosis. Laskowski, M.D.: The bent-over row is an exercise you can do with resistance tubing to work the muscles in the back of the shoulder. If you are a Mayo Clinic patient, this could include protected health information. Mayo Clinic and our partners use technologies such as cookies to collect information from your browser to deliver relevant advertising on our site, in emails and across the Internet, personalize content and perform site analytics.
[309] Position Statement: Exercise Guidelines for Osteoporosis Management and ... — To attain the maximal benefits of resistance training in individuals with osteoporosis or osteopenia, careful manipulation of training variables, such as intensity, volume, and frequency, is required. Traditional resistance training recommendations suggest an intensity of below 60% 1-repetition maximum (1RM) in older healthy adults to improve muscular function. However, as shown in Table 2 in the articles with osteoporosis patients, participants initially performed 2 sets of 10 to 12 repetitions at 50% 1RM as a warm-up and gradually progressed to 85% of 1RM at 5 to 8 repetitions based on the patient’s condition. Concerning resistance training intensity, the majority of studies indicate that exercises generating high-intensity loading forces (70%–90% 1RM) are more effective for increasing BMD among postmenopausal women. The number of training sessions in a given period can also determine the training benefits and recovery from acute exercise, especially in the older population. For instance, Borba-Pinheiro et al.
[310] PDF — Weight-bearing and resistance exercises have many benefits. These are good activities to help with bone strength. Weight-bearing exercise means your feet and legs support your body's weight. Some examples are: • Walking • Hiking • Dancing • Low-impact aerobics • Stair climbing Walking as little as 3 to 5 miles a week can help build your