Abstract
Osteoporosis is the most frequent metabolic bone disease. It is characterized by decreased bone strength and bone fractures and consequently decreased quality of life with increased morbidity and mortality. It affects the population of postmenopausal women and older people of both gender, but also patients with other primary diseases. Modern diagnostic procedures such as bone mineral density measurement, trabecular bone score (TBS) measurement, and fracture assessment risk score (FRAX) enable early diagnosis and treatment in high-risk patients. The complex etiology and pathophysiology of osteoporosis require secondary causes to be differentiated from primary osteoporosis before the most optimal treatment is initiated. The treatment should be personalized. Two methods of treatment are antiresorptive treatment aimed toward the inhibition of bone degradation and anabolic treatment with stimulation of new bone formation. Ideally, the prevention of fractures should be the treatment of choice, otherwise, prevention of new fractures and improvement of life is the therapeutic goal. Bisphosphonates are the first line antiresorptive treatment together with denosumab, a monoclonal human antibody against RANK ligand (receptor activator of nuclear factor kappa B). Teriparatide, an N-terminal parathormone fragment, is the dominant anabolic drug. Vitamin D deficiency is a widespread problem and contributes to bone mass decrement and increased risk for fractures. With further advancements in understanding the biology of bone tissue, new therapeutic agents are expected in the treatment of patients with osteoporosis.
Publisher
Centre for Evaluation in Education and Science (CEON/CEES)
Reference20 articles.
1. Compston JE, McClung MR, Leslie WD. Osteoporosis. Lancet. 2019 Jan 26;393(10169):364-76;
2. Black DM, Rosen CJ. Postmenopausal Osteoporosis. N Engl J Med. 2016 May 26;374(21):2096-7;
3. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001 Feb 14;285(6):785-95;
4. LeBoff MS, Greenspan SL, Insogna KL, Lewiecki EM, Saag KG, Singer AJ, et al. The clinician's guide to prevention and treatment of osteoporosis. Osteoporos Int. 2022 Oct;33(10):2049-102;
5. Kanis JA on behalf of the World Health Organization Scientific Group (2007) Assessment of osteoporosis at the primary health-care level. Technical Report. World Health Organization Collaborating Centre for Metabolic Bone Diseases, University of Sheffield, UK. 2007: Printed by the University of Sheffield;