musculoskeletal and connective tissue disorders
Osteoporosis
Key Points
Peak bone mass in men and women occurs around age 30; in women, bone loss accelerates after menopause to about 2% a year for about 10 years. Nearly all cases of osteoporosis in men and women are primary, without an identifiable cause. Suspect osteoporosis in patients who have fractures caused by unexpectedly little force (fragility fractures) of the spine, humerus, distal radius, or hip. Use DXA to measure bone mineral density in women ≥ 65 years; women between menopause and age 65 who have risk factors (eg, family history of osteoporosis, a low body mass index, and use of tobacco and/or medications with a high risk of bone loss [eg, chronic corticosteroid use]); men and women of any age who have fragility fractures; evidence on imaging studies of decreased bone mineral density or asymptomatic vertebral compression fractures; and patients at risk of secondary osteoporosis. Consider testing patients for causes of secondary bone loss if they have a Z-score ≤ -2.0, a decline in bone mineral density, an unexplained fracture while on treatment for osteoporosis, or a cause of secondary bone loss is clinically suspected. For treatment and prevention, ensure adequate intake of calcium andvitamin D, using supplements when necessary, and modify risk factors to help preserve bone mass (eg, with weight-bearing exercise and by minimizing use of alcohol and tobacco) and reduce fall risk. Medications include antiresorptives (eg, bisphosphonates, a receptor activator of nuclear factor kappa-B ligand [RANKL] inhibitor, a selectiveestrogenreceptor modulator, medications used for hormone replacement therapy) or anabolic agents such asteriparatide,abaloparatide, orromosozumab. Monitor response to treatment with DXA at appropriate intervals depending upon the specific medication regimen used. 