Osteoporosis Diagnosis and Treatment

Abstract

Articles that update the state of knowledge regarding osteoporosis run the risk of quickly becoming obsolete because research and studies on osteoporosis today are arousing great interest among researchers, the pharmaceutical and medical equipment industries, governments and even WHO. All orthopedists know about osteoporosis because of its most deleterious effect: osteoporotic fracture. Osteoporosis without fractures does not arouse suspicion because this is a pathological condition with a nonspecific clinical profile. Osteoporotic fractures have an economic cost (from treatment), a social cost (from its sequelae) and a medical cost (from deaths). Many fractures could be avoided through diagnosing osteoporosis prior to the first fracture and thus many temporary and permanent disabilities could be avoided and many lives saved. Awareness of the risk factors for osteoporosis raises suspicions and bone densitometry aids in diagnosis. Treatment should be based on the physiopathology of the disease. Hence, for prevention or treatment of osteoporosis, the activity of osteoclasts should be diminished or the activity of osteoblasts should be increased, or both. Treatment that reduces the incidence of fractures by improving the bone geometry and microarchitecture would be ideal. Newly formed bone tissue needs to have good cell and matrix quality, normal mineralization, a good ratio between mineralized (mechanically resistant) and non-mineralized (flexible) bone, and no accumulated damage. The ideal treatment should have a positive remodeling rate and fast and long-lasting therapeutic effects. Such effects need to be easily detectable. They need to be safe.

Primary and secondary osteoporotic fractures prophylaxis: evaluation of a prospective cohort

“…Baron et al 16 found a predominance of this type of fracture among those between 50 and 70 years, especially in females after menacme. The incidence of non-vertebral fractures in several studies is higher in the femur, radius and humerus, 17 similar to our study.…”

“…Pinheiro et al 4 show that sedentary lifestyle is among the main risk factors for low impact fractures in both genders, which may be related to poor bone quality, as well as lower neuromuscular control (with a higher incidence of falls). 17 …”

Prevalência da deficiência de vitamina D em pacientes com fraturas ocasionadas por trauma de baixa energia

“…7 Vitamin D deficiency reduces calcium absorption and, as a result, increases parathyroid hormone (PTH) levels, which increases serum calcium levels, diminishes phosphate levels, increases osteoclasts activities, and, therefore, exacerbates osteopenia and osteoporosis. 8 9 As such, evidences show that vitamin D deficiency relates to a reduction in bone mineral density even in healthy populations. Moreover, the reduced muscle strength in the elderly increases their risk of fall.…”

“…7 A deficiência da vitamina D causa diminuição da absorção de cálcio e consequentemente aumento do PTH, o que eleva o cálcio sérico e diminui o fosfato, aumenta a atividade dos osteoclastos e, portanto, exacerba a osteopenia e osteoporose. 8 9 De tal modo, evidências apontam estar relacionada a uma diminuição da densidade mineral óssea mesmo na população saudável. Além disso, nos idosos a força muscular está diminuída, o que aumenta o risco de quedas.…”

Association between bone mass and functional capacity among elderly people aged 80 years and over

“…Diminished bone mass and advanced age can be considered to be two of the main risk factors for fractures 2 . Bone fractures are one of the main causes of morbidity, mortality and hospitalization among the elderly and represent one of the biggest public health problems 3 .…”