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Published Online: 10 July 2014

Osteoporosis Prevention, Screening, and Treatment: A Review

Publication: Journal of Women's Health
Volume 23, Issue Number 7

Abstract

Osteoporosis, defined as low bone mass leading to increased fracture risk, is a major health problem that affects approximately 10 million Americans. The aging U.S. population is predicted to contribute to as much as a 50% increase in prevalence by 2025. Although common, osteoporosis can be clinically silent, and without prevention and screening, the costs of osteoporotic fracture–related morbidity and mortality will burden the U.S. healthcare system. This is a particularly relevant concern in the context of diminishing health care resources. Dual-energy X-ray absorptiometry is the most widely used, validated technique for measuring bone mineral density (BMD) and diagnosing osteoporosis. Cost-effectiveness analyses support early detection and treatment of high-risk patients with antiresorptive medications such as bisphosphonates. Moreover, optimization of bone health throughout life can help prevent osteoporosis. Current guidelines recommend screening women by age 65 years, but because no guidelines for screening intervals exist, decisions are made on the basis of clinical judgment alone. Although the recent literature provides some guidance, this review further explores current recommendations in light of newer evidence to provide more clarity on prevention, screening, and management strategies for patients with osteoporosis in the primary care setting.

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References

1.
National Osteoporosis Foundation. America's bone health: The state of osteoporosis and low bone mass in our nation. Washington, DC: The Foundation, 2002;1–55.
2.
Burge R, Dawson-Hughes B, Solomon DH, Wong JB, King A, Tosteson A. Incidence and economic burden of osteoporosis-related fractures in the United States, 2005–2025. J Bone Miner Res 2007;22:465–475.
3.
National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. Washington, DC: National Osteoporosis Foundation, 2010;1–56.
4.
Johnell O, Kanis J. Epidemiology of osteoporotic fractures. Osteoporos Int 2005;16:S3–S7.
5.
World Health Organization. WHO Scientific Group on the assessment of osteoporosis at primary health care level: Summary meeting report; May 5–7, 2004, Brussels, Belgium. Geneva, Switzerland: World Health Organization, 2007;1–17.
6.
McCloskey EV, Vasireddy S, et al. Vertebral fracture assessment (VFA) with a densitometer predicts future fractures in elderly women unselected for osteoporosis. J Bone Miner Res 2008;23:1561–1568.
7.
World Health Organization (WHO) Study Group. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report No. 843. Geneva, Switzerland: World Health Organization, 1994;1–134.
8.
Lewiecki EM, Watts NB, McLund MR, et al. Official positions of the International Society for Clinical Densitometry. JCEM 2004;89:3651–3655.
9.
Osteoporosis prevention, diagnosis, and therapy. NIH Consensus Statement. 2000;17:1–45.
10.
Howe TE, Shea B, Dawson LJ, et al. Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database Syst Rev 2011;7:CD000333.
11.
The North American Menopause Society (NAMS). Management of osteoporosis in postmenopausal women: 2010 position statement of The North American Menopause Society. Menopause 2010:17;23–24.
12.
Lim LS, Hoeksema LJ, Sherin K; ACPM Prevention Practice Committee. Screening for osteoporosis in the adult U.S. population: ACPM position statement on preventive practice. Am J Prev Med 2009;36:366–375.
13.
U.S. Preventive Services Task Force. Screening for osteoporosis: U.S. preventive services task force recommendation statement. Ann Intern Med 2011;154:356–364.
14.
Florence R, Allen S, Benedict L, Compo R, Jensen A, Kalogeropoulou D, et al. Diagnosis and treatment of osteoporosis. Bloomington, MN: Institute for Clinical Systems Improvement, 2013.
15.
Gourlay ML, Fine JP, Preisser JS, et al. Study of Osteoporotic Fractures Research Group. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 2012;366:225–233.
16.
U.S. Preventive Services Task Force (USPSTF). Vitamin D and calcium supplementation to prevent fractures. Rockville, MD: USPSTF, 2013. Available at: www.uspreventiveservicestaskforce.org/uspstf/uspsvitd.htm Accessed May 2013.
17.
Institute of Medicine (IOM). Dietary reference intakes for calcium and vitamin D. Washington DC: National Academy of Sciences, 2010. Available at: www.iom.edu/Reports/2010/Dietary-Reference-Intakes-for-Calcium-and-Vitamin-D.aspx Accessed August 2012.
18.
Standing Committee on the Scientific Evaluation of Dietary Reference Intakes. Dietary reference intakes for calcium, phosphorus, magnesium, vitamin D, and fluoride. Washington, DC: National Academy of Sciences, 1997.
19.
Cranney A, Weiler HA, O'Donnell S, Puil L. Summary of evidence-based review on vitamin D efficacy and safety in relation to bone health. Am J Clin Nutr 2008;88:513S–519S.
20.
Foley KF, Boccuzzi L. Urine calcium: laboratory measurement and clinical utility. Lab Med 2010;41:683–686.
21.
Jackson RD, LaCroix AZ, Gass M, et al.; Women's Health Initiative Investigators. Calcium plus vitamin D supplementation and the risk of fractures. N Engl J Med. 2006;354:669–683 Erratum in: N Engl J Med. 2006;354:1102.
22.
Vacek JL, Vanga SR, Good M, Lai SM, Lakkireddy D, Howard PA. Vitamin D deficiency and supplementation and relation to cardiovascular health. Am J Cardiol 2012;109:359–363.
23.
Wang TJ, Pencina MJ, Booth SL, et al. Vitamin D deficiency and risk of cardiovascular disease. Circulation 2008;117:503–511.
24.
Lutsey PL, Michos ED. Vitamin D, calcium, and atherosclerotic risk: Evidence from serum levels and supplementation studies. Curr Atheroscler Rep 2013;15:293.
25.
LaCroix AZ, Kotchen J, Anderson G, et al. Calcium plus vitamin D supplementation and mortality in postmenopausal women: The Women's Health Initiative calcium-vitamin D randomized controlled trial. J Gerontol A Biol Sci Med Sci 2009;64:559–567.
26.
Cauley JA, Chlebowski RT, Wactawski-Wende J, et al. Calcium plus vitamin D supplementation and health outcomes five years after active intervention ended: The Women's Health Initiative. J Womens Health (Larchmt) 2013;22:915–929.
27.
Michaelsson K, Melhus H, Warensjo Lemming E, Wolk A, Byberg L. Long term calcium intake and rates of all cause and cardiovascular mortality: Community based prospective longitudinal cohort study. BMJ 2013;346:f228.
28.
Rossouw JE, Anderson GL, Prentice RL, et al.; Writing Group for the Women's Health Initiative Investigators. Risks and benefits of estrogen plus progestin in healthy postmenopausal women: Principal results From the Women's Health Initiative randomized controlled trial. JAMA 2002;288:321–333.
29.
Chung M, Balk EM, Brendel M, et al. Vitamin D and calcium: A systematic review of health outcomes. Evidence Reports/Technology Assessments, No. 183. Rockville, MD: Agency for Healthcare Research and Quality, 2009.
30.
Dawson-Hughes B, Harris SS, Krall EA, Dallal GE. Effect of calcium and vitamin D supplementation on bone density in men and women 65 years of age or older. N Engl J Med 1997;337:670–676.
31.
Chapuy MC, Arlot ME, Duboeuf F, et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637–1642.
32.
Tucker KL, Jugdaohsingh R, Powell JJ, et al. Effects of beer, wine, and liquor intakes on bone mineral density in older men and women. Am J Clin Nutr 2009;89:1188–1196.
33.
Sommer I, Erkkila AT, Jarvinen R, et al. Alcohol consumption and bone mineral density in elderly women. Public Health Nutr 2013;16:70–7–12.
34.
Kanis JA, Hans D, Cooper C, et al; Task Force of the FRAX Initiative. Interpretation and use of FRAX in clinical practice. Osteoporos Int 2011;22:2395–411.
35.
Abrahamsen B. Screening: FRAX in clinical practice. Nat Rev Rheumatol 2011;7:686–688.
36.
Cummings SR, Bates D, Black DM. Clinical use of bone densitometry: scientific review. JAMA 2002;288:1889–1897 Erratum in: JAMA 2002;288:2825.
37.
Kern LM, Powe NR, Levine MA, et al. Association between screening for osteoporosis and the incidence of hip fracture. Ann Intern Med 2005;142:173–181.
38.
Cummings SR, Black DM, Nevitt MC, et al. Bone density at various sites for prediction of hip fractures: The study of Osteoporotic Fractures Research Group. Lancet 1993;341:72–75.
39.
Leslie WD, Tsang JF, Caetano PA, Lix LM; Manitoba Bone Density Program. Effectiveness of bone density measurement for predicting osteoporotic fractures in clinical practice. J Clin Endocrinol Metab 2007;92:77–81.
40.
MacLean C, Newberry S, Maglione M, et al. Systematic review: comparative effectiveness of treatments to prevent fractures in men and women with low bone density or osteoporosis. Ann Intern Med. 2008;148:197–213.
41.
Hillier TA, Stone KL, Bauer DC, et al. Evaluating the value of repeat bone mineral density measurement and prediction of fractures in older women: The study of osteoporotic fractures. Arch Intern Med 2007;167:155–160.
42.
Frost SA, Nguyen ND, Center JR, Eisman JA, Nguyen TV. Timing of repeat BMD measurements: Development of an absolute risk-based prognostic model. J Bone Miner Res 2009;24:1800–1807.
43.
Nayak S, Roberts MS, Greenspan SL. Cost-effectiveness of different screening strategies for osteoporosis in postmenopausal women. Ann Intern Med. 2011;155:751–761.
44.
Hosking D, Adami S, Felsenberg D, et al. Comparison of change in bone resorption and bone mineral density with once-weekly alendronate and daily risedronate: a randomised, placebo-controlled study. Curr Med Res Opin 2003;19:383–394.
45.
Downs RW Jr, Bell NH, Ettinger MP, et al. Comparison of alendronate and intranasal calcitonin for treatment of osteoporosis in postmenopausal women. J Clin Endocrinol Metab 2000;85:1783–1788.
46.
Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev 2008;1:CD001155.
47.
Anastasilakis AD, Goulis DG, Kita M, Avramidis A. Oral bisphosphonate adverse effects in 849 patients with metabolic bone diseases. Hormones (Athens) 2007;6:233–241.
48.
Lewiecki EM. Current and emerging pharmacologic therapies for the management of postmenopausal osteoporosis. J Womens Health (Larchmt) 2009;18:1615–1626.
49.
Munoz-Torres M, Alonso G, Raya MP. Calcitonin therapy in osteoporosis. Treat Endocrinol 2004;3:117–132.
50.
Cummings SR, San Martin J, McClung MR, et al; FREEDOM Trial. Denosumab for prevention of fractures in postmenopausal women with osteoporosis. N Engl J Med 2009;361:756–765 Erratum in: N Engl J Med. 2009;361:1914.
51.
Rimes KA, Salkovskis PM. Prediction of psychological reactions to bone density screening for osteoporosis using a cognitive-behavioral model of health anxiety. Behav Res Ther 2002;40:359–381.
52.
Wainwright SA, Marshall LM, Ensrud KE, et al; Study of Osteoporotic Fractures Research Group. Hip fracture in women without osteoporosis. J Clin Endocrinol Metab 2005;90:2787–2793.
53.
Schuit SC, van der Klift M, Weel AE, et al. Fracture incidence and association with bone mineral density in elderly men and women: The Rotterdam Study. Bone 2004;34:195–202 Erratum in: Bone 2006;34:603.
54.
Brown JP, Josse1 RG; Scientific Advisory Council of the Osteoporosis Society of Canada. 2002 clinical practice guidelines for the diagnosis and management of osteoporosis in Canada. CMAJ 2002;167:S1–S34. Errata in: CMAJ. 2003;168:400. CMAJ 2003;168:676 CMAJ 2003;167:544.
55.
Osteoporosis: Review of the evidence for prevention, diagnosis and treatment and cost-effectiveness analysis: Executive summary. Osteoporos Int 1998;8:S3–S6.
56.
Nelson HD, Haney EM, Dana T, Bougatsos C, Chou R. Screening for osteoporosis: an update for the U.S. Preventive Services Task Force. Ann Intern Med 2010;153:99–111.
57.
Lenart BA, Lorich DG, Lane JM. Atypical fractures of the femoral diaphysis in postmenopausal women taking alendronate. N Engl J Med 2008;358:1304–1306.
58.
Giusti A, Hamdy NA, Papapoulos SE. Atypical fractures of the femur and bisphosphonate therapy: A systematic review of case/case series studies. Bone 2010;47:169–180.
59.
Girgis CM, Seibel MJ. Atypical femur fractures: a review of the evidence and its implication to clinical practice. Ther Adv Musculoskelet Dis 2011;3:301–314.
60.
McClung M, Harris ST, Miller PD, Bauer DC, Davison KS, Dian L, et al. Bisphosphonate therapy for osteoporosis: Benefits, risks, and drug holiday. Am J Med 2013;126:13–20.
61.
Komm BS, Chines AA. An update on selective estrogen receptor modulators for the prevention and treatment of osteoporosis. Maturitas 2012;71:221–226.
62.
Siminoski K, Josse RG. Prevention and management of osteoporosis: Consensus statements from the Scientific Advisory Board of the Osteoporosis Society of Canada: 9, calcitonin in the treatment of osteoporosis. CMAJ 1996;155:962–965.
63.
In brief: Cancer risk with salmon calcitonin. Med Lett Drugs Ther 2013;55:29.
64.
Krum SA, Brown M. Unraveling estrogen action in osteoporosis. Cell Cycle 2008;7:1348–1352.
65.
Peterson JA. Osteoporosis overview. Geriatr Nurs 2001;22:17–21.
66.
Bergmann P, Body JJ, Boonen S, et al; Members of Advisory Board on Bone Markers. Evidence-based guidelines for the use of biochemical markers of bone turnover in the selection and monitoring of bisphosphonate treatment in osteoporosis: A consensus document of the Belgian Bone Club. Int J Clin Pract 2009;63:19–26.
67.
Vasikaran SD. Utility of biochemical markers of bone turnover and bone mineral density in management of osteoporosis. Crit Rev Clin Lab Sci 2008;45:221–258.
68.
Lee J, Vasikaran S. Current recommendations for laboratory testing and use of bone turnover markers in management of osteoporosis. Ann Lab Med 201232:105–112. Erratum in: Ann Lab Med 2012;32:242.
69.
National Osteoporosis Foundation (NOF). Learn about osteoporosis. Washington, DC: National Osteoporosis Foundation. Available from: www.nof.org/node/40 Accessed August15, 2012.
70.
Looker AC, Johnston CC Jr, Wahner HW, et al. Prevalence of low femoral bone density in older U.S. women from NHANES III. J Bone Miner Res 1995;10:796–802.
71.
Hamrick I, Cao Q, Agbafe-Mosley D, Cummings DM. Osteoporosis healthcare disparities in postmenopausal women. J Womens Health (Larchmt) 2012;21:1232–1236.

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Information

Published In

cover image Journal of Women's Health
Journal of Women's Health
Volume 23Issue Number 7July 2014
Pages: 563 - 572
PubMed: 24766381

History

Published online: 10 July 2014
Published in print: July 2014
Published ahead of print: 25 April 2014

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Affiliations

Juliana M. Kling
Department of Internal Medicine, Mayo Clinic Hospital, Phoenix, Arizona.
Bart L. Clarke
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.
Nicole P. Sandhu
Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota.

Notes

Address correspondence to:Nicole P. Sandhu, MDDepartment of Internal MedicineMayo Clinic200 First Street SouthwestRochester, MN 55905E-mail: [email protected]

Disclosure Statement

No competing financial interests exist.

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