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Osteoporosis

Osteoporosis is a common (>10% of Americans over age 50 in 2010) systemic condition characterized by low bone mass. The reduction in bone mass increases bone fragility and fracture risk. Although any bone can be fractured, certain bones are fractured more commonly and lead to reduced quality of life and increased risk of death. For example, in one study, it was determined that the risk of death in the first year following hip fracture was double that of patients who did not fracture their hip. Because of the prevalence and the associated risk, the United States Preventive Services Task Force recommends that all women over the age of 65 and younger women as well as all men at elevated risk of osteoporosis undergo screening. Osteoporosis screening starts with a thorough history and physical exam to assess risk factors such as family history, body habitus, medication use, smoking history and past medial history. Many patients will then undergo a Dual Energy X-Ray Absorptiometry (DXA) which is essentially a special type of xray that allows for calculation of bone mineral density (BMD). Based on the bone mineral density the therapeutic plan can be implemented. Like many other chronic conditions, the first steps in treating osteoporosis include lifestyle modifications. Maintaining a healthy weight is pivotal to reducing fracture risk as is smoking cessation and avoiding excessive alcohol use. Physical activity also has benefits on osteoporosis beyond weight management. Some patients may also need calcium and vitamin D supplementation and some may need medications such as alendronate which slow bone breakdown.

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Reference:
Ensrud KE and Crandall CJ. In The Clinic: Osteoporosis. Ann Intern Med. 2017 Aug 1; 167 (3)