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Musculoskeletal Function
commonly referred to as
dowager hump.
Usually, there
is no generalized bone tenderness. When pain occurs, it
usually is related to fractures. Systemic symptoms such
as weakness and weight loss suggest that the osteoporo-
sis may be caused by underlying disease.
Diagnosis and Treatment.
An important advance in
diagnostic methods used for the identification of osteo-
porosis has been the use of BMD assessment.
20–22
The
clinical method of choice for BMD studies is dual-
energy x-ray absorptiometry (DEXA) of the spine and
hip. Measurement of serial heights in older adults is
another simple way to screen for osteoporosis. A further
advance in the diagnosis of osteoporosis is the refine-
ment of risk factors, permitting better analysis of risk
pertaining to particular persons. The U.S. Preventive
Services Task Force (USPSTF) recommends a screening
DEXA of all women 65 years of age and older, as well
as women 60 to 64 years of age who have an increased
fracture risk.
23
Although there are no USPSTF guidelines
for BMD testing in men, the National Osteoporosis
Foundation (NOF) recommends screening for all men
70 years of age and older and men 50 to 69 years of age
with risk factors.
22
Prevention and early detection of osteoporosis are
essential to the prevention of associated deformities and
fractures. It is important to identify persons in high-risk
groups so that preventive measures can begin early (see
Chart 44-1). Regular exercise and adequate calcium and
vitamin D intake are important factors in preventing
osteoporosis. Weight-bearing exercises such as walking,
jogging, rowing, and weight lifting are important in the
maintenance of bone mass. Studies have indicated that
premenopausal women need more than 1000 mg/day of
calcium, and postmenopausal women need at least 1200
mg of calcium daily.
20,22
Because most older American
women do not consume a sufficient quantity of dairy
products to meet their calcium needs, calcium supple-
mentation is recommended. A daily intake of 800 to
1000 IU of vitamin D is recommended for adults age 50
years and older. Many elderly persons are at high risk
for vitamin D deficiency, especially those with chronic
illness, malabsorption disorders (e.g., celiac disease),
and limited exposure to sunlight. It is recommended that
serum vitamin D levels be obtained for persons at risk
of a deficiency and that supplemental vitamin D be pre-
scribed for persons with low serum levels.
22
There are five main types of drugs used in the treat-
ment of osteoporosis: bisphosphonates, selective
estrogen receptor modulators (SERMs), calcitonin,
recombinant parathyroid hormone, and the RANKL
inhibitor denosumab.
24
Bisphosphonates
are effective
inhibitors of bone resorption and the most effective
agents for prevention and treatment of osteoporosis.
The bisphosphonates (e.g., alendronate, risedronate,
ibandronate, zoledronate) are analogs of endogenous
inorganic pyrophosphate that the body cannot break
down. In bone, they bind to hydroxyapatite and prevent
FIGURE 44-1.
Osteoporosis. Femoral head of an 82-year-
old woman with osteoporosis and femoral neck fracture
(right), compared with a normal control bone cut to the
same thickness (left). (From Garcia RA, Klein MJ, Schiller
AL. Bones and joints. In: Rubin R, Strayer DS, eds. Rubin’s
Pathology: Clinicopathologic Foundations of Medicine. 6th ed.
Philadelphia, PA: Wolters Kluwer Health | Lippincott Williams &
Wilkins; 2012:1226.)
Compression
fracture of
vertebrae
Dowager hump
Fracture of
distal radius
Fractured hip
Predisposition
to fractures
Decrease
in height
FIGURE 44-2.
Clinical manifestations of osteoporosis.
