Osteoporosis natural history, complications and prognosis: Difference between revisions

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=== Natural history ===
=== Natural history ===
*Symptoms of [[osteoporosis]] typically develop in the sixth decade of life. The risk of [[osteoporosis]] increases proportionately with age.
*Symptoms of [[osteoporosis]] typically develop in the sixth decade of life.
* Researchers have shown that relationship between age and decreased [[bone density]] of [[Spine (journal)|spine]] is not linear, but quadratic; in which [[bone loss]] tails off with increasing age. During the first years of the [[Postmenopausal|postmenopausal]] period, women would have a fast decrease in [[bone]] density of [[spine]] by the rate of 3.12% annually; then the rate slows down to 0.02% per square with increasing age.<ref name="pmid18305885">{{cite journal| author=Zhai G, Hart DJ, Valdes AM, Kato BS, Richards JB, Hakim A et al.| title=Natural history and risk factors for bone loss in postmenopausal Caucasian women: a 15-year follow-up population-based study. | journal=Osteoporos Int | year= 2008 | volume= 19 | issue= 8 | pages= 1211-7 | pmid=18305885 | doi=10.1007/s00198-008-0562-x | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18305885  }}</ref>
*The risk of [[osteoporosis]] increases proportionately with age.<ref name="pmid9797914">{{cite journal |vauthors=Guthrie JR, Ebeling PR, Hopper JL, Barrett-Connor E, Dennerstein L, Dudley EC, Burger HG, Wark JD |title=A prospective study of bone loss in menopausal Australian-born women |journal=Osteoporos Int |volume=8 |issue=3 |pages=282–90 |year=1998 |pmid=9797914 |doi=10.1007/s001980050066 |url=}}</ref>  
*Guthrie also mentioned that in first 3 years after [[menopause]], the rate of decreasing [[bone density]] increased annually; then with years past from [[menopause]], the rate of [[bone loss]] slowed  down.<ref name="pmid9797914">{{cite journal |vauthors=Guthrie JR, Ebeling PR, Hopper JL, Barrett-Connor E, Dennerstein L, Dudley EC, Burger HG, Wark JD |title=A prospective study of bone loss in menopausal Australian-born women |journal=Osteoporos Int |volume=8 |issue=3 |pages=282–90 |year=1998 |pmid=9797914 |doi=10.1007/s001980050066 |url=}}</ref>
*Another major factor that directly affects [[Bone mineral density|BMD]] is [[body weight]]. Women with increased body weight and [[Body mass index|body mass index (BMI)]] have more changes in their [[Bone mineral density|BMD]] in both [[hip]] and [[lumbar spine]] as they age.
*Another major factor that directly impacts changing [[Bone mineral density|BMD]] is [[body weight]]; women with increased body weight and [[Body mass index|body mass index (BMI)]] may have more change in their [[Bone mineral density|BMD]] in both [[hip]] and [[lumbar spine]], during the course of time.
*[[Bone]] site is an important factor to determine the measure of [[bone]] loss. The magnitude of [[bone density]] loss is higher at the spine (-3.12% annually) compared to the [[femoral neck]] (1.67% annually). The main proposed theory for the phenomenon is "different effect of [[estrogen]] deficiency on different [[bone]] sites".  
* Surprisingly, the [[bone]] site is an important factor to determine the measure of [[bone]] loss. The studies have found that magnitude of [[bone density]] loss is higher at the spine (-3.12% annually) compared to the [[femoral neck]] (1.67% annually). The main proposed theory for the phenomenon is "different effect of [[estrogen]] deficiency on different [[bone]] sites". On the other hand, it may show the preventive effect of weight bearing on [[hip]] [[osteoporosis]].<ref name="pmid18305885" />


* With the appropriate and timely usage of [[medications]] along with [[calcium]] and/or [[vitamin D]] supplementation, the outcome of [[osteoporosis]] is usually good. But if the disease is left untreated, or not treated optimally, results in [[Fractures|fracture]] leading to increased morbidity and mortality. The main type of [[fracture]] that influences the [[quality of life]] more and happens earlier, is the [[vertebral]] [[fracture]].<ref name="pmid9102060">{{cite journal |vauthors=Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I |title=Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis |journal=Osteoporos Int |volume=7 |issue=1 |pages=36–8 |year=1997 |pmid=9102060 |doi= |url=}}</ref>
* With the appropriate and timely usage of [[medications]] along with [[calcium]] and/or [[vitamin D]] supplementation, the outcome of [[osteoporosis]] is usually good. But if the disease is left untreated, or not treated optimally, osteoporosis results in [[Fractures|fracture]] leading to increased morbidity and mortality.  
* [[Vertebral]] [[fracture|fractures]] are more common and affect the quality of life more significantly.<ref name="pmid9102060">{{cite journal |vauthors=Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I |title=Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis |journal=Osteoporos Int |volume=7 |issue=1 |pages=36–8 |year=1997 |pmid=9102060 |doi= |url=}}</ref>


===Complications===
===Complications===
* The major probable complications of [[osteoporosis]] include:
The major complications of [[osteoporosis]] include:
** [[Fractures]]: [[hip]] and [[lumbar]] spine are among the most frequent sites of [[fracture]].
* [[Fractures]]: [[hip]] and [[lumbar]] spine are among the most frequent sites of [[fracture]].
** [[DVT|Deep venous thrombosis (DVT)]]: It can be caused by prolonged [[immobility]].
* [[DVT|Deep venous thrombosis (DVT)]]: It can be caused by prolonged [[immobility]].
** [[Kyphosis]] (Dowager's hump): Due to decreased height of anterior aspect of [[cervical]] [[vertebrae]] body (wedge shape).  
* [[Kyphosis]] (Dowager's hump): Due to decreased height of anterior aspect of [[cervical]] [[vertebrae]] body (wedge shape).  
** [[Restrictive lung disease]]: Due to decreased [[thoracic]] space, due to [[vertebrae|vertebral]] compression.
* [[Restrictive lung disease]]: Due to decreased [[thoracic]] space, due to [[vertebrae|vertebral]] compression.
 
* Apart from the risk of death and other complications, osteoporotic [[Bone fracture|fractures]] are associated with a reduced [[quality of life]] due to [[immobility]] and other emotional problems resulting from osteoporosis.<ref>{{cite journal |author=Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES |title=Impact of recent fracture on health-related quality of life in postmenopausal women |journal=J. Bone Miner. Res. |volume=21 |issue=6 |pages=809–16 |year=2006 |pmid=16753011 |doi=10.1359/jbmr.060301}}</ref>
* Apart from the risk of death and other complications, osteoporotic [[Bone fracture|fractures]] are associated with a reduced [[quality of life]] due to [[immobility]] and other emotional problems resulting from osteoporosis.<ref>{{cite journal |author=Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES |title=Impact of recent fracture on health-related quality of life in postmenopausal women |journal=J. Bone Miner. Res. |volume=21 |issue=6 |pages=809–16 |year=2006 |pmid=16753011 |doi=10.1359/jbmr.060301}}</ref>


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===Prognosis===
===Prognosis===
* Early identification of the [[Bone mineral density|bone mass density]] loss and appropriate treatment results in a good prognosis of osteoporosis.   
* Early identification of the [[Bone mineral density|bone mass density]] loss and appropriate treatment results in a good prognosis of osteoporosis.   
* The most important issue to identify the [[osteoporosis]] [[prognosis]] is [[Bone fracture|fractures]]; mainly affected by two factors:
* Osteoporotic fractures are increased by:  
**Advancing age
**Advancing age
**Low [[Bone mineral density|BMD]].
**Low [[Bone mineral density|BMD]]  
The relation consists of having about a 2-fold increase in the risk of various [[fractures]] following a decrease of [[Bone mineral density|BMD]] by every [[Standard deviation|SD]] or an increase in age by 5 years.<ref name="pmid8093403">{{cite journal |vauthors=Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM |title=Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group |journal=Lancet |volume=341 |issue=8837 |pages=72–5 |year=1993 |pmid=8093403 |doi= |url=}}</ref>
 
* When the lifetime [[Bone fracture|fracture]] at age 60 is adjusted with the death rate, it may be 44% for womean and 25% for men. The lifetime [[fracture]] risk for [[hip]] is 9% in women and 4% in men. The researchers suggest that lifetime risk of the [[hip|hip]] [[fracture]] in 60 years old women is 1 in 7 (15%); which is higher than estimated lifetime risk of [[breast cancer]] (9.3%). Similarly, [[fracture]] risk of [[hip]] and [[vertebrae]] in men (15%) is totally noticeable along with their [[prostate cancer]] risk. This means that the impact of [[osteoporosis]] and also osteoporotic [[fractures]] on public life would be worse than lot of other life threatening [[diseases]]; especially with [[aging]].<ref name="pmid17352657">{{cite journal| author=Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV| title=Residual lifetime risk of fractures in women and men. | journal=J Bone Miner Res | year= 2007 | volume= 22 | issue= 6 | pages= 781-8 | pmid=17352657 | doi=10.1359/jbmr.070315 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=17352657 }}</ref>
* The lifetime [[Bone fracture|fracture]] at age 60 adjusted with the death rate may be as high as 44% for women and 25% for men.
* Most children with [[idiopathic]] juvenile [[osteoporosis]] (IJO) experience a complete recovery of [[bone]] tissue. Although growth may be somewhat impaired during the acute phase of the disorder, normal growth resumes—and catch-up growth often occurs—afterwards. Unfortunately, in some cases, IJO can result in permanent disability such as [[kyphoscoliosis]] or collapse of the [[rib cage]].<ref name="urlJuvenile Osteoporosis">{{cite web |url=https://www.niams.nih.gov/health_info/bone/Bone_Health/Juvenile/juvenile_osteoporosis.asp |title=Juvenile Osteoporosis |format= |work= |accessdate=}}</ref>
* The lifetime [[fracture]] risk for [[hip]] is 9% in women and 4% in men.  
* Similarly, [[fracture]] risk of [[hip]] and [[vertebrae]] in men (15%) is totally noticeable along with their [[prostate cancer]] risk.  
* Most children with [[idiopathic]] juvenile [[osteoporosis]] (IJO)&nbsp;experience a complete recovery of [[bone]] tissue. Although growth may be somewhat impaired during the acute phase of the disorder, normal growth resumes and catch-up growth often occurs afterwards.
* In some cases, IJO can result in permanent disability such as [[kyphoscoliosis]] or collapse of the [[rib cage]].<ref name="urlJuvenile Osteoporosis">{{cite web |url=https://www.niams.nih.gov/health_info/bone/Bone_Health/Juvenile/juvenile_osteoporosis.asp |title=Juvenile Osteoporosis |format= |work= |accessdate=}}</ref>
 
==Monitoring==
Suggested follow-up:<ref name="pmid22256806">{{cite journal| author=Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY | display-authors=etal| title=Bone-density testing interval and transition to osteoporosis in older women. | journal=N Engl J Med | year= 2012 | volume= 366 | issue= 3 | pages= 225-33 | pmid=22256806 | doi=10.1056/NEJMoa1107142 | pmc=3285114 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22256806 }} [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=22782920 Review in: Evid Based Med. 2013 Feb;18(1):e7]  [https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=&cmd=prlinks&id=23000664 Review in: J Fam Pract. 2012 Sep;61(9):555-6] </ref>
* Normal (T score, −1.00 or higher)- 15 years
* Mild osteopenia (T score, −1.01 to −1.49) - 15 years
* Moderate osteopenia (T score, −1.50 to −1.99) - 5 years
* Advanced osteopenia (T score, -2.00 to −2.49) - 1 year


==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
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Latest revision as of 14:57, 1 June 2023

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2]

Overview

If left untreated, most of the patients with osteoporosis develop fractures. With the appropriate and timely usage of medications along with calcium and/or vitamin D supplementation, the outcome of osteoporosis is usually good. Apart from the risk of death and other complications, osteoporotic fractures are associated with deep venous thrombosis, kyphosis, and a reduced quality of life due to immobility.

Natural History, Complications, and Prognosis

Natural history

  • Symptoms of osteoporosis typically develop in the sixth decade of life.
  • The risk of osteoporosis increases proportionately with age.[1]
  • Another major factor that directly affects BMD is body weight. Women with increased body weight and body mass index (BMI) have more changes in their BMD in both hip and lumbar spine as they age.
  • Bone site is an important factor to determine the measure of bone loss. The magnitude of bone density loss is higher at the spine (-3.12% annually) compared to the femoral neck (1.67% annually). The main proposed theory for the phenomenon is "different effect of estrogen deficiency on different bone sites".
  • With the appropriate and timely usage of medications along with calcium and/or vitamin D supplementation, the outcome of osteoporosis is usually good. But if the disease is left untreated, or not treated optimally, osteoporosis results in fracture leading to increased morbidity and mortality.
  • Vertebral fractures are more common and affect the quality of life more significantly.[2]

Complications

The major complications of osteoporosis include:

  • Apart from the risk of death and other complications, osteoporotic fractures are associated with a reduced quality of life due to immobility and other emotional problems resulting from osteoporosis.[3]

Fracture risk

Fracture risk categories in glucocorticoid-treated patients are listed in the table below.[4]

Adults ≥ 40 years of age Adults <40 years of age
High fracture risk
Moderate fracture risk
  • FRAX 10-year risk of major osteoporotic fracture 10–19%
  • FRAX 10-year risk of hip fracture >1% and <3%

or

and

Low fracture risk
  • FRAX 10-year risk of major osteoporotic fracture <10%

Prognosis

  • Early identification of the bone mass density loss and appropriate treatment results in a good prognosis of osteoporosis.
  • Osteoporotic fractures are increased by:
    • Advancing age
    • Low BMD
  • The lifetime fracture at age 60 adjusted with the death rate may be as high as 44% for women and 25% for men.
  • The lifetime fracture risk for hip is 9% in women and 4% in men.
  • Similarly, fracture risk of hip and vertebrae in men (15%) is totally noticeable along with their prostate cancer risk.
  • Most children with idiopathic juvenile osteoporosis (IJO) experience a complete recovery of bone tissue. Although growth may be somewhat impaired during the acute phase of the disorder, normal growth resumes and catch-up growth often occurs afterwards.
  • In some cases, IJO can result in permanent disability such as kyphoscoliosis or collapse of the rib cage.[5]

Monitoring

Suggested follow-up:[6]

  • Normal (T score, −1.00 or higher)- 15 years
  • Mild osteopenia (T score, −1.01 to −1.49) - 15 years
  • Moderate osteopenia (T score, −1.50 to −1.99) - 5 years
  • Advanced osteopenia (T score, -2.00 to −2.49) - 1 year

References

  1. ↑ Guthrie JR, Ebeling PR, Hopper JL, Barrett-Connor E, Dennerstein L, Dudley EC, Burger HG, Wark JD (1998). "A prospective study of bone loss in menopausal Australian-born women". Osteoporos Int. 8 (3): 282–90. doi:10.1007/s001980050066. PMID 9797914.
  2. ↑ Lips P, Cooper C, Agnusdei D, Caulin F, Egger P, Johnell O, Kanis JA, Liberman U, Minne H, Reeve J, Reginster JY, de Vernejoul MC, Wiklund I (1997). "Quality of life as outcome in the treatment of osteoporosis: the development of a questionnaire for quality of life by the European Foundation for Osteoporosis". Osteoporos Int. 7 (1): 36–8. PMID 9102060.
  3. ↑ Brenneman SK, Barrett-Connor E, Sajjan S, Markson LE, Siris ES (2006). "Impact of recent fracture on health-related quality of life in postmenopausal women". J. Bone Miner. Res. 21 (6): 809–16. doi:10.1359/jbmr.060301. PMID 16753011.
  4. ↑ Buckley, Lenore; Guyatt, Gordon; Fink, Howard A.; Cannon, Michael; Grossman, Jennifer; Hansen, Karen E.; Humphrey, Mary Beth; Lane, Nancy E.; Magrey, Marina; Miller, Marc; Morrison, Lake; Rao, Madhumathi; Robinson, Angela Byun; Saha, Sumona; Wolver, Susan; Bannuru, Raveendhara R.; Vaysbrot, Elizaveta; Osani, Mikala; Turgunbaev, Marat; Miller, Amy S.; McAlindon, Timothy (2017). "2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis". Arthritis & Rheumatology. 69 (8): 1521–1537. doi:10.1002/art.40137. ISSN 2326-5191.
  5. ↑ "Juvenile Osteoporosis".
  6. ↑ Gourlay ML, Fine JP, Preisser JS, May RC, Li C, Lui LY; et al. (2012). "Bone-density testing interval and transition to osteoporosis in older women". N Engl J Med. 366 (3): 225–33. doi:10.1056/NEJMoa1107142. PMC 3285114. PMID 22256806. Review in: Evid Based Med. 2013 Feb;18(1):e7 Review in: J Fam Pract. 2012 Sep;61(9):555-6

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