Osteoporosis natural history, complications and prognosis: Difference between revisions
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==Overview== | ==Overview== | ||
If left untreated, most of patients with [[Osteoporosis]] may progress to develop [[fracture]]. With appropriate and timely usage of [[medications]] along with [[calcium]] and/or [[vitamin D]] supplementation, the outcome of [[osteoporosis]] is usually good. Apart from risk of death and other complications, osteoporotic [[fractures]] are associated with a reduced [[quality of life]] due to [[immobility]]; [[emotional]] problems may also | If left untreated, most of the patients with [[Osteoporosis]] may progress to develop a [[fracture]]. 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 a reduced [[quality of life]] due to [[immobility]]; [[emotional]] problems may also arise as a consequence. As studies suggested, the impact of [[osteoporosis]] and also osteoporotic [[fractures]] on public life would be worse than lots of life threatening [[diseases]]; especially with [[aging]]. | ||
==Natural history, complications, and prognosis== | ==Natural history, complications, and prognosis== | ||
=== Natural history === | === Natural history === | ||
* Typically, symptoms of [[osteoporosis]] are developed in the sixth decade of life. The risk of getting [[osteoporosis]] is increased proportionately with age. | * Typically, symptoms of [[osteoporosis]] are developed in the sixth decade of life. The risk of getting [[osteoporosis]] is increased proportionately with age. | ||
* Researchers have shown that relationship between lowering [[bone density]] of [[Spine (journal)|spine]] and age is not linear, but quadratic; in which [[bone loss]] tailing off when age raised. During the first years of [[Postmenopausal| | * Researchers have shown that relationship between lowering [[bone density]] of [[Spine (journal)|spine]] and age is not linear, but quadratic; in which [[bone loss]] tailing off when age raised. 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 slowed down to 0.02% per square age increased.<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> | ||
* However, 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]] will slow 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> | * However, 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]] will slow 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> | ||
* One another major factor that directly | * One another major factor that directly impacts changing [[Bone mineral density|BMD]] is [[body weight]]; women with heavier weight and also higher [[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 time. | ||
* 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 spine (-3.12% annually) compared to [[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" /> | * 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 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 left untreated, or not favorably treated, the clinical consequence would be [[Fractures|fracture]] and the [[morbidity]] that happen thereafter. The main type of [[fracture]] that | * 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 left untreated, or not favorably treated, the clinical consequence would be the [[Fractures|fracture]] and the [[morbidity]] that happen thereafter. The main type of [[fracture]] that influences the [[quality of life]] more and happened 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> | ||
===Complications=== | ===Complications=== | ||
| Line 21: | Line 21: | ||
** [[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): The main reason could be decreasing the height of anterior aspect of [[cervical]] [[vertebrae]] body (wedge shape). | ** [[Kyphosis]] (Dowager's hump): The main reason could be decreasing the height of anterior aspect of [[cervical]] [[vertebrae]] body (wedge shape). | ||
** [[Restrictive lung disease]]: Because of decreasing [[thoracic]] space, due to [[vertebrae]] | ** [[Restrictive lung disease]]: Because of decreasing [[thoracic]] space, due to [[vertebrae|vertebral]] compression. | ||
* Apart from risk of death and other complications, osteoporotic [[Bone fracture|fractures]] are associated with a reduced [[quality of life]] due to [[immobility]]; emotional problems may also | * Apart from the risk of death and other complications, osteoporotic [[Bone fracture|fractures]] are associated with a reduced [[quality of life]] due to [[immobility]]; emotional problems may also arise as a consequence.<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> | ||
=== Fracture risk === | === Fracture risk === | ||
[[Fracture]] risk categories in [[glucocorticoid]]-treated patients | [[Fracture]] risk categories in [[glucocorticoid]]-treated patients are listed in the table below.<ref name="BuckleyGuyatt2017">{{cite journal|last1=Buckley|first1=Lenore|last2=Guyatt|first2=Gordon|last3=Fink|first3=Howard A.|last4=Cannon|first4=Michael|last5=Grossman|first5=Jennifer|last6=Hansen|first6=Karen E.|last7=Humphrey|first7=Mary Beth|last8=Lane|first8=Nancy E.|last9=Magrey|first9=Marina|last10=Miller|first10=Marc|last11=Morrison|first11=Lake|last12=Rao|first12=Madhumathi|last13=Robinson|first13=Angela Byun|last14=Saha|first14=Sumona|last15=Wolver|first15=Susan|last16=Bannuru|first16=Raveendhara R.|last17=Vaysbrot|first17=Elizaveta|last18=Osani|first18=Mikala|last19=Turgunbaev|first19=Marat|last20=Miller|first20=Amy S.|last21=McAlindon|first21=Timothy|title=2017 American College of Rheumatology Guideline for the Prevention and Treatment of Glucocorticoid-Induced Osteoporosis|journal=Arthritis & Rheumatology|volume=69|issue=8|year=2017|pages=1521–1537|issn=23265191|doi=10.1002/art.40137}}</ref> | ||
{| class="wikitable" | {| class="wikitable" | ||
! | ! | ||
| Line 61: | Line 61: | ||
===Prognosis=== | ===Prognosis=== | ||
* | * 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 include advancing age and low [[Bone mineral density|BMD]]. The relation is consist of having about 2-fold increase in risk of various [[fractures]] following every [[Standard deviation|SD]] lowering of [[Bone mineral density|BMD]] or 5 years age advance.<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> | * The most important issue to identify the [[osteoporosis]] [[prognosis]] is [[Bone fracture|fractures]]; mainly affected by two factors include advancing age and low [[Bone mineral density|BMD]]. The relation is consist of having about a 2-fold increase in the risk of various [[fractures]] following every [[Standard deviation|SD]] lowering of [[Bone mineral density|BMD]] or 5 years age advance.<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 [[Bone fracture|fracture]] | * 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 [[fracture]] risk o[[fracture|the]] [[hip|hipip]] 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 lots of 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> | ||
* 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—afterward. 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> | * 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—afterward. 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> | ||
==References== | ==References== | ||
{{Reflist|2}} | {{Reflist|2}} | ||
Revision as of 16:22, 8 September 2017
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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 may progress to develop a fracture. 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 a reduced quality of life due to immobility; emotional problems may also arise as a consequence. As studies suggested, the impact of osteoporosis and also osteoporotic fractures on public life would be worse than lots of life threatening diseases; especially with aging.
Natural history, complications, and prognosis
Natural history
- Typically, symptoms of osteoporosis are developed in the sixth decade of life. The risk of getting osteoporosis is increased proportionately with age.
- Researchers have shown that relationship between lowering bone density of spine and age is not linear, but quadratic; in which bone loss tailing off when age raised. During the first years of the postmenopausal period, women would have a fast decrease in bone density of spine by the rate of 3.12% annually; then the rate slowed down to 0.02% per square age increased.[1]
- However, 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 will slow down.[2]
- One another major factor that directly impacts changing BMD is body weight; women with heavier weight and also higher body mass index (BMI) may have more change in their BMD in both hip and lumbar spine, during the time.
- 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.[1]
- 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 left untreated, or not favorably treated, the clinical consequence would be the fracture and the morbidity that happen thereafter. The main type of fracture that influences the quality of life more and happened earlier, is the vertebral fracture.[3]
Complications
- The major probable complications of osteoporosis include:
- Fractures: hip and lumbar spine are among the most frequent sites of fracture.
- Deep venous thrombosis (DVT): It can be caused by prolonged immobility.
- Kyphosis (Dowager's hump): The main reason could be decreasing the height of anterior aspect of cervical vertebrae body (wedge shape).
- Restrictive lung disease: Because of decreasing thoracic space, due to vertebral compression.
- Apart from the risk of death and other complications, osteoporotic fractures are associated with a reduced quality of life due to immobility; emotional problems may also arise as a consequence.[4]
Fracture risk
Fracture risk categories in glucocorticoid-treated patients are listed in the table below.[5]
| Adults ≥ 40 years of age | Adults <40 years of age | |
|---|---|---|
| High fracture risk |
|
|
| Moderate fracture risk |
|
or and
|
| Low fracture risk |
|
|
Prognosis
- Early identification of the bone mass density loss and appropriate treatment results in a good prognosis of osteoporosis.
- The most important issue to identify the osteoporosis prognosis is fractures; mainly affected by two factors include advancing age and low BMD. The relation is consist of having about a 2-fold increase in the risk of various fractures following every SD lowering of BMD or 5 years age advance.[6]
- When the lifetime 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 fracture risk othe hipip 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 lots of life threatening diseases; especially with aging.[7]
- 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—afterward. Unfortunately, in some cases, IJO can result in permanent disability such as kyphoscoliosis or collapse of the rib cage.[8]
References
- ↑ 1.0 1.1 Zhai G, Hart DJ, Valdes AM, Kato BS, Richards JB, Hakim A; et al. (2008). "Natural history and risk factors for bone loss in postmenopausal Caucasian women: a 15-year follow-up population-based study". Osteoporos Int. 19 (8): 1211–7. doi:10.1007/s00198-008-0562-x. PMID 18305885.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ 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.
- ↑ Cummings SR, Black DM, Nevitt MC, Browner W, Cauley J, Ensrud K, Genant HK, Palermo L, Scott J, Vogt TM (1993). "Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group". Lancet. 341 (8837): 72–5. PMID 8093403.
- ↑ Nguyen ND, Ahlborg HG, Center JR, Eisman JA, Nguyen TV (2007). "Residual lifetime risk of fractures in women and men". J Bone Miner Res. 22 (6): 781–8. doi:10.1359/jbmr.070315. PMID 17352657.
- ↑ "Juvenile Osteoporosis".