Osteoporosis

Osteoporosis is a common, underdiagnosed, and undertreated condition, complicated by fractures which lead to significant mortality and morbidity. The prevalence of osteoporotic fractures in postmenopausal women exceeds the combined prevalence of breast cancer, stroke, heart failure, and myocardial infarction. Often called "the silent disease," it does not reveal itself with obvious symptoms until a fracture occurs. In the first year after sustaining a hip fracture, mortality is increased by almost 24% in women and is even higher in men. About half of those who sustain an osteoporotic hip fracture become so disabled that they are no longer able to resume their daily activities, and as many as 20% require long-term institutional care. Effective treatments for osteoporosis are now available if it is diagnosed and addressed in a timely manner. Unfortunately, this disease remains shockingly underdiagnosed and undertreated, even in patients who sustain low-trauma hip fractures. The past two decades have witnessed radical changes in the diagnosis and management of osteoporosis. The densitometric diagnosis of osteoporosis is noninvasive, quick, and relatively simple. Tools are now available to predict the patient's probability of sustaining fractures, to identify patients who are particularly vulnerable, and to determine which patients will benefit from further investigation and treatment. Various associations have developed guidelines to help clinicians reach a diagnosis and initiate treatment. Due to better understanding of the basic pathophysiology of bone turnover, potent and relatively safe medications that significantly reduce the risk of fractures are now widely available. It is of paramount importance that this disease be diagnosed and treated as early as possible in order to take advantage of these developments and reduce the enormous socioeconomic and psychological impact of osteoporosis. Given the burden of osteoporotic fractures, all clinicians should have a working knowledge of e diagnosis, treatment, and prevention of the disease. Clinicians should feel comfortable diagnosing and initiating treatment for the majority of patients with osteoporosis. Only complicated cases or patients who are unresponsive to treatment should be referred to specialists. The aim of this book is to distill the available information on osteoporosis into an easily comprehensible format that will serve as a practical guide for busy clinicians. Numerous boxes, tables, diagrams, and figures present the information in an accessible manner. This book will be of particular use to general practitioners, endocrinologists, rheumatologists, gynecologists, internists, geriatricians, and orthopedic surgeons.1. DEFINITION & EPIDEMIOLOGY ; 2. BASIC BONE PATHOPHYSIOLOGY ; 3. BONE DENSITOMETRY ; 4. DIAGNOSIS ; 5. IDENTIFYING PATIENTS AT RISK OF FRACTURES ; 6. NON-PHARMACOLOGIC MANAGEMENT OF OSTEOPENIA AND OSTEOPOROSIS ; 7. PHARMACOLOGIC MANAGEMENT OF OSTEOPOROSIS, PART 1 ; 8. PHARMACOLOGIC MANAGEMENT OF OSTEOPOROSIS, PART 2 ; 9. MONITORING PATIENTS ON TREATMENT ; 10. VERTEBRAL AUGMENTATION PROCEDURES ; 11. CORTICOSTEROID-INDUCED BONE LOSS ; 12. PRIMARY HYPERPARATHYROIDISM ; 13. PREMENOPAUSAL WOMEN ; 14. MEN ; 15. ATYPICAL FEMORAL SHAFT FRACTURES ; 16. OSTEONECROSIS OF THE JAW ; 17. OSTEOPOROSIS IN CHILDREN AND ADOLESCENTS