University „Alexandru Ioan Cuza” din Iasi

Facultyde Education Phisic and Sport

Osteoporosis

Teacher:
Perez - Cenel Augusto

Student:
Todirenche Gabriela - Larisa

IAȘI
2019
 Osteoporosis
Abstract Osteoporosis is a worldwide disease characterized by reduction of bone mass
and alteration of bone architecture resulting in increased bone fragility and increased fracture
risk. Causes of osteoporosis include increasing age, female sex, postmenopausal status,
hypogonadism or premature ovarian failure, low body mass index, ethnic background,
rheumatoid arthritis, low bone mineral density (BMD), vitamin D deficiency, low calcium intake,
hyperkyphosis, current smoking, alcohol abuse, immobilization, and long-term use of certain
medications. The diagnosis of osteoporosis is established by measurement of BMD of the hip
and spine using dual energy X-ray absorptiometry.
According to the World Health Organization criteria, osteoporosis is defined as a BMD
that lies 2.5 standard deviation or more below the average value for young healthy women. Bone
turnover biomarker detection may be useful in monitoring osteoporosis treatment and assessing
fracture risk but not for diagnosis of osteoporosis. Management of osteoporosis consists of
nonpharmacological interventions, which are recommended for all subjects, and pharmacological
therapy in all postmenopausal women who have had an osteoporotic fracture or have BMD
values consistent with osteoporosis.
According to the National Institutes of Health Consensus Development Panel on
Osteoporosis,9 osteoporosis is defined as “a skeletal disorder characterized by compromised
bone strength leading to an increased risk of fracture.” Moreover, according to the World Health
Organization (WHO) criteria, osteoporosis is defined as a bone mineral density (BMD) that lies
2.5 standard deviation (SD) or more below the average value for young healthy women (a T-
score of < 2.5 SD). Osteoporosis can be subdivided into primary osteoporosis, which includes
postmenopausal osteoporosis (type I) and senile osteoporosis (type II), and secondary
osteoporosis, which has a clearly definable etiologic mechanism such as malabsorption,
medications such as glucocorticoids, and some diseases such as hyperparathyroidism.
Risk Factors Causes of osteoporosis include increasing age, female sex, postmenopausal
status, hypogonadism or premature ovarian failure, low body mass index, ethnic background
(white persons are at higher risk than black persons), rheumatoid arthritis (RA), low BMD,
vitamin D deficiency, low calcium intake, hyperkyphosis, current smoking, alcohol abuse,
immobilization, and long-term use of certain medications, such as glucocorticoids,
anticoagulants, anticonvulsants, aromatase inhibitors, cancer chemotherapeutic drugs, and
gonadotropin-releasing hormone agonists.
Diagnosis Osteoporosis is a silent disease without obvious symptoms and evidence until a
fracture occurs. Thus, screening by dual energy X-ray absorptiometry (DEXA) is important to
obtain an early diagnosis and to avoid fractures. All women aged 65 years or older and men aged
70 years or older, postmenopausal women with medical causes of bone loss (e.g., steroid use)
regardless of age, postmenopausal women aged 50 years or older with additional risk factors for
fracture (e.g., current smoker, RA, history of hip fracture in a parent), and postmenopausal
women with a fragility fracture should be screened for osteoporosis by BMD measurement at the
hip and lumbar spine as recommended by the U.S. Preventive Services Task Force (USPSTF),
the National Osteoporosis Foundation, and by other guidelines.
HYP is produced from the degradation of bone collagen during bone resorption.Since
HYP can be found in other tissues such as skin and cartilage, it is considered a nonspecific
marker of bone resorption. Pyridinoline and DPD are released during breakdown of bone and
cartilage; their concentration in urine are more sensitive and specific markers of bone resorption
than urinary HYP.
The primary goal of osteoporosis therapy is to reduce the risk of fracture. Treatment and
prevention strategies of osteoporosis and osteoporotic fractures include fall avoidance by
correcting decreased visual acuity, reducing consumption of medication that alters alertness and
balance, reducing fall hazards in the home (slippery floors, obstacles, insufficient light),
practicing physical activity to improve muscle strength, balance, and maintaining bone mass, the
avoidance of cigarette smoking and excessive alcohol intake, and adequate dietary intake of
protein, calcium, and vitamin D. In women, the recommended daily allowance (RDA) for
calcium is 1,000 mg/d for age range of 19 to 50 years and increases to 1,200 mg/d for older than
50 years; in men, the RDA of calcium is 1,000 mg/d for age range of 19 to 70 years and increases
to 1,200 mg/d for older than 70 years. The RDA for vitamin D is 600 IU/d for men and women
aged 19 to 70 years and increases to 800 IU/d for those older than 70 years. All postmenopausal
women, regardless of their bone density or clinical risk factors for osteoporosis should observe
these recommendations.
The North American Menopause Society recommends adding osteoporosis drug therapy
in all postmenopausal women who have had an osteoporotic vertebral or hip fracture, all those
who have BMD values consistent with osteoporosis at the lumbar spine, femoral neck, or total
hip region and all those who have T-scores from -1.0 to -2.5 and a 10-year risk of major
osteoporotic fracture of at least 20% or a risk of hip fracture of at least 3%. Pharmacological
agents are classified into two groups: those that decrease bone resorption (antiresorptive agents)
and those that increase skeletal formation (anabolic agents).7 Antiresorptive drugs
(bisphosphonates [BPs], denosumab, strontium ranelate, estrogen replacement therapy [ERT],
and selective estrogen receptor modulator [SERM]) reduce the rate of bone resorption and the
rate of bone formation. The overall changes are associated with increases of BMD, but up to a
certain point due to the coupling between bone resorption and formation. Anabolic drugs
(teriparatide, romosozumab) stimulate bone formation and partially bone resorption.
Osteoporosis treatments are currently limited to the use of a single drug at a fixed dose,
while combination pharmacotherapy is not recommended.Combination of more than two
antiresorptive agents have demonstrated very limited additive effects on bone mass. Similarly,
combination of PTH and teriparatide with BPs or SERM does not have an overall superior effect
on BMD compared with monotherapy. On the contrary, it has been shown that combined therapy
of teriparatide with denosumab or zoledronate may be an effective treatment option for patients
who do not respond to teriparatide monotherapy.
 A study found that the addition of alendronate to teriparatide after the first 9 months of
teriparatide treatment contributed to a reopening of the anabolic window and led to a return of
bone resorption to levels comparable at the initiation of teriparatide therapy, whereas bone
formation was less suppressed and remained elevated. Furthermore, the recent denosumab and
teriparatide administration study indicated that the combination of denosumab and teriparatide
produced a more prominent effect on increasing BMD and decreasing fracture risk than each
drug did alone. It also indicated that teriparatide treatment after denosumab was associated with
transient bone loss in lumbar spine and proximal femur and with prolonged BMD decrease in
distal radius, while teriparatide followed by denosumab continuously increased the BMD of
lumbar spine and proximal femur. The authors concluded that it is necessary to consider the
timing of teriparatide use, as well as the order of sequential use of teriparatide, in the long-term
management of patients with osteoporosis.38 Finally, since discontinuation of estrogens,
SERMs, denosumab, or teriparatide therapy is associated with a rapid loss of their effects on
BMD and BTMs over 1 to 2 years, a follow-up treatment with BP should be considered to reduce
or prevent the rebound increase in bone turnover.
Osteoporosis is a skeletal disorder characterized by compromised bone strength leading
to an increased risk of fracture It is defined as a BMD that lies 2.5 SD or more below the average
value for young healthy women, as measured with DEXA. According to the current guidelines
on osteoporosis management, BTMs cannot diagnose osteoporosis, but changes in BTMs may be
useful in monitoring osteoporosis treatment to confirm the efficacy of treatment and treatment
adherence and can improve the specificity of assessment of fracture risk. All postmenopausal
women should be encouraged to maintain a healthy weight; to obtain adequate calcium, vitamin
D, and protein intake; to participate in appropriate exercise; to avoid excessive alcohol
consumption and smoking; and to utilize measures that prevent falls. Finally, drug therapy is
recommended in all postmenopausal women who have a history of osteoporotic vertebral or hip
fracture, in those who have BMD values consistent with osteoporosis, and in those who have T-
scores from -1.0 to -2.5 and a 10-year risk of major osteoporotic fracture.