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PubMedDate not supplied

Knowledge and health beliefs of osteoporosis in college nursing students.

PURPOSE: This purpose of this study was to describe college students' knowledge of osteoporosis, health beliefs regarding osteoporosis, self-efficacy to perform osteoporosis-preventing activities, and actual performance of osteoporosis-preventing activities. METHOD: This descriptive study used a survey method. Participants completed a questionnaire consisting of the Osteoporosis preventing Behaviors Survey, the Osteoporosis Knowledge Test, the Osteoporosis Health Belief Scale, and the Osteoporosis Self-Efficacy Scale. SAMPLE: One-hundred ninety-four nursing student subjects (86 sophomore students and 108 senior students). RESULTS: Senior students were more knowledgeable about osteoporosis than sophomore students and were more confident about performing osteoporosis-preventing behaviors. There were no significant differences between the groups regarding their health beliefs about osteoporosis, their performance of weight-bearing exercise, dietary calcium intake, or intake of caffeinated products. CONCLUSION: These results may be useful in examining the nursing curricula at colleges of nursing, as well as investigating methods of helping beginning nurses, as health promoters, to make lifestyle changes. This, in turn, may lead to behaviors to prevent osteoporosis in themselves and those for whom they provide care.

Adolescent↗
PubMed2006

Effects of an osteoporosis educational programme for men.

AIM: This paper reports an evaluation of the effects on knowledge, health beliefs and preventive behaviours of an osteoporosis educational programme for men. BACKGROUND: Osteoporosis is an increasing global health concern, and educational programmes have been identified as a crucial strategy in its prevention. However, the effectiveness of osteoporosis educational programmes has mainly been evaluated in women. METHODS: A randomized controlled trial was carried out to identify the effects of an osteoporosis educational programme for men. The study was conducted between September 2004 to February 2005, and 128 Hong Kong Chinese men were randomly assigned to an intervention or control group, with 64 in each group. The intervention group attended an osteoporosis educational programme. All participants completed pre- and post-test self-administered questionnaires: Osteoporosis Knowledge Test, Osteoporosis Health Belief Scale and Osteoporosis Self-Efficacy Scale. RESULTS: The intervention group showed a statistically significant increase in both knowledge (P < 0.0005) and health beliefs (P = 0.007) about osteoporosis and preventive behaviours in comparison with the control group. However, the difference in self-efficacy between the two groups was not statistically significant (P = 0.154). CONCLUSIONS: An osteoporosis educational programme can increase men's knowledge levels and change their health beliefs about osteoporosis and preventive behaviours. This approach should be more widely used in nursing practice to promoting the adoption of osteoporosis prevention behaviours in men.

Adult↗
PubMed2025

Development and evaluation of a machine learning model for osteoporosis risk prediction in Korean women.

BACKGROUND: The aim of this study was to develop a machine learning (ML) model for classifying osteoporosis in Korean women based on a large-scale population cohort study. This study also aimed to assess ML model performance compared with traditional osteoporosis screening tools. Furthermore, this study aimed to examine the factors influencing the risk of osteoporosis through variable importance. METHODS: Data was collected from 4199 women aged 40-69 years in the baseline survey of the Ansan and Ansung cohort of the Korean Genome and Epidemiology Study. Osteoporosis was set as the dependent variable to develop ML classification models. Independent variables included 122 factors related to osteoporosis risk, such as socio-demographic characteristics, anthropometric parameters, lifestyle factors, reproductive factors, nutrient intakes, diet quality indices, medical history, medication history, family history, biochemical parameters, and genetic factors. The six classification models were developed using ML techniques, including decision tree, random forest, multilayer perceptron, support vector machine, light gradient boosting machine, and extreme gradient boosting (XGBoost). The six ML classification models were compared with two traditional osteoporosis screening tools, including the osteoporosis risk assessment instrument (ORAI) and the osteoporosis self-assessment tool (OST). The ML model performances were evaluated and compared using the confusion matrix and area under the curve (AUC) metrics. Variable importance was assessed using the XGBoost technique to investigate osteoporosis risk factors. RESULTS: The XGBoost model showed the highest performance out of the six ML classification models, with an accuracy of 0.705, precision of 0.664, recall of 0.830, and F1 score of 0.738. Moreover, the XGBoost model showed a higher performance on AUC than ORAI and OST. Variable importance scores were identified for 69 out of the 122 variables associated with osteoporosis risk factors. Age at menopause ranked first in variable importance. Variables of arthritis, physical activities, hypertension, education level, income level; alcohol intake, potassium intake, homeostatic model assessment for insulin resistance; energy intake, vitamin C intake, gout; and dietary inflammatory index ranked in the top 20 out of the 69 variables, using the XGBoost technique. CONCLUSIONS: This study found that an XGBoost model can be utilized to classify osteoporosis in Korean women. Age at menopause is a significant factor in osteoporosis risk, followed by arthritis, physical activities, hypertension, and education level.

Humans↗
PubMed2004

Idiopathic or hypogonadal osteoporosis in men: current and future treatment options.

Osteoporosis is being recognized increasingly in men, and represents a substantial public health problem. As the male population ages and lives longer, the incidence of osteoporotic fractures is expected to increase. The current lifetime risk for a fragility fracture is approximately 27% in men aged 50 years or more, and will increase further over the next 20 years. A major problem with osteoporosis in men is that it continues to be unrecognized, and the majority of men with fragility fractures due to osteoporosis are not being treated. A higher level of awareness is required amongst both general practitioners and the general public that osteoporosis is a treatable condition that can affect men. Secondary causes for osteoporosis are more common in men than in women, and require rigorous exclusion and treatment. Undiagnosed clinical hypogonadism is a common cause of osteoporosis in men, and is readily treatable. The cause of primary osteoporosis in men is unknown, but it results in an osteoblast defect. Genetic factors are likely to be important. In some but not all men, relative estrogen deficiency contributes to rapid rates of age-related bone loss and fractures. An adequate calcium intake, regular weight-bearing exercise, and normal vitamin D status are all very important, particularly with increasing age. The role of testosterone in treating eugonadal men with osteoporosis is currently unclear, and larger prospective studies will be required to carefully evaluate the benefits and risks of therapy. First-line treatment of osteoporosis in hypogonadal or eugonadal men is with bisphosphonates. Alendronate increases bone density and reduces vertebral fractures measured using a semiquantitative method in eugonadal or hypogonadal men with osteoporosis. In the near future, it is likely that subcutaneous human parathyroid hormone (1-34) or teriparatide will also be available as an important new anabolic treatment for men with osteoporosis. Teriparatide treatment also increases bone density in men. Selective estrogen receptor modulating drugs require further evaluation in men, but would appear to theoretically benefit men, especially those with low estradiol levels. In the future, selective androgen receptor modulating drugs may be useful in the prevention and treatment of osteoporosis, and in increasing lean body mass in men, without having adverse effects on prostate and breast tissue.

Endocrinology↗
PubMed2002

How should clinicians manage osteoporosis in ankylosing spondylitis?

Osteoporosis is a common complication of AS, with an incidence between 18.7% and 62%. The prevalence of osteoporosis is greater in males, and increases with increasing patient age and disease duration. Osteoporosis is also more common in patients with syndesmophytes, cervical fusion, and peripheral joint involvement. These variables are not all independent, as they may be indicators of disease duration. Osteoporosis in patients with AS is largely confined to the axial skeleton, in contrast to the pattern of osteoporosis seen in rheumatoid arthritis. BMD at the lumbar spine and femoral neck may be severely reduced, while most studies indicate that carpal and radial BMD remain within normal limits. The development of syndesmophytes in late AS can lead to difficulties in the use of DEXA scanning to determine lumbar BMD, as the extraspinal bone may obscure osteoporotic vertebrae. Under these circumstances more accurate assessment of lumbar BMD, and one that correlates better with femoral neck BMD, may be obtained by quantitative CT scanning or DEXA scanning of the lateral aspect of the L3 vertebra. Osteoporosis in AS significantly increases the risk of vertebral compression fractures within 5 years of the diagnosis of AS. The risk of a vertebral compression fracture occurring over a 30 year period following the diagnosis of AS is 14%, compared to 3.4% for population controls. In patients with vertebral osteoporosis relatively minor trauma, such as slipping, can lead to spinal fracture and dislocatior with subsequent damage to the spinal cord. There is a higher incidence of spinal cord injury following spinal fracture dislocations in patients with AS, and the resulting neurological deficit can range from mild sensory loss to complete paraplegia. Cytokines such as TNF-alpha and IL-6 may play an important part in the pathogenesis of osteoporosis in early AS, and IL-6 levels have been correlated with markers of disease activity and severity. In late AS, mechanical factors such as decreased mobility and the support provided by extraspinal bone may play a role in vertebral osteoporosis. Screening patients with AS for the presence of osteoporosis is an important, but contentious subject. This and subsequent monitoring needs to be considered in all patients, but longterm studies are needed to determine with confidence which patients should undergo screening, by which methods, and how often. The treatment of osteoporosis in AS is at present similar to that used for primary osteoporosis, except that due to the male predominance and a relatively young age of patients, there is a limited role for hormone replacement therapy. Exercise regimens and bisphosphonates are widely used, but a study of the relative efficacy of different bisphosphonate agents in patients with AS is required.

Absorptiometry, Photon↗
PubMed1994

[Osteoporosis in young people].

Osteoporosis in young people is divided into idiopathic juvenile osteoporosis and secondary osteoporosis. Idiopathic juvenile osteoporosis is a rare, self-limited disease characterized by its recover after 3 or 4 years from the incidence. In severe type of idiopathic juvenile osteoporosis, the deformity of spine and extremities due to numerous vertebral and metaphyseal fractures and frequent long bone fractures makes a limitation of daily activities. On the treatment it is important to take care not to make deformity. Idiopathic juvenile osteoporosis is very rare in Japan and unknown cause, is necessary to make more researches in its cause. Many disease are known to cause secondary osteoporosis. And the patients number of secondary osteoporosis are much more than idiopathic juvenile osteoporosis. In secondary osteoporosis, of cause, it is most important to treat the original disease. The treatment of secondary osteoporosis is made a great difference by patient condition. Osteoporosis in young people makes deformity of spine and extremities and height loss, and influences the growth and development for serious disorder. It is necessary for treatment of these young people to take care to make the disorder to minimum.

Adolescent↗
PubMedDate not supplied

[Differential therapy of osteoporosis].

In the past decade, we observed progress in the differential diagnosis of osteoporosis, mainly because of advanced radiological and laboratory procedures, including new bone markers. Loss of bone can also be related to primary and secondary forms of osteoporosis. Consequently, secondary osteoporosis (and osteomalacia) should be treated primarily according to the original disease. Although etiopathology of primary osteoporosis is still unclean differential therapy should be applied to the different subgroups (juvenile, postmenopausal, and senile osteoporosis). Furthermore, even patients of the same age and sex can be at risk for osteoporosis or have definite osteoporosis. This can be differentiated in "low or high turnover osteoporosis" and should be diagnosed and treated as described. Conjugated estrogens in combination with progesterone decrease the rate of endometrial carcinoma and have been established to be very effective in the treatment of high turnover osteoporosis and patients at high risk of developing manifest osteoporosis. In combination with calcium (1 g/day) total doses of estrogen can be reduced to 0.3 g/day. The same applies for the treatment of low turnover (mostly manifest) osteoporosis with fluoride. Daily doses of fluoride can be decreased from 80 mg sodium fluoride to 50g in combination with calcium. These reductions of daily fluoride doses decreases the rate of side effects and allows longer control periods, provided that bone measurements demonstrate a beneficial long-term effect. The control periods depend on the sensitivity of the bone density measurements. Special indications, modifications, alterations and additions of further drugs are discussed for the individual patient.

Combined Modality Therapy↗
PubMed2007

Developments of the incidence of osteoporosis in The Netherlands: a PHARMO study.

PURPOSE: To assess recent and to predict future time trends in the incidence of osteoporosis using routine databases in The Netherlands in the period 1993-2015 and to compare estimations based on hip fractures versus a proxy based on pharmacy and hospitalisation data. METHODS: The incidence of hip fractures was estimated over the period 1986-2002 using information from the Dutch Medical Registry, covering more than 99% of all Dutch hospitalisations. Additionally, a proxy (hospitalisation for osteoporosis or osteoporotic fractures, treatment with glucocorticosteroids or treatment with anti-osteoporosis drugs) was constructed in order to identify osteoporotic patients in the PHARMO database. Age and gender specific incidences of hip fractures and osteoporosis were calculated and extrapolated to The Netherlands. Results of both studies were extrapolated till 2015 using a power function. RESULTS: The incidence of hip fractures decreased slightly (270 per 100,000 in 1993, 260 per 100,000 in 2002). The incidence of osteoporosis using the constructed proxy decreased from 870 per 100,000 in 1993 to 700 per 100,000 in 2002. The incidence of hip fractures and osteoporosis remained fairly constant when modelled till 2015. Both studies showed the same time trends. CONCLUSION: Both the estimations based on the hospitalisations for hip fracture and on our proxy for osteoporosis showed that the increase in the incidence of osteoporosis as observed in the 1990s is levelling off. Due to ageing of the population the absolute number of hip fractures will however increase. Our definition of osteoporosis resulted in a higher estimation of the incidence of osteoporosis and may be used in future studies to follow developments in osteoporosis prevalence and incidence.

Adult↗
PubMed2002

Osteoporosis prevention: pediatricians' knowledge, attitudes, and counseling practices.

BACKGROUND: Strategies to prevent adult osteoporosis are best undertaken during childhood and adolescence, when the greatest amount of bone mineral density is acquired. This study examines pediatricians' knowledge and practices regarding osteoporosis prevention. METHODS: One hundred eighty-seven primary care pediatricians from San Diego and Imperial Counties responded to a 44-item mailed survey that measured physician knowledge, attitudes, and practices regarding osteoporosis prevention. RESULTS: Knowledge of U.S. RDA for calcium in children and adolescents was limited, with only 23.7 and 32.3% of pediatricians correctly identifying the recommended values for children and adolescents, respectively. Thirty-eight percent of respondents regarded osteoporosis prevention to be an important issue, and less than half reported that they counseled patients for osteoporosis prevention. Of those pediatricians who did perform osteoporosis counseling, the two most frequently cited motivators for counseling were that counseling is recommended by professional boards and having a personal or professional interest in osteoporosis prevention. The most commonly reported barriers to counseling were other issues taking greater priority and having insufficient time to undertake counseling for osteoporosis prevention. CONCLUSIONS: Osteoporosis prevention should begin in childhood and adolescence. This study suggests that many pediatricians do not counsel patients to reduce osteoporosis risk, nor do they consider this an important issue. Furthermore, they may not have full knowledge about how to prevent osteoporosis.

Adolescent↗
PubMed1998

Secondary osteoporosis.

Generalized osteoporosis currently represents a heterogeneous group of conditions with many different causes and pathogenetic mechanisms, that often are variably associated. The term "secondary" is applied to all patients with osteoporosis in whom the identifiable causal factors are other than menopause and aging. In this heterogeneous group of conditions, produced by many different pathogenetic mechanisms, a negative bone balance may be variably associated with low, normal or increased bone remodeling states. A consistent group of secondary osteoporosis is related to endocrinological or iatrogenic causes. Exogenous hypercortisolism may be considered an important risk factor for secondary osteoporosis in the community, and probably glucocorticoid-induced osteoporosis is the most common type of secondary osteoporosis. Supraphysiological doses of corticosteroids cause two abnormalities in bone metabolism: a relative increase in bone resorption, and a relative reduction in bone formation. Bone loss, mostly of trabecular bone, with its resultant fractures is the most incapacitating consequence of osteoporosis. The estimated incidence of fractures in patients prescribed corticosteroid is 30% to 50%. Osteoporosis is considered one of the potentially serious side effects of heparin therapy. The occurrence of heparin-induced osteoporosis appeared to be strictly related to the length of treatment (over 4-5 months), and the dosage (15,000 U or more daily), but the pathogenesis is poorly understood. It has been suggested that heparin could cause an increase in bone resorption by increasing the number of differentiated osteoclasts, and by enhancing the activity of individual osteoclasts. Hyperthyroidism is frequently associated with loss of trabecular and cortical bone; the enhanced bone turnover that develops in thyrotoxicosis is characterized by an increase in the number of osteoclasts and resorption sites, and an increase in the ratio of resorptive to formative bone surfaces, with the net result of bone loss. Despite these findings, the occurrence of pathological fractures in patients with hyperthyroidism is relatively low, and probably due to the fact that deficiencies in bone mass may be reversed by treatment of the thyroid disease. Most, but not all, studies on insulin-dependent diabetes mellitus (IDDM) report an association with osteopenia. In IDDM, the extent of bone loss is usually slight, which helps explain the discrepancy between the frequency of decreased bone mineral density, and the frequency of osteoporotic fractures in long-standing diabetes. Contradictory results have been obtained in non-insulin-dependent diabetes mellitus (NIDDM) patients. Increased rates of bone loss at the radius and lumbar spine were demonstrated either in patients with two-thirds gastric resection and Billroth II reconstruction, or in those with one-third resection and Billroth I anastomosis, and the metabolic bone disease following gastrectomy may consist also of osteomalacia or mixed pattern of osteoporosis-osteomalacia, with secondary hyperparathyroidism. Miscellaneous causes of secondary osteoporosis are also immobilization, pregnancy and lactation, and alcohol abuse.

Adult↗
PubMed2000

[Osteoporosis in the male].

BACKGROUND: Osteoporotic fractures occur frequently also in men. Epidemiologic data from Germany indicate that more than 900,000 men are affected by osteoporotic fractures. Diagnosis and therapy of male osteoporosis are hampered by a lack of clinical studies. DIAGNOSIS: Risk factor analysis, conventional spine X-rays, bone densitometry and a limited number of serum and urine analyses contribute to the diagnosis of osteoporosis and the assessment of future fracture risk. Bone densitometry at the femoral neck is superior to measurements at the lumbar spine because of the high prevalence of degenerative changes at the lumbar spine in elderly men. Major risk factors for osteoporosis are hypogonadism, glucocorticoid therapy, hypercalciuria, gastrointestinal disease, and high alcohol consumption. In individual cases, bone histology or additional biochemical studies are needed to establish the cause of osteoporosis. THERAPY: Calcium and vitamin D deficits should be substituted both in prevention and treatment of male osteoporosis. Testosterone replacement therapy is effective in hypogonadism. In primary osteoporosis and in corticosteroid-induced osteoporosis, bisphosphonates (cyclical etidronate, alendronate) and fluorides are therapeutic options. CONCLUSION: Important principles in the care of men with osteoporosis are the transfer of knowledge established for postmenopausal osteoporosis and the rigorous search for secondary osteoporosis aiming at treatment of the underlying cause. Large prospective randomized trials aiming at the reduction of fracture rate in male osteoporosis are missing. They are urgently needed.

Aged↗
PubMed2005

The near absence of osteoporosis treatment in older men with fractures.

The burden of osteoporotic fractures in older men is significant. The objectives of our study were to: (1) characterize older men with fractures associated with osteoporosis, (2) determine if medication treatment rates for osteoporosis are improving and (3) identify patient, healthcare benefit and utilization, and clinician characteristics that are significantly associated with treatment. This retrospective cohort study assessed 1,171 men aged 65 or older with any new fracture associated with osteoporosis between 1 January 1998 and 30 June 2001 in a non-profit health maintenance organization in the United States. Multiple logistic regression was used to evaluate pre-fracture factors for their association with osteoporosis treatment in the 6-month post-fracture period. The main outcome measure was pharmacologic treatment for osteoporosis in the 6 months after the index fracture. Subjects' average age was 76.7 years; 3.3% had a diagnosis of osteoporosis and 15.2% a diagnosis or medication associated with secondary osteoporosis. Only 7.1% of the study population and 16.0% of those with a hip or vertebral fracture received a medication for osteoporosis following the index fracture, and treatment rates did not improve over time. In the multivariate model, factors significantly associated with drug treatment were a higher value on the Charlson Comorbidity Index (odds ratio 1.26, 95% confidence interval 1.05-1.51), having an osteoporosis diagnosis (odds ratio 8.11, 95% confidence interval 3.08-21.3), chronic glucocorticoid use (odds ratio 5.37, 95% confidence interval 2.37-12.2) and a vertebral fracture (odds ratio 16.6, 95% confidence interval 7.8-31.4). Bone mineral density measurement was rare (n =13, 1.1%). Our findings suggest that there is under-ascertainment and under-treatment of osteoporosis and modifiable secondary causes in older men with fractures. Information systems merging diagnostic and treatment information can help delineate gaps in patient management. Interventions showing promise in other conditions should be evaluated to improve care for osteoporosis.

Absorptiometry, Photon↗
PubMed2006

Utility of biochemical screening in the context of evaluating patients with a presumptive diagnosis of osteoporosis.

The ageing population is expected to increase the burden of osteoporosis on the health care system. Secondary causes of osteoporosis are found in a proportion of patients. There is much controversy regarding the best work-up for patients who have been diagnosed as having osteoporosis based on bone mineral density. It is difficult to decide where interventions should be targeted both from a patient's perspective and for cost effectiveness. We evaluated the utility of a standard panel (full blood count, plasma viscosity, plasma protein, electrophoresis, urine Bence Jones protein, thyroid function test, bone profile, fasting lipids and liver function test) of biochemical investigations in 327 consecutive patients (287 females, 40 males) referred to the new patient osteoporosis clinic from April 1999 to March 2000. Patients were characterised after measurement of spinal/femoral neck bone mineral density after a dual energy X-ray absorptiometry (DEXA) scan. There were 88 patients with osteoporosis, 91 with osteopenia, 130 had normal bone mineral density and 20 who did not have a bone scan. No case of multiple myeloma was found in this cohort of patients. There was no difference in the mean plasma viscosity of patients with and without osteoporosis (P=0.182). There was no significant difference in the abnormal urine calcium/creatinine (Ca/Cr ratio) in patients with osteoporosis and those without osteoporosis (P=0.316). There was no significant difference in the prevalence of hypothyroidism (P=0.213) or thyrotoxicosis (P=0.138) in patients with and without osteoporosis. There was no strong correlation between cholesterol concentrations and osteoporosis (r=0.069). We found no utility in performing a myeloma screen. A small proportion of patients had abnormalities of calcium homeostasis or thyroid disease. We recommend that a screening biochemical evaluation should be restricted to calcium/bone profile and thyroid function tests in patients with a presumptive diagnosis of osteoporosis.

Bone Density↗
PubMed1999

Outpatient costs of osteoporosis in a national health insurance population.

There are few valid data on the outpatient diagnosis and treatment of osteoporosis in Germany, despite the high prevalence of this disease and the high costs associated with its complications. We therefore conducted a retrospective cohort study to investigate the prevalence of documented osteoporosis and the use of health care resources in its outpatient treatment in a representative random sample of 7490 patients from the Dresden area who were insured under the national health insurance program for a 1-year period from the 3rd quarter of 1993 to the 2nd quarter of 1994. Documented cases of osteoporosis were identified by International Statistical Classification of Diseases, 10th Revision diagnostic codes M80 to M82, and the costs of diagnostic services for osteoporosis were calculated using a uniform fee schedule. Specific and nonspecific osteoporosis medications were classified using a published anatomic-therapeutic-chemical code, and their costs were calculated on the basis of pharmacy sales prices. Three age- and sex-matched controls without documented osteoporosis (n = 705) were assigned for each case patient in estimating the net use of resources. Data for the region, as well as age-standardized information for the overall German national health insurance system, were calculated. The 1-year prevalence of documented osteoporosis in the region was 3.14% (5.20% in women, 0.89% in men), and the age-standardized prevalence in the German national health insurance system was 2.25%. During the study period, 51.1% of the cases and 2.1% of the controls were examined by osteodensitometry. Patients received 106 defined daily doses of osteoporosis medications during the year; 37.0% of the prescribed daily doses were for sodium fluorophosphate/calcium combinations, 4.3% were for sodium fluoride, and 7.7% were for calcium alone. Sex hormones and calcitonin each accounted for 7.7% of the prescribed daily doses. Only a fraction of epidemiologically expected cases of osteoporosis have been identified and documented in the outpatient sector. Only approximately 50% of these receive osteoporosis-specific therapy, and compliance with therapy is low. To reduce osteoporosis-associated fracture rates, which are extremely cost intensive and greatly impair patients' quality of life, more consistent treatment is needed.

Adolescent↗
PubMed1999

Prescription attitudes among gynecologists towards two particular risk factors of osteoporosis: the patient's age and her bone mineral density.

OBJECTIVE: The present report assesses, among Belgian gynecologists, the effect of age and bone mineral density on osteoporosis prescription strategy in postmenopausal women. METHODS: Charts of postmenopausal women were summarized. We constructed cases by modifying some parameters. Ten years of age were added or subtracted to the real age of the patient. The bone mineral density (BMD) result was also modified (three levels: normal BMD, osteopenia, osteoporosis). A total of 612 cases were constructed. Twelve cases were sent out of these 612 files to every Belgian gynecologist (n = 1010). For each chart the gynecologists were asked whether they would treat the patient with HRT. They were also asked whether they would prescribe other therapies than HRT and if so, which ones. RESULTS: The chance to have an osteoporosis prevention or treatment prescribed increased when BMD decreased (respectively 57.4% for normal BMD, 73.1% for osteopenia cases and 89.4% for osteoporosis cases; P < 0.001). HRT was the most frequently prescribed medication (67% of the cases), but its prescription rate does not reflect only osteoporosis prevention. Nevertheless, for similar cases with osteopenia, the HRT prescription rate increased by a factor 1.25 and for similar cases with osteoporosis, HRT prescription rate increased by a factor 1.39. Calcium was the 2nd most frequent prescribed regimen. It was prescribed in 17% of the cases. A 3.4-fold increase for osteopenia cases and 7.6-fold increase for osteoporosis cases was observed, compared to women with normal BMD. When calcium was prescribed, it was in association with HRT in 64% of the osteopenia cases and in 76% of osteoporosis cases. Other drugs were less often prescribed. For the "younger age group", that is, with a mean age of 55 years, a prescription rate of 82.9% for any osteoporosis regimen was reached, whereas in the age group that was 10 years older a 20% lower prescription rate was reached (62.6%, P < 0.001). This was mostly due to a decrease in HRT prescription. CONCLUSIONS: Prescription of medication known to reduce osteoporosis occurred more often in cases with low BMD. In the older patients with osteoporosis, gynecologists prescribed HRT less frequently. This was not compensated by a higher prescription rate of other medication.

Adult↗
PubMed1993

Osteoporosis: pathogenesis, diagnosis, prevention and management.

Osteoporosis has emerged as a major and increasing health problem requiring interventions at both the individual and community levels. Most cases of osteoporosis are found among women after the menopause, since menopausal status and age are key predictors of fracture risk. This review has focused particularly on osteoporosis occurring in postmenopausal women: the magnitude of the problem, how it occurs, how it is diagnosed, strategies in prevention and treatment. The diagnosis of osteoporosis and identification of individuals with heightened fracture risk due to osteopenia have been greatly facilitated by the development of dual energy X-ray absorptiometry, a simple, safe, highly precise technique for bone density measurement. Where possible, intervention strategies in osteoporosis have been related to what is known about the pathogenesis of bone loss, especially the management of modifiable risk factors. Oestrogen deficiency of any cause results in accelerated bone turnover, with an increase in the rate of net bone loss. Exogenous oestrogens can control this form of bone loss. In established osteoporosis, hormone replacement therapy can achieve clinically-significant gains in bone mass. Consideration of hormone replacement therapy is pivotal in preventive and therapeutic strategies. Issues other than osteoporosis must be taken into account when hormone replacement is considered. Attention to other modifiable risk factors, both in the lifestyle and of a medical nature, is also indicated. A number of promising agents for the treatment of established osteoporosis are described. However, available data on fracture prevention by these agents are limited. There is concern that an ideal therapy for established osteoporosis may not be achievable. Therefore, strong emphasis is placed on the need for osteoporosis prevention now and in the foreseeable future. Although much has been learnt in recent years, more research is needed in the long-term prediction of fracture risk, broadly-applicable measures to reduce the prevalence of osteoporosis, and targeted interventions for individuals at high risk.

Bone Density↗
PubMedDate not supplied

Osteoporosis in women: prevention and treatment.

OBJECTIVE: To review osteoporosis, its pathophysiology, lifestyle and dietary factors that influence osteoporosis, and treatments to prevent and treat the disease in women. DATA SOURCES: MEDLINE using the search term osteoporosis and individual therapies and interventions for 1974-1988. STUDY SELECTION: English-language studies in humans were reviewed. Prospective clinical trial data were selected when available; epidemiologic data were used when prospective clinical trials were not available. DATA SYNTHESIS: Pharmacists should initiate discussions with women of all ages to help prevent, recognize, and treat osteoporosis. Assessing and modifying calcium, vitamin D, caffeine, alcohol, and phosphate intake, increasing exercise, and minimizing falls can help prevent osteoporosis and fractures. The risks and benefits of hormone replacement therapy should be presented to women so they can make an informed decision. Hormone replacement therapy is the treatment of choice for preventing and treating osteoporosis; it also reduces cardiovascular morbidity and mortality. The benefits must be put into the proper perspective with adverse effects, events such as vaginal bleeding and the risk of breast cancer, that prevent women from taking estrogen. As not every woman is willing or able to take estrogen, alternatives should be discussed. Raloxifene prevents osteoporosis, has beneficial lipid effects, and does not stimulate breast or endometrial tissue. Alendronate is a safe and effective for the prevention and treatment of osteoporosis when administered properly. Calcitonin is approved for treatment of osteoporosis and provides analgesic effects for fractures. CONCLUSION: Pharmacists should initiate discussions with women of all ages to help prevent, recognize, and treat osteoporosis. Assessing and modifying calcium and vitamin D, caffeine, alcohol, and phosphate intake, increasing exercise, and minimizing falls can help prevent osteoporosis and fractures.

Aged↗
PubMed2006

Osteoporosis in men: prevalence and investigation.

In the past, osteoporosis was thought to affect only women; however, in the last decade it has become apparent that osteoporosis is common in men, particularly elderly men. Osteoporosis affects as many as 2 million men in the United States. Osteoporosis most commonly affects the hip and the lumbar vertebrae, but other bones, such as the radius, tibia, and ribs, may also fracture. The main feature of the etiology of the disease is that low bone mineral density results in increased susceptibility to bone fracture. The World Health Organization has defined osteoporosis as a bone mineral density T-score value >2.5 SDs below the mean observed in young adult women. Although the validity of this score for evaluating men has been questioned and it is not clear whether a male or female reference database should be used, it is nonetheless often used in this way. The disease affects men differently than women in a number of respects. It manifests itself later in life in men than in women, probably because men initially have greater bone mass. Mortality and morbidity associated with hip fractures are high in all elderly individuals, but they are substantially higher in men than in women. Unlike in women, there is an underlying cause for the osteoporosis in almost half of affected men. Thus, for elderly men, a complete history and physical examination may reveal some remediable conditions; treating these may stop further progression of the disease and prevent further morbidity or mortality. Corticosteroid therapy for arthritis or asthma is a common cause of osteoporosis in elderly men. Hypogonadism is a recognized cause of osteoporosis in men treated for carcinoma of the prostate with androgen withdrawal therapy; treatments to modify the effects of these agents on bone are available. Consumption of large amounts of alcohol will eventually result in osteoporosis in some elderly men. Moreover, alcohol can predispose confused elderly patients to falls and to fracture bones that are already osteoporotic. Hyperthyroidism is associated with a reduction in bone mineral density and an increased likelihood of bony fracture. A careful search for undiagnosed hyperthyroidism in elderly osteoporotic men may prove worthwhile. Vitamin D deficiency is common among older men and could contribute to an increase in fractures. Routine analyses of blood and biochemistry should be carried out in any older male patient with newly diagnosed osteoporosis. Dual x-ray energy absorptiometry should be performed on every new patient with newly diagnosed osteoporosis.

Bone Density↗