Osteoporosis is a major public health problem in Canada (and worldwide) and its prevalence is increasing. In Canada, approximately 1 in 4 women and 1 in 8 men have osteoporosis.1 Because some 25% of the population will be over 65 years of age by 2041, the incidence of osteoporosis is expected to rise steeply over the next few decades.2 The public health and clinical importance of osteoporosis lies in the fractures associated with the disease. According to conservative estimates, a 50-yearold Caucasian woman has a remaining lifetime risk of 40% for hip, vertebra or wrist fractures. цялата статия...

Bone mass declines and the risk of fractures increases as people age, especially as women pass through the menopause. Hip fractures, the most serious outcome of osteoporosis, are becoming more frequent than before because the world’s population is ageing and because the frequency of hip fractures is increasing by 1–3% per year in most areas of the world. Rates of hip fracture vary more widely from region to region than does the prevalance of vertebral fractures. Low bone density and previous fractures are risk factors for almost all types of fracture, but each type of fracture also has its own unique risk factors. Prevention of fractures with drugs could potentially be as expensive as medical treatment of fractures. Therefore, epidemiological research should be done and used to identify individuals at high-risk of disabling fractures, thereby allowing careful allocation of expensive treatments to individuals most in need. цялата статия...

There is no one cause of bone fragility; genetic and environmental factors play a part in development of smaller bones, fewer or thinner trabeculae, and thin cortices, all of which result in low peak bone density. Material and structural strength is maintained in early adulthood by remodelling; the focal replacement of old with new bone. However, as age advances less new bone is formed than resorbed in each site remodelled, producing bone loss and structural damage. In women, menopause-related oestrogen deficiency increases remodelling, and at each remodelled site more bone is resorbed and less is formed, accelerating bone loss and causing trabecular thinning and disconnection, cortical thinning and porosity. There is no equivalent midlife event in men, though reduced bone formation and subsequent trabecular and cortical thinning do result in bone loss. Hypogonadism contributes to bone loss in 20–30% of elderly men, and in both sexes hyperparathyroidism secondary to calcium malabsorption increases remodelling, worsening the cortical thinning and porosity and predisposing to hip fractures. Concurrent bone formation on the outer (periosteal) cortical bone surface during ageing partly compensates for bone loss and is greater in men than in women, so internal bone loss is better offset in men. More women than men sustain fractures because their smaller skeleton incurs greater architectural damage and adapts less effectively by periosteal bone formation. The structural basis of bone fragility is determined before birth, takes root during growth, and gains full expression during ageing in both sexes. цялата статия...

The diagnosis of osteoporosis centres on the assessment of bone mineral density (BMD). Osteoporosis is defined as a BMD 2·5 SD or more below the average value for premenopausal women (T score <–2·5 SD). Severe osteoporosis denotes osteoporosis in the presence of one or more fragility fractures. The same absolute value for BMD used in women can be used in men. The recommended site for diagnosis is the proximal femur with dual energy X-ray absorptiometry (DXA). Other sites and validated techniques, however, can be used for fracture prediction. Although hip fracture prediction with BMD alone is at least as good as blood pressure readings to predict stroke, the predictive value of BMD can be enhanced by use of other factors, such as biochemical indices of bone resorption and clinical risk factors. Clinical risk factors that contribute to fracture risk independently of BMD include age, previous fragility fracture, premature menopause, a family history of hip fracture, and the use of oral corticosteroids. In the absence of validated population screening strategies, a case finding strategy is recommended based on the finding of risk factors. Treatment should be considered in individuals subsequently shown to have a high fracture risk. Because of the many techniques available for fracture risk assessment, the 10-year probability of fracture is the desirable measurement to determine intervention thresholds. Many treatments can be provided cost-effectively to men and women if hip fracture probability over 10 years ranges from 2% to 10% dependent on age. цялата статия...

ДА НЕ ПОДЦЕНЯВАМЕ ЕФЕКТИТЕ НА ХОРМОНАЛНАТА ТЕРАПИЯ

БИОФОСФОНАТИ ЗА ПРОФИЛАКТИКА И ЛЕЧЕНИЕ НА ОСТЕОПОРОЗАТА И ПРЕДПАЗВАНЕ ОТ ФРАКТУРИ

СЕЛЕКТИВНИ МОДУЛАТОРИ НА ЕСТРОГЕНОВИТЕ РЕЦЕПТОРИ И КАЛЦИТОНИН

ЗА ОНЕЗИ, КОИТО НЕ ЖЕЛАЯТ ДА ПРИЕМАТ СИНТЕТИЧНИ МЕДИКАМЕНТИ

OSTEOPOROSIS PREVENTION, DIAGNOSIS AND THERAPY

КАК ДА СЕ ПРЕДПАЗИМ ОТ ОСТЕОПОРОЗА