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Osteoporosis, defined as low bone mass leading Osteoporosis in asian americans increased fracture risk, is a major health problem that affects approximately 10 million Americans. The aging U. Although common, osteoporosis can be clinically silent, and without prevention and screening, the costs of osteoporotic fracture—related morbidity and mortality will burden the U. This is a particularly relevant concern in the context of diminishing health care resources.

Dual-energy X-ray absorptiometry is the most widely used, validated technique for measuring bone mineral density BMD and diagnosing osteoporosis. Cost-effectiveness analyses support early detection and treatment Osteoporosis in asian americans high-risk patients with antiresorptive medications such as bisphosphonates.

Moreover, optimization of bone health throughout life can help prevent osteoporosis. Current guidelines recommend screening women by age 65 years, but because no guidelines for screening intervals exist, decisions are made on the basis of clinical judgment alone. Although the recent literature provides some guidance, this review further explores current recommendations in light of newer evidence to provide more clarity on prevention, screening, and management strategies for patients with osteoporosis in the primary care setting.

O steoporosis is a major U. Osteoporosis is characterized by low bone mass, structural deterioration, and porous bone, which are associated with higher fracture risk.

Screening and diagnosis use a bone mineral density BMD measurement that estimates bone strength. BMD is reported as Osteoporosis in asian americans T-score, defined as the difference in number of standard deviations SDs Osteoporosis in asian americans the mean BMD of a normally distributed, healthy adult reference population 7 ; it is expressed as a negative number.

Normal bone is no more than 1 SD below Osteoporosis in asian americans value, and osteopenia is 1 to 2. Severe osteoporosis is BMD greater than 2. Screening for osteoporosis may facilitate treatment before osteoporotic fracture occurrence. Cost-effectiveness analyses support early detection and treatment of high-risk patients with antiresorptive medications, 4 and optimization of bone health throughout life can help prevent osteoporosis.

However, newer data provide insight into this question. Adapted from the National Osteoporosis Foundation. Clinician's Guide to Prevention and Treatment of Osteoporosis. All rights reserved. Osteoporosis was previously considered a normal part of aging, but it is now understood to be preventable and treatable. These strategies include adequate combined calcium and vitamin D intake calcium alone has not been shown to reduce fracturesantiresorptive therapy, weight-bearing exercise, tobacco avoidance, moderate alcohol intake, and avoidance Osteoporosis in asian americans trip or fall hazards.

Adequate calcium and vitamin D intake provides sufficient levels for bone formation and bone density maintenance; it ultimately reduces hip Osteoporosis in asian americans risk in osteopenic and osteoporotic patients and decreases the incidence of falls in at-risk older adults. Osteoporosis in asian americans has long been considered important for Osteoporosis in asian americans and secondary prevention, but concern about potential risks of supplementation and the unclear balance of benefits and harms has led to a recent change in guidelines.

The U. Their conclusions were based on a meta-analysis of 19 randomized controlled trials and 28 observational studies showing that the benefits of calcium and vitamin D supplementation for fracture risk reduction were setting-dependent. The prior USPSTF statement regarding the benefit of vitamin D supplementation to prevent falls in at-risk community-dwelling older adults has not changed.

Circulating Osteoporosis in asian americans D [25 OH D] is the functional indicator of vitamin D status, reflecting the total amount from dietary intake, cutaneous synthesis, and oral supplementation. The most common adverse effects of vitamin D supplementation are hypercalcemia and hypercalciuria. Meanwhile, patients should strive to obtain sufficient calcium through their diets.

Table 4 reviews literature regarding calcium and vitamin D supplementation. Multiple studies demonstrate the health benefits of exercise, including reduced risk of falls and fractures. Weight-bearing and muscle-strengthening exercise is recommended for osteoporosis prevention because it improves agility, posture, balance, and strength to prevent falls. A recent Cochrane review 10 included 43 randomized controlled trials investigating whether exercise could prevent bone loss and fractures in postmenopausal women.

A small but statistically significant effect of exercise on BMD was observed. Specifically, non-weight-bearing, high-force exercise e. Osteoporosis in asian americans exercise programs were the most effective for the spine. Tobacco and excessive alcohol intake are detrimental to bone health. The amount of daily alcohol intake that is harmful is unclear. However, in several studies, moderate alcohol intake appeared to be associated with slightly higher BMD and lower fracture risk in postmenopausal women.

We recommend no more than 1 unit of alcohol daily for women and no more than 2 units daily for men. Fall prevention helps prevent osteoporosis-related morbidity. Interventions include vision and hearing correction, removing trip or fall hazards, evaluating suspected neurologic problems, avoiding medications that cause imbalance, and advising hip pad protectors for those with significant risk.

Lastly, antiresorptive medications or selective estrogen-receptor modulators can be initiated in patients with osteopenia who have significant risk of osteoporosis. The American College of Preventive Medicine and USPSTF recommend that clinicians consider using osteoporosis risk-assessment tools to estimate absolute fracture risk when considering pharmacologic agents to prevent osteoporosis. FRAX is a computerized fracture-risk algorithm developed by the WHO that uses global models of population-based cohorts combined with clinical risk factors.

These values can be used to decide if treatment should be initiated; for example, U. Combining BMD and clinical risk factors Osteoporosis in asian americans sensitivity and maintains specificity. Disadvantages to FRAX include an inability to incorporate all known clinical risk factors e.

It also does not incorporate spine BMD. Disadvantages include the inability to accurately compare results from one center to another or to account for bone architecture. Multiple organizations have developed evidence-based osteoporosis screening recommendations Table 1.

However, the rationale for screening is based largely on indirect evidence. Most guidelines recommend Osteoporosis in asian americans screening of postmenopausal women by age 65 or younger postmenopausal women with risk factors.

However, the latter group can be difficult to identify clearly. No guidelines have been issued regarding screening intervals or cessation of screening due to insufficient data.

Only three published studies have tried to identify appropriate screening intervals. Ina prospective cohort study was conducted to determine whether repeated BMD screening measurements aided fracture-risk prediction beyond the initial measurement.

Ina study Osteoporosis in asian americans 1, nonosteoporotic women aged 60 years and older attempted to identify the ideal timing for repeat screening of BMD measurements by using fracture as the outcome metric. Both studies used risk of or development of fracture as the primary outcome, rather than identification of osteoporosis before fracture, illustrating a limitation in applying the findings to the establishment of guidelines for screening intervals.

A study investigated how Osteoporosis in asian americans testing interval related to osteoporosis development before fracture occurrence. Estimates were adjusted for major clinical risk factors such as smoking, glucocorticoid use, and rheumatoid arthritis. However, for women with advanced Real teachers with big boobs T-score, —2.

Thus, based on this study, the key determinant of the BMD testing interval appears to be baseline T-score. For those with initial normal BMD or mild osteopenia, the screening interval could be 15 years. For women with moderate osteopenia, screening every 5 years may be sufficient, and for women with advanced osteopenia, screening should likely be performed yearly. Notably, the estimated time to osteoporosis decreased with increasing age. These were the first evidence-based estimates for Osteoporosis in asian americans screening intervals before the development of osteoporotic fractures and before initiation of treatment for older postmenopausal women.

InNayak et al. Their model showed that the most effective and best value strategy i. This study, as well as the Osteoporosis in asian americans studies described, did not address screening intervals for younger postmenopausal women, nor did it indicate the appropriate time to consider cessation of screening.

Abundant evidence demonstrates that treatment reduces fracture risk due to postmenopausal osteoporosis. Additionally, potential harms of screening and treatment include anxiety from perceived vulnerability Osteoporosis in asian americans fracture, 51 false-negative results leading to lack of treatment and false reassurance, 5253 and potential harm from radiation exposure.

Osteoporosis in asian americans thorough history, physical examination, and routine blood work [including complete blood count, comprehensive metabolic panel, thyroid stimulating hormone, calcium and serum 25 OH D] Osteoporosis in asian americans identify most secondary causes. Bisphosphonates inhibit bone resorption through osteoclast function effects and are well tolerated.

All bisphosphonates can reduce the incidence of vertebral and nonvertebral fractures, but only some reduce hip fractures. Recently, concerns have been raised about the long-term safety of bisphosphonate therapy. Multiple case series have illustrated a link between prolonged bisphosphonate use and atypical fractures, as characterized by clinical and radiographic features. A systematic review 58 evaluated 32 case series reporting atypical femur fractures and showed that ethnicity and undiagnosed skeletal disorders may have a role in these atypical Osteoporosis in asian americans. Alendronate was the most commonly used bisphosphonate, and risk factors included concurrent glucocorticoid or proton-pump inhibitor use and prodromal thigh or hip pain.

Hot big boobs actress studies of subtrochanteric femur fractures identified additional Soleil moon frye fakes factors, including prolonged glucocorticoid therapy, active rheumatoid arthritis, and low serum 25 OH D levels.

Although multiple case series demonstrate a possible association between atypical fractures and bisphosphonate therapy, results have conflicted among several population-based studies. Cumulatively, the current body of evidence is thought to support this association. An additional, less common adverse effect of bisphosphonates is osteonecrosis of the jaw.

Selective estrogen-receptor modulators e. Calcitonin is a naturally occurring peptide that strongly inhibits osteoclast function through a receptor-mediated process. Synthetic or salmon-derived preparations are available as a parenteral injection, but they are most commonly administered intranasally.

Calcitonin was previously approved by the FDA for treatment of osteoporosis in women who are postmenopausal for at least 5 years. The cancer link was not clear but was believed to be plausible after considering the available evidence.

Estrogen decreases BMD loss by suppressing osteoclast cytokine release while inducing osteoclast death.

Important adverse effects include increased risk of thromboembolic events 40 and cardiovascular disease in older postmenopausal women. Human recombinant parathyroid hormone 1—34 also termed teriparatide is an anabolic agent Wifes nude nipples mature increases BMD by stimulating bone formation and inhibiting resorption.

It is administered by daily subcutaneous injection and is recommended for up to 2 years because of the short duration of safety and efficacy testing. Studies in rats have demonstrated an increased incidence of osteosarcoma, so it is contraindicated for patients with increased risk for osteosarcoma or a history of radiotherapy. By binding this ligand, denosumab ultimately inhibits osteoclast-mediated bone resorption. The international, randomized, placebo-controlled Fracture Reduction Evaluation of Denosumab in Osteoporosis FREEDOM trial showed that 36 months of denosumab significantly reduced the risk of vertebral and nonvertebral fractures in women aged 60 to 90 years with a diagnosis of osteoporosis.

It is generally not used as initial treatment for osteoporosis, given the efficacy, cost, and long-term safety data of bisphosphonates, but it may be used Osteoporosis in asian americans high-risk women. Biochemical markers e.

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