Este documento discute controversias en el tratamiento de la osteoporosis y osteopenia. Primero, describe los problemas frecuentemente encontrados en el tratamiento de la osteoporosis como el subdiagnóstico, falta de políticas claras para la prevención y falta de seguimiento a largo plazo. Luego, cubre recomendaciones para evaluar a pacientes para osteoporosis y exámenes de laboratorio e imágenes útiles. Finalmente, resume pautas para el diagnóstico, tratamiento y prevención de la osteoporosis.
Osteoporosis y tratamientos: Controversias y recomendaciones
1. Osteoporosis y Osteopenia.
Controversias en el tratamiento
Dra. Xiomara Emely Juarez M.
Dra. Xiomara Emely Juarez M.
Medicina Interna y Endocrinologia
Medicina Interna y Endocrinologia
2. Osteoporosis es …
Una alteración metabólica de los
huesos que causa que ellos se hagan
débiles y suceptibles a fracturas.
3. Fracturas de cadera: Una mala
caída
Mueren por
20
complicacioness
Incapacidad permanente 30
Incapacidad para llevar
50
una vida independiente
Requiere hospitalización 90
0 20 40 60 80 100
AACE Medical Guidelines for Clinical Practice for the Prevention and Management of
Postmenopausal osteoporosis
4. La fracturas osteoporoticas son más comunes en
mujeres que los infartos, accidentes vasculares
cerebrales, y cáncer de mama combinados 1-3
2,000,000
Incidencia annual de enfermedades comunes
1,500,000
1,500,000
*
300,000
cadera
1,000,000 250,000
antebrazo
250,000
otros sitios 513,000
500,000 **
228,000 184,300
700,000 vertebrales †
‡
0
Fracturas Infarto AVC Cancer de mama
Osteoporóticas
*
annual incidence all
ages
1. Riggs, B.L., and Melton, L.J. III, Bone 17(5)(Suppl.):505S-511S, 1995
**
annual estimate
2. Heart and Stroke Facts: 1996 Statistical Supplement, American Heart
women 29+
Association
†
annual estimate
3. Cancer Facts & Figures—1996, American Cancer Society
women 30+
5.
6.
7. Resistencia del hueso
Resistencia ósea = DMO + Calidad ósea
• Arquitectura
• Masa ósea pico
• Recambio óseo
• Cantidad de masa ósea
• Daño acumulado
• Mineralización
8. El Proceso de Remodelación Osea
Estado de descanso
Remodelación Iniciación
terminada
Resorción
Osteoclasto
(~proceso de 2 semanas)
Osteoblastos
Formación Fase de reversión
Bone HG, et al. Clin Ther. 2000;22:15-28.
9.
10.
11. Osteoporosis se caracteriza por
♦ Masa ósea baja
♦ Deterioro y fragilidad del tejido óseo
♦ Riesgo aumentado de fractura por fragilidad
ósea
12. Factores de riesgo
♦ Sexo femenino.
♦ Raza blanca.
♦ Edad avanzada.
♦ Historia personal de una fractura.
♦ Historia familiar de osteoporosis / fractura en un familiar
de primer grado.
♦ Hábito corpóreo pequeño / bajo peso (<127 lbs).
♦ Estilo de vida sedentaria / pobre actividad física.
♦ Uso de tabaco.
♦ Ingesta alcohólica excesiva (> 2 bebidas al día)
13. ♦ Insuficiente ingesta de calcio o vitamina D.
♦ Excesiva ingesta de cafeína.
♦ Menopausia temprana (<45 años)
– Falla ovárica prematura.
– Menopausia médica o quirúrgica.
14. ♦ Los estudios sobre Densidad Osea muestran que
hay pérdida del hueso en la mandíbula al
aumentar la edad. Esto ocurre con mayor
frecuencia en las mujeres que en los hombres, y
la pérdida de dientes puede ser un signo de
osteoporosis.
15.
16. PÉRDIDA ÓSEA DESPUÉS DE LA
MENOPAUSIA
Adaptado de Wasnich RD et al. Osteoporosis: Critique and Practicum,
Honolulu, Banyan Press, 1989, pp. 179-213.
29. Problemas frecuentemente encontrados en
el tratamiento de la osteoporosis
1. Sub-diagnóstico
2. No hay políticas claras para la Prevención
3. Preparar al médico para ofrecer tratamiento adecuado
4. Falta de seguimiento a largo plazo
30. A quiénes evaluar?
♦ Todas las mujeres mayores de 65 años
♦ Todas las mujeres adultas con historia de fractura
no causada por trauma severo
♦ Mujeres posmenopáusicas más jovenes que
tengan factores de riesgo
– Bajo peso (menos de 57.6 kilos)
– Historia familiar de fractura de cadera o columna
31. Cuando se sospecha la osteoporosis se
recomienda
♦ Evaluación clínica completa
♦ Determinar la densidad mineral ósea
♦ Evaluar la confiabilidad y entendimiento del
paciente y su deseo de aceptar los tratamiento
disponibles
32. Exámen físico
Apariencia general
Estatura
Deformidades
Pruebas de laboratorio
Hemograma
Química sanguínea (proteínas, enzimas
hepáticas, fosfatasa alcalina, creatinina,
electrolitos)
Urinalisis, incluyendo pH y calciuria
Evaluación adicional
TSH, PTH, 1-25 hidroxivitamina D,
cortisol, marcadores de resorción ósea
33. National Osteoporosis
Foundation
♦ Mujeres arriba de 65 años, independientemente de
los factores de riesgo.
♦ Mujeres postmenopáusicas más jóvenes, con uno
o más factores de riesgo además del sexo, raza y
estado postmenopáusico.
34. U.S. Preventive Services Task Force
♦ Todas las mujeres >65 años, independientemente
de los factores de riesgo.
♦ Mujeres entre los 60-65 años de edad, con riesgo
incrementado de fracturas, basado primariamente
en peso bajo (<70kg) o falta de terapia de
reemplazo hormonal.
35. American College of Obstetricians and
Gynecologists
♦ Todas las mujeres >65 años, independientemente
de los factores de riesgo.
♦ Mujeres postmenopáusicas <65 años con factores
de riesgo adicionales.
36. ♦ La densidad ósea baja es la principal característica
de la osteoporosis
♦ La medida de la densidad ósea ayuda en:
– Diagnóstico de la osteoporosis
– Determina su severidad
– Determina el riesgo de fractura
– Monitorea la respuesta al tratamiento
37. “Las máquinas no mienten, pero no existe
máquina alguna capaz de decirnos toda la
verdad.”
G K Chesterton (1874-1936)
38. ♦ RX convencional NO
detecta osteoporosis a
tiempo
♦ Se sospecha al
perderse 30 a 40% de
la DMO
40. Evaluación de la densidad mineral ósea .
♦ DEXA central y periférica.
♦ TAC cuantitativa.
♦ USG periférica.
41. Pruebas periféricas de Tamizaje
♦ Son pruebas para detectar población en riesgo
♦ Se requiere entrenamiento especializado
♦ Falsos positivos y falsos negativos
♦ NO hay criterios diagnósticos establecidos
♦ Decisión de pasos a seguir dependen del médico
especialista
♦ NO se utilizan para seguimiento de la osteoporosis
42. DXA
• Técnica más utilizada.
• Separa hueso y otros tejidos
• Puede medir en sitios relevantes
de fractura (cuerpo entero,cadera,
antebrazo, columna lumbar)
• Rapidez, (20 a 30 minutos).
• Precisión alta (< 1 % error)
• Exactitud alta (< 3% error).
• Dosis baja radiación (1 a 5 uSv)
• Buena correlación con Riesgo de
Fracturas.
45. Criterios diagnósticos de osteoporosis
Diagnóstico Criterio de DMO
Normal DMO dentro de 1 DS del promedio de adultos jovenes
Osteopenia DMO -1 DS y - 2.5 DS por debajo del promedio adulto joven
Osteoporosis DMO - 2.5 DS por debajo del promedio adulto
DMO = densidad mineral ósea; DS = desviasión estandard
referencia
48. .
Hueso normal Osteopenia Osteoporosis
Dempster DW, et al. A simple method for correlative light and scanning electron microscopy of
human iliac crest bone iopsies: Qualitative observations in normal and osteoporotic subjects. J
Bone Miner Res 1986;1(1):15-21.
49. Evaluación de laboratorio
♦ Evaluar causas secundarias de osteoporosis.
♦ La Fundación Nacional para la
Osteoporosis:
– TSH
– PTH
– Niveles de vitamina D
– Electroforesis de proteínas séricas
– Calcio y cortisol en orina de 24 horas.
50. Otros tests a considerar:
♦ Función renal.
♦ Función hepática.
♦ Evaluación de testosterona, LH y
FSH.
51. Marcadores séricos y urinarios de
recambio óseo
♦ Marcadores de formación ósea:
– Fosfatasa alcalina.
– Osteocalcina.
♦ Marcadores de resorción ósea:
– Hidroxiprolina urinaria.
– Telopéptidos colágeno termial N y C.
52. ♦ 20-50% del hueso se debe haber perdido
para hacerse evidentes cambios en las
radiografías.
♦ Rayos X de columna lumbosacra puede
considerarse.
53. Prevención de la osteoporosis
Optimizar el desarrollo esquelético y maximizar el pico de masa
ósea
Prevenir las causas secundarias de pérdida ósea y las
relacionadas con la edad
Preservar la integridad estructural del esqueléto
Prevenir fracturas
54. Tx farmacológico
♦ Todos los adultos con fracturas
osteoporóticas de cadera o columna.
♦ Adultos con score T <= -2.0 SD que no
tienen factores de riesgo específicos para
osteoporosis.
♦ Adultos con score T <= -1.5 SD que tienen
factores de riesgo para osteoporosis.
55. Mantener huesos fuertes – Previene la osteoporosis
♦ Buena nutrición
♦ Una dieta adecuada en calcio (2 to 3 vasos de leche al
día)
♦ Ingesta adecuada de vitamina D
♦ Ejercicio regular (caminata/bicicleta)
♦ Evitar uso de tabaco o ingesta excesiva de licor
56.
57. Alimentos ricos en
calcio*
1 taza de leche descremada 302 mg
1 taza de yogurt desgrasado 306 mg
1 onza de queso Cheddar 183 mg
1/2 taza de yogurt congelado 154 mg
2 onzas de sardines con hueso 217 mg
1 taza de broccoli 42 mg
1 taza de garbanzos 80 mg
* Alimentación en Osteroporosis
58. El Calcio Solo no Previene la Pérdida Ósea
Posmenopáusica Temprana
Columna Vertebral Cuello femoral
Citrato de Carbonato Citrato de Carbonato
Placebo calcio de calcio Placebo calcio de calcio
(n = 14) (n = 25) (n = 28) (n = 11) (n = 24) (n = 23)
Cambio en DMO Después de 2 Años (%)
0 0
-1 -1
-2 -2
-3 -3
-4
* -4
* *
Complemento de calcio = 500 mg/día.
*P < .01 contra la basal.
Dawson-Hughes B, y col. N Engl J Med. 1990;323:878-83.
59.
60. Vitamina D
♦ Recomendaciones diarias 400-800 IU por día
♦ Fuentes
De la dieta
Del sol
61. METAS DEL TRATAMIENTO DE LA
OSTEOPOROSIS
Prevenir fracturas futuras
Maximizar la función física
Detener las deformidades
62. Expectativas de un Medicamento para el
Tratamiento de la Osteoporosis
♦ Consistencia en objetivos de eficacia
♦ Aumento de la DMO en todos los sitios
♦ Reducción consistente de fractura
– Fracturas vertebrales (morfométricas y clínicas)
– Fracturas no-vertebrales
– Fracturas de cadera
♦ Resultados reproducibles y consistentes en
– Subgrupos
– Múltiples estudios
– Diferentes poblaciones
♦ Eficacia y seguridad establecida a largo plazo
63. Medicamentos: Qué es lo que hay?
♦ Bisfosfonatos Todos estos agentes :
– Alendronato • Suprimen la resorción ósea
– Risedronato
• Mejoran la DMO
♦ Calcitonina
• Reducen riesgo de fracturas
♦ Estrógenos
La tibolona no se incluyó pues
♦ Raloxifeno no ha sido aprobada para el
tratamiento de la osteoporosis
por la FDA
64. Recomendaciones de ACCE
♦ Primera prioridad
– Agentes aprobados por FDA para la prevención de la
osteoporosis
♦ Segunda prioridad *
– Agentes que no son aprobados por la FDA pero que
tienen niveles de evidencia 1 o 2 de eficacia y
seguridad
* Se usarían en caso de que los primeros no puedan
ser empleados por alguna razón
65. Agentes aprobados por FDA para la
prevención de la osteoporosis
Nivel 1 Nivel 2
Existe evidencia de eficacia en Existe evidencia de eficacia
antifractura de nivel 2 para:
reducción de fracturas
vertebrales
Bisfosfonatos
Calcitonina
Raloxifeno Estrógenos
Solo los bisfosfonatos demostraron reducción de fracturas de cadera y
de otros sitios
66. Bisfosfonatos
♦ Alendronato
– Es un bisfosfonato que contiene un grupo nitrógeno
♦ Indicaciones
– Prevención de osteoporosis
– Tratamiento de osteoporosis pos menopáusica
– Tratamiento de osteoporosis inducida por glucocorticoides
♦ Presentaciones
– Tabletas de 10 y 70 mg
♦ Dosis
– Tableta 10 mg una vez al día; tableta 70 mg una vez por
semana, debe tomarse con un vaso grande de agua pura con
el estómago vacío, 1/2 hora antes del desayuno; el paciente no
debe acostarse después de tomar el medicamento
67. ♦ Eficacia : En estudios clínicos controlados, doble
ciego, comparado contra placebo:
– Previene la pérdida del hueso y aumenta la DMO en columna y
cadera entre el 5 a 10 %, previene la pérdida de hueso en el
antebrazo (Nivel 2 de evidencia)
– Reduce el riesgo de fracturas vertebrales y no vertebrales
hasta en un 40 a 50 % (Nivel 1 de evidencia)
– Los efectos sobre la DMO en columna y cadera se mantienen
por lo menos después de dos años de haber sido
descontinuado en mujeres de edad avanzada
– Ha demostrado se efectivo para el tratamiento de osteoporosis
inducida por glucocorticoides
71. Moduladores selectivos de los
receptores estrogénicos
♦ Activan los receptores estrogénicos en órgano blanco y
producen efectos estrogénicos variables en los tejidos
que responden a esas hormonos.
♦ Aprobados por FDA para el tratamiento de la osteoporosis
posmenopáusica y la prevención de la pérdida de hueso
en mujeres menopáusicas de reciente diagnóstico.
♦ Disponible como tabletas de 60 mg.
♦ Dosis 60 mg diarios
72. ♦ Eficacia:
– Estudios de 36 meses de duración con raloxifeno (60 y 120 mg
diarios) redujo las fracturas vertebrales en un 30 a 50 % (Nivel 1 de
evidencia)
– No reduce fracturas no vertebrales y aumenta la DMO en la columna
en un 2.7 % y en la cadera en un 2.4% comparado contra placebo.
♦ Efectos no esqueléticos
– Reduce el colesterol total y el Col LDL, el efecto
cardiovascular de raloxifeno no se conoce.
– En el estudio MORE se observó una reducción del 76% en el
cáncer de mama y una disminución del 90% de los cánceres
de mama sensibles a estrógenos
73. ♦ Efectos secundarios
– Riesgo tres veces mayor de tromboembolismo venoso
– Calores en la cara
– Calambres en las piernas
– Edema periférico
– Acumulación de líquido endometrial
♦ Contraindicaciones
– Embarazo
– Tromboflebitis o enfermedad tromboembólica o
antecedentes de tromboembolismo
– Hipersensibilidad
♦ Duración del tratamiento
– La eficacia y seguridad se ha determinado hasta por 40
meses
75. PUNTOS CLAVE
♦ Las consecuencias clínicas de la osteoporosis
están principalmente relacionadas con las fracturas
por fragilidad, que se presentan más
frecuentemente en columna, cadera y muñeca.
♦ La parte clave de evaluación en pacientes que se
sospecha osteoporosis es evaluar su densidad ósea
por DEXA (dual energy x-ray absorptiometry).
76. ♦ Osteoporosis y osteopenia se definen como scores T > 2.5
y 1-2.5 SDs por debajo de la media de referencia para el
joven adulto.
♦ Todos los pacientes con fracturas osteoporóticas, un score
T <-2.0, o un score T < -1.5 con factores de riesgo
adicionales deberían tratarse para osteoporosis.
♦ Es vital asegurar que todos los pacientes con osteoporosis
tengan una adecuada ingesta de calcio y vitamina D, lo
cual usualmente requiere suplemento.
77. ♦ Bifosfonatos (alendronato, risedronato) son generalmente los
agentes de primera línea en el tratamiento de la osteoporosis, ya
que son la única opción terapéutica que ha probado reducir el
desarrollo de fracturas de cadera y vertebrales.
♦ Terapia de reemplazo con estrógenos y terapia de reemplazo
hormonal pueden prevenir el desarrollo de fracturas osteoporóticas,
pero este beneficio debe valorarse contra el riesgo incrementado de
muchos resultados adversos.
78. Prevención y tratamiento de la
osteoporosis
Mejor calidad de
vida
Menos fracturas
Menos gastos en
servicios médicos
Hinweis der Redaktion
In its simplest form, osteoporosis can be defined as a metabolic disorder of the bones causing them to become weaker and more susceptible to fracture.
Hip fractures are the most serious complication of osteoporosis, requiring hospitalization for nine out of 10 sufferers. Costly and painful, they result in permanent disability in more than 30 percent of patients and more than 50 percent are unable to return to independent living. Sadly, up to 20 percent of hip fracture patients die within one year of fracture.
Did you know, that the incidence of osteoporotic fracture in women is far greater than that of heart attack, stroke and breast cancer combined? In light of the staggering statistics, it is important for physicians and patients to understand that osteoporosis should be managed as aggressively as other diseases.
Osteoporosis is characterized by low bone mass, the deterioration of bone tissue leading to fragility and a heightened risk of fracture. Bones usually stop growing in your late teens, but they continue to increase in density until about age 35. Increasing your bone mass before age 35 can help to prevent osteoporosis as you age. Once you have started to lose bone tissue, the condition cannot be reversed, only slowed down.
Once weekly dosing with alendronate can be considered as a potential alternative treatment regimen based on the biology of bone remodeling and the knowledge that alendronate remains at the bone surface, where it is active, for up to several weeks after dosing. Bone remodeling occurs in discrete remodeling units or sites. At any point in time, most bone surface is inactive, and lining cells cover the surface during the resting stage. The first step in remodeling is activation of resorption; the lining cells retreat, and osteoclasts then resorb the exposed mineralized tissue. Resorption proceeds for approximately 2 weeks at each remodeling site. For this reason, an antiresorptive agent, administered up to every 2 weeks, but not less frequently, would be anticipated to affect all active remodeling sites. Once the resorption phase is completed, osteoblasts migrate to the resorption pit and refill it with new osteoid matrix, which becomes well mineralized within 1-2 weeks of deposition; a subsequent further increase in the density of mineralization occurs over the following 4-6 months. Initiation of new remodeling sites occurs continuously and asynchronously throughout the skeleton. Thus, there are remodeling sites at various stages of bone resorption and formation at any point in time.
Osteoporosis is characterized by low bone mass, the deterioration of bone tissue leading to fragility and a heightened risk of fracture. Bones usually stop growing in your late teens, but they continue to increase in density until about age 35. Increasing your bone mass before age 35 can help to prevent osteoporosis as you age. Once you have started to lose bone tissue, the condition cannot be reversed, only slowed down.
For those diagnosed with osteoporosis, the AACE medical guidelines recommend a comprehensive follow-up examination that included a patient history and physical examination. The physical exam will include: an assessment of risk factors for fractures, laboratory tests such as, blood and urine samples, and an assessment of the patient’s reliability, understanding, and willingness to accept available interventions. Adding an endocrinologist to your osteoporosis management team is also strongly suggested.
For those diagnosed with osteoporosis, the AACE medical guidelines recommend a comprehensive follow-up examination that included a patient history and physical examination. The physical exam will include: an assessment of risk factors for fractures, laboratory tests such as, blood and urine samples, and an assessment of the patient’s reliability, understanding, and willingness to accept available interventions. Adding an endocrinologist to your osteoporosis management team is also strongly suggested.
Low bone density is a major, consistent characteristic of osteoporosis. There is a strong inverse relationship between a person’s bone density and their future risk of fracture. Your bone density is the best indicator of your fracture risk. However, it is important to realize that patients may fracture at different bone density levels. Measuring your bone density provides your medical team with the information needed to make a clinical decision about next steps in your osteoporosis management and care.
For those diagnosed with osteoporosis, the AACE medical guidelines recommend a comprehensive follow-up examination that included a patient history and physical examination. The physical exam will include: an assessment of risk factors for fractures, laboratory tests such as, blood and urine samples, and an assessment of the patient’s reliability, understanding, and willingness to accept available interventions. Adding an endocrinologist to your osteoporosis management team is also strongly suggested.
Although there currently is no cure for osteoporosis, there are several preventive measures and treatments available. The goals for treatment are to prevent fractures,maximize physical function, and halt progressive deformity. The ability to achieve these goals depends on the commitment to therapy of both the patient and his or her medical team, and the potential for the chosen therapeutic program to produce positive results. Often, a patient’s therapy includes a combination of treatments.
The progression of osteoporosis can be delayed through a number of preventive measures. Effective prevention strategies are important for all people, particularly children and adolescents who are still in the “bone-building” years. A balanced diet high in calcium (1,000 to 1,500 mg/day) and vitamin D (400 to 800 IU/day) helps retain healthy bone mass. Weight-bearing exercises, such as walking, dancing and biking, enhance bone development and may slow bone loss linked to the lack of activity in the elderly. Maintaining a healthy lifestyle, and avoiding smoking and excessive alcohol consumption may also offer modest preventive benefits. It is also important to add bone density testing to your regular check up once you turn 45 or feel you might be at risk.
Lack of calcium is known to lead to the development of osteoporosis, but calcium also plays an important role in the proper function of the heart, muscles and nerves and also in the clotting of blood. Nutritional surveys indicate that young girls and women consume less than half of the recommended amount of calcium need to grow and maintain healthy bones. Your recommended daily calcium intake ranges from 1,000 mg to 1,500 mg. In addition to dairy products, certain vegetables (broccoli, turnip greens), canned fish (sardines), tofu, corn bread, eggs and calcium fortified foods are good sources of calcium.
Los efectos sobre el esqueleto del complemento de calcio no son claros por completo. 1 Los resultados de estudios aleatorizados, prospectivos no son concluyentes; sin embargo, la mayoría de los datos indica que el complemento de calcio no previene la pérdida ósea en mujeres posmenopáusicas en los primeros años. Este estudio doble ciego, controlado con placebo, aleatorizado, evaluó el efecto de 2 formas de calcio sobre la pérdida ósea en la columna vertebral y cuello en mujeres que habían sido posmenopáusicas durante 5 años o menos. 2 Después de 2 años, todos los grupos experimentaron reducciones significativas en la DMO. Además, comparado con placebo, no hubo diferencias significativas en la pérdida ósea en ninguno de los grupos de calcio. Así, en la mayoría de las mujeres posmenopáusicas en los primeros años pudiera ser necesario el tratamiento contra la resorción para prevenir la pérdida ósea. 1 American Association of Clinical Endocrinologists. American Association of Clinical Endocrinologists 2001 medical guidelines for clinical practice for the prevention and management of postmenopausal osteoporosis. Endocr Pract . 2001;7:293-312. 2 Dawson-Hughes B, Dallal GE, Krall EA, Sadowski L, Sahyoun N, Tannenbaum S. A controlled trial of the effect of calcium supplementation on bone density in postmenopausal women. N Engl J Med . 1990;323:878-883.
Vitamin D, which aids in the absorption of calcium, is not widely found in natural food sources. It is primarily found in fish oils, some vegetables, and fortified milks, cereals, and breads. You can also receive vitamin D through your skin following direct exposure to sunlight. 10-15 minutes of sun exposure two to three times a week is usually enough to satisfy your body’s vitamin D requirement. As you age, your ability to absorb vitamin D through your skin decreases and you might need to take a multi-vitamin to increase your vitamin D consumption. Too much vitamin D can be harmful, so consult your doctor before you start taking any supplements.
Although there currently is no cure for osteoporosis, there are several preventive measures and treatments available. The goals for treatment are to prevent fractures,maximize physical function, and halt progressive deformity. The ability to achieve these goals depends on the commitment to therapy of both the patient and his or her medical team, and the potential for the chosen therapeutic program to produce positive results. Often, a patient’s therapy includes a combination of treatments.
Alendronate and Risedronate, medications from the bisphosphonates class of drugs, are effective alternatives to estrogen replacement therapy for treating postmenopausal osteoporosis in women who cannot or will not take estrogen. They have been approved for use in steroid-induced osteoporosis that occurs in men and women. Calcitonin is a hormone made by the thyroid gland which prevents the cells that break down bone from working properly, improving the action of bone building cells. Calcitonin is particularly effective immediately following fractures because of its pain suppressing effect. Estrogen replacement therapy is the most common treatment for osteoporosis. In the United States, oral and transdermal forms of estrogen are approved for the prevention of bone loss in newly menopausal women. Estrogen therapy may be continued for a lifetime. Direct evidence suggests that bone loss recurs after estrogen treatment is discontinued. SERMs or selective estrogen receptor modulators are a new generation of synthetic hormones, which have estrogen-like effects in some parts of the body but not others. They prevent bone loss in the spine, hip and total body.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
For most osteoporosis sufferers, an endocrinologist is a valuable member of the treatment team. We are physicians who specialize in your body’s glands and hormones, with a specific concentration on metabolic bone disease. By training, endocrinologists are the experts in osteoporosis management, as we also have a thorough understanding of the underlying causes of the disease. If you have been diagnosed with osteoporosis, you may wish to consult with an endocrinologist. Endocrinologists also are an important resource for primary physicians treating bone disease.
To effectively manage osteoporosis, physicians must first identify the underlying cause of the disease. Without this critical information, effective therapy is unlikely. Specifically, AACE recommends that you should see an endocrinologist when: your osteoporosis is unexpectedly severe or has unusual features; you have very low bone density; you are young (premenopausal if female) yet have osteoporosis; you fracture easily despite borderline or normal bone mass density results; [continued on next slide]