Skip to main content
NCBI home page
Postgraduate Medical Journal logoLink to Postgraduate Medical Journal
. 2003 Mar;79(929):133–138. doi: 10.1136/pmj.79.929.133

What is osteoporosis?

C Christodoulou 1, C Cooper 1
PMCID: PMC1742639  PMID: 12697910

Abstract

Osteoporosis is a very common disorder, which results in an increase in fracture risk. The annual cost attributable to hip, vertebral, and wrist fractures in England and Wales is £1.7 billion. Significant mortality and morbidity are associated with osteoporotic fractures. The method that is most widely used for the diagnosis of osteoporosis is dual energy x-ray absorptiometry. The aim of prevention and treatment of osteoporosis is to prevent the occurrence of future fractures. Lifestyle changes should be encouraged in high risk patients. Pharmacological treatments include the bisphosphonates, hormone replacement therapy, selective oestrogen receptor modulators, calcitonin, the 1–34 fragment of parathyroid hormone, calcium and vitamin D supplements, and calcitriol.

Full Text

The Full Text of this article is available as a PDF (160.9 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adachi J. D., Roux C., Pitt P. I., Cooper C., Moniz C., Dequeker J., Ioannidis G., Cawley M. I., Jenkins E. A., Walker-Bone K. E. A pooled data analysis on the use of intermittent cyclical etidronate therapy for the prevention and treatment of corticosteroid induced bone loss. J Rheumatol. 2000 Oct;27(10):2424–2431. [PubMed] [Google Scholar]
  2. Black D. M., Cooper C. Epidemiology of fractures and assessment of fracture risk. Clin Lab Med. 2000 Sep;20(3):439–453. [PubMed] [Google Scholar]
  3. Black D. M., Cooper C. Epidemiology of fractures and assessment of fracture risk. Clin Lab Med. 2000 Sep;20(3):439–453. [PubMed] [Google Scholar]
  4. Browner W. S., Seeley D. G., Vogt T. M., Cummings S. R. Non-trauma mortality in elderly women with low bone mineral density. Study of Osteoporotic Fractures Research Group. Lancet. 1991 Aug 10;338(8763):355–358. doi: 10.1016/0140-6736(91)90489-c. [DOI] [PubMed] [Google Scholar]
  5. Chapuy M. C., Arlot M. E., Duboeuf F., Brun J., Crouzet B., Arnaud S., Delmas P. D., Meunier P. J. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992 Dec 3;327(23):1637–1642. doi: 10.1056/NEJM199212033272305. [DOI] [PubMed] [Google Scholar]
  6. Chesnut C. H., 3rd, Silverman S., Andriano K., Genant H., Gimona A., Harris S., Kiel D., LeBoff M., Maricic M., Miller P. A randomized trial of nasal spray salmon calcitonin in postmenopausal women with established osteoporosis: the prevent recurrence of osteoporotic fractures study. PROOF Study Group. Am J Med. 2000 Sep;109(4):267–276. doi: 10.1016/s0002-9343(00)00490-3. [DOI] [PubMed] [Google Scholar]
  7. Chrischilles E. A., Butler C. D., Davis C. S., Wallace R. B. A model of lifetime osteoporosis impact. Arch Intern Med. 1991 Oct;151(10):2026–2032. [PubMed] [Google Scholar]
  8. Colditz G. A., Hankinson S. E., Hunter D. J., Willett W. C., Manson J. E., Stampfer M. J., Hennekens C., Rosner B., Speizer F. E. The use of estrogens and progestins and the risk of breast cancer in postmenopausal women. N Engl J Med. 1995 Jun 15;332(24):1589–1593. doi: 10.1056/NEJM199506153322401. [DOI] [PubMed] [Google Scholar]
  9. Compston J. E., Cooper C., Kanis J. A. Bone densitometry in clinical practice. BMJ. 1995 Jun 10;310(6993):1507–1510. doi: 10.1136/bmj.310.6993.1507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Compston J. E., Cooper C., Kanis J. A. Bone densitometry in clinical practice. BMJ. 1995 Jun 10;310(6993):1507–1510. doi: 10.1136/bmj.310.6993.1507. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Compston J. Prevention and treatment of osteoporosis. Clinical guidelines and new evidence. J R Coll Physicians Lond. 2000 Nov-Dec;34(6):518–521. [PMC free article] [PubMed] [Google Scholar]
  12. Compston J. Prevention and treatment of osteoporosis. Clinical guidelines and new evidence. J R Coll Physicians Lond. 2000 Nov-Dec;34(6):518–521. [PMC free article] [PubMed] [Google Scholar]
  13. Cooper C., Atkinson E. J., Jacobsen S. J., O'Fallon W. M., Melton L. J., 3rd Population-based study of survival after osteoporotic fractures. Am J Epidemiol. 1993 May 1;137(9):1001–1005. doi: 10.1093/oxfordjournals.aje.a116756. [DOI] [PubMed] [Google Scholar]
  14. Cooper C. Epidemiology and public health impact of osteoporosis. Baillieres Clin Rheumatol. 1993 Oct;7(3):459–477. doi: 10.1016/s0950-3579(05)80073-1. [DOI] [PubMed] [Google Scholar]
  15. Cumming R. G., Nevitt M. C. Calcium for prevention of osteoporotic fractures in postmenopausal women. J Bone Miner Res. 1997 Sep;12(9):1321–1329. doi: 10.1359/jbmr.1997.12.9.1321. [DOI] [PubMed] [Google Scholar]
  16. Cummings S. R., Black D. M., Nevitt M. C., Browner W., Cauley J., Ensrud K., Genant H. K., Palermo L., Scott J., Vogt T. M. Bone density at various sites for prediction of hip fractures. The Study of Osteoporotic Fractures Research Group. Lancet. 1993 Jan 9;341(8837):72–75. doi: 10.1016/0140-6736(93)92555-8. [DOI] [PubMed] [Google Scholar]
  17. Cummings S. R., Nevitt M. C., Browner W. S., Stone K., Fox K. M., Ensrud K. E., Cauley J., Black D., Vogt T. M. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767–773. doi: 10.1056/NEJM199503233321202. [DOI] [PubMed] [Google Scholar]
  18. Cummings S. R., Nevitt M. C., Browner W. S., Stone K., Fox K. M., Ensrud K. E., Cauley J., Black D., Vogt T. M. Risk factors for hip fracture in white women. Study of Osteoporotic Fractures Research Group. N Engl J Med. 1995 Mar 23;332(12):767–773. doi: 10.1056/NEJM199503233321202. [DOI] [PubMed] [Google Scholar]
  19. Delmas P. D., Bjarnason N. H., Mitlak B. H., Ravoux A. C., Shah A. S., Huster W. J., Draper M., Christiansen C. Effects of raloxifene on bone mineral density, serum cholesterol concentrations, and uterine endometrium in postmenopausal women. N Engl J Med. 1997 Dec 4;337(23):1641–1647. doi: 10.1056/NEJM199712043372301. [DOI] [PubMed] [Google Scholar]
  20. Delmas Pierre D. Treatment of postmenopausal osteoporosis. Lancet. 2002 Jun 8;359(9322):2018–2026. doi: 10.1016/S0140-6736(02)08827-X. [DOI] [PubMed] [Google Scholar]
  21. Eastell R., Reid D. M., Compston J., Cooper C., Fogelman I., Francis R. M., Hosking D. J., Purdie D. W., Ralston S. H., Reeve J. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med. 1998 Oct;244(4):271–292. doi: 10.1046/j.1365-2796.1998.00408.x. [DOI] [PubMed] [Google Scholar]
  22. Eastell R., Reid D. M., Compston J., Cooper C., Fogelman I., Francis R. M., Hosking D. J., Purdie D. W., Ralston S. H., Reeve J. A UK Consensus Group on management of glucocorticoid-induced osteoporosis: an update. J Intern Med. 1998 Oct;244(4):271–292. doi: 10.1046/j.1365-2796.1998.00408.x. [DOI] [PubMed] [Google Scholar]
  23. Elders P. J., Lips P., Netelenbos J. C., van Ginkel F. C., Khoe E., van der Vijgh W. J., van der Stelt P. F. Long-term effect of calcium supplementation on bone loss in perimenopausal women. J Bone Miner Res. 1994 Jul;9(7):963–970. doi: 10.1002/jbmr.5650090702. [DOI] [PubMed] [Google Scholar]
  24. Grady D., Rubin S. M., Petitti D. B., Fox C. S., Black D., Ettinger B., Ernster V. L., Cummings S. R. Hormone therapy to prevent disease and prolong life in postmenopausal women. Ann Intern Med. 1992 Dec 15;117(12):1016–1037. doi: 10.7326/0003-4819-117-12-1016. [DOI] [PubMed] [Google Scholar]
  25. Hodsman Anthony B., Hanley David A., Josse Robert. Do bisphosphonates reduce the risk of osteoporotic fractures? An evaluation of the evidence to date. CMAJ. 2002 May 28;166(11):1426–1430. [PMC free article] [PubMed] [Google Scholar]
  26. Johnell O., Gullberg B., Allander E., Kanis J. A., MEDOS Study Group The apparent incidence of hip fracture in Europe: a study of national register sources. Osteoporos Int. 1992 Nov;2(6):298–302. doi: 10.1007/BF01623186. [DOI] [PubMed] [Google Scholar]
  27. Kanis J. A. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: synopsis of a WHO report. WHO Study Group. Osteoporos Int. 1994 Nov;4(6):368–381. doi: 10.1007/BF01622200. [DOI] [PubMed] [Google Scholar]
  28. Laskey M. A., Crisp A. J., Cole T. J., Compston J. E. Comparison of the effect of different reference data on Lunar DPX and Hologic QDR-1000 dual-energy X-ray absorptiometers. Br J Radiol. 1992 Dec;65(780):1124–1129. doi: 10.1259/0007-1285-65-780-1124. [DOI] [PubMed] [Google Scholar]
  29. Laskey M. A., Flaxman M. E., Barber R. W., Trafford S., Hayball M. P., Lyttle K. D., Crisp A. J., Compston J. E. Comparative performance in vitro and in vivo of Lunar DPX and Hologic QDR-1000 dual energy X-ray absorptiometers. Br J Radiol. 1991 Nov;64(767):1023–1029. doi: 10.1259/0007-1285-64-767-1023. [DOI] [PubMed] [Google Scholar]
  30. Law M. R., Hackshaw A. K. A meta-analysis of cigarette smoking, bone mineral density and risk of hip fracture: recognition of a major effect. BMJ. 1997 Oct 4;315(7112):841–846. doi: 10.1136/bmj.315.7112.841. [DOI] [PMC free article] [PubMed] [Google Scholar]
  31. Looker A. C., Orwoll E. S., Johnston C. C., Jr, Lindsay R. L., Wahner H. W., Dunn W. L., Calvo M. S., Harris T. B., Heyse S. P. Prevalence of low femoral bone density in older U.S. adults from NHANES III. J Bone Miner Res. 1997 Nov;12(11):1761–1768. doi: 10.1359/jbmr.1997.12.11.1761. [DOI] [PubMed] [Google Scholar]
  32. Lukert B. P., Raisz L. G. Glucocorticoid-induced osteoporosis: pathogenesis and management. Ann Intern Med. 1990 Mar 1;112(5):352–364. doi: 10.7326/0003-4819-112-5-352. [DOI] [PubMed] [Google Scholar]
  33. Mazess R., Collick B., Trempe J., Barden H., Hanson J. Performance evaluation of a dual-energy x-ray bone densitometer. Calcif Tissue Int. 1989 Mar;44(3):228–232. doi: 10.1007/BF02556569. [DOI] [PubMed] [Google Scholar]
  34. Melton L. J., 3rd, Chrischilles E. A., Cooper C., Lane A. W., Riggs B. L. Perspective. How many women have osteoporosis? J Bone Miner Res. 1992 Sep;7(9):1005–1010. doi: 10.1002/jbmr.5650070902. [DOI] [PubMed] [Google Scholar]
  35. Neer R. M., Arnaud C. D., Zanchetta J. R., Prince R., Gaich G. A., Reginster J. Y., Hodsman A. B., Eriksen E. F., Ish-Shalom S., Genant H. K. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001 May 10;344(19):1434–1441. doi: 10.1056/NEJM200105103441904. [DOI] [PubMed] [Google Scholar]
  36. Ooms M. E., Roos J. C., Bezemer P. D., van der Vijgh W. J., Bouter L. M., Lips P. Prevention of bone loss by vitamin D supplementation in elderly women: a randomized double-blind trial. J Clin Endocrinol Metab. 1995 Apr;80(4):1052–1058. doi: 10.1210/jcem.80.4.7714065. [DOI] [PubMed] [Google Scholar]
  37. Prince R. L., Smith M., Dick I. M., Price R. I., Webb P. G., Henderson N. K., Harris M. M. Prevention of postmenopausal osteoporosis. A comparative study of exercise, calcium supplementation, and hormone-replacement therapy. N Engl J Med. 1991 Oct 24;325(17):1189–1195. doi: 10.1056/NEJM199110243251701. [DOI] [PubMed] [Google Scholar]
  38. Reid I. R., Evans M. C., Ames R., Wattie D. J. The influence of osteophytes and aortic calcification on spinal mineral density in postmenopausal women. J Clin Endocrinol Metab. 1991 Jun;72(6):1372–1374. doi: 10.1210/jcem-72-6-1372. [DOI] [PubMed] [Google Scholar]
  39. Tilyard M. W., Spears G. F., Thomson J., Dovey S. Treatment of postmenopausal osteoporosis with calcitriol or calcium. N Engl J Med. 1992 Feb 6;326(6):357–362. doi: 10.1056/NEJM199202063260601. [DOI] [PubMed] [Google Scholar]
  40. Wu Fiona, Ames Ruth, Clearwater Judy, Evans Margaret C., Gamble Greg, Reid Ian R. Prospective 10-year study of the determinants of bone density and bone loss in normal postmenopausal women, including the effect of hormone replacement therapy. Clin Endocrinol (Oxf) 2002 Jun;56(6):703–711. doi: 10.1046/j.1365-2265.2002.01534.x. [DOI] [PubMed] [Google Scholar]

Articles from Postgraduate Medical Journal are provided here courtesy of BMJ Publishing Group

RESOURCES