Postmenopausal osteoporosis.
Osteoporosis is a metabolic bone disorder that is characterized by low bone mass and micro-architectural deterioration of bone tissue. Fractures of the proximal femur, the vertebrae and the distal radius are the most frequent osteoporotic fractures, although most fractures in the elderly are probably at least partly related to bone fragility. The incidence of fractures varies greatly by country, but on average up to 50% of women >50 years of age are at risk of fractures. Fractures severely affect the quality of life of an individual and are becoming a major public health problem owing to the ageing population. Postmenopausal osteoporosis, resulting from oestrogen deficiency, is the most common type of osteoporosis. Oestrogen deficiency results in an increase in bone turnover owing to effects on all types of bone cells. The imbalance in bone formation and resorption has effects on trabecular bone (loss of connectivity) and cortical bone (cortical thinning and porosity). Osteoporosis is diagnosed using bone density measurements of the lumbar spine and proximal femur. Preventive strategies to improve bone health include diet, exercise and abstaining from smoking. Fractures may be prevented by reducing falls in high-risk populations. Several drugs are licensed to reduce fracture risk by slowing down bone resorption (such as bisphosphonates and denosumab) or by stimulating bone formation (such as teriparatide). Improved understanding of the cellular basis for osteoporosis has resulted in new drugs targeted to key pathways, which are under development.
Academic Unit of Bone Metabolism, and Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK.
Richard
R
Eastell
Arthritis Research UK Centre for Epidemiology, Centre for Musculoskeletal Research, Manchester Academic Health Science Centre (MAHSC), The University of Manchester, Manchester, UK.
Terence W
TW
O'Neill
Division of Endocrinology, Diabetes, and Bone Diseases and Centre for Healthy Aging, Technische Universität Dresden Medical Center, Dresden, Germany.
Lorenz C
LC
Hofbauer
Department of Endocrinology and Internal Medicine, Aarhus University Hospital, Aarhus, Denmark.
Bente
B
Langdahl
Department of Medicine, University of Auckland, Auckland, New Zealand.
Ian R
IR
Reid
Departments of Psychiatry &Behavioral Sciences, Sociology, and Psychology &Neuroscience, Duke University Medical Center, Durham, North Carolina, USA.
Deborah T
DT
Gold
San Francisco Coordinating Center, California Pacific Medical Center Research Institute and the University of California, San Francisco, San Francisco, California, USA.
Steven R
SR
Cummings