The American corporation of Obstet...

The American corporation of Obstetricians and Gynecologists (ACOG) lately issued guidelines for the clinical management of osteoporosis in women including recommendations for screening, prevention, and treatment of this condition. The guidelines appeared in the January 2004 issue of Obstetrics and Gynecology

Approximately 13 to 18 percent of women in the United States who are at least 50 years antiquated have osteoporosis and an additional 37 to 50 percent have osteopenia. Risk factors for osteoporotic fractures in this population include a family history of osteoporosis, previous fractures, white race, dementia, poor nutrition, cigarette smoking, alcoholism, reasonable weight and body mass index, estrogen deficiency, early menopause (before 45 years of age) or extended premenopausal amenorrhea, long-term low calorie intake, impaired eyesight despite adequate correction, history of falls, and inadequate physical activity. Appropriate screening strategies and significant pharmacologic interventions are available to obviate and treat osteoporosis.

According to ACOG, the preferr order for diagnosing osteoporosis is bone mineral density testing. Dual-energy x-ray absorptiometry (DEXA) is the technical standard for measuring bone mineral density because it measures at important sites of osteoporotic fractures, has high precision and accuracy, is relatively inexpensive, and has unostentatious radiation exposure.

Clinical Considerations and Recommendations

When should screening for osteoporosis be initiated? These guidelines commit that testing of bone mineral density be performed based upon the patient's risk factors and is not indicated unles the consequence s will affect a treatment or regimen program. Specifically, testing for bone mineral density should be make acceptableed for all women who are postmenopausal and at least 65 years of age. Bone mineral density testing may be approveed for women who are postmenopausal and younger than 65 years who have at least undivided risk factor for osteoporosis. Finally, bone mineral density testing should be performed onward all women who are postmenopausal with fractures to confirm the diagnosis of osteoporosis and determine the severity of disease.

Bone mineral density testing may be of use in pre- and postmenopausal women with certain diseases or medical conditions (i.e., acquired immunodeficiency syndrome human immunodeficiency virus, chronic obstructive pulmonary disease, hyperparathyroidism, inflammatory bowel disease, rheumatoid arthritis) and those who take medications associated with an increased risk of osteoporosis. Screening should not be performed more oftentimes than every two years in women who do not make known new risk factors.

in subordination to what circumstances are screening touchstones other than DEXA useful? Peripheral bone densitometry devices (including quantitative ultrasonography, single-energy xray absorptiometry, peripheral DEXA, and peripheral quantitative comput tomography) are les expensive, portable, have grave radiation exposure, and have reasonable precision. The use of these devices is limited to the evaluation of bone los of the peripheral skeleton, and cannot replace DEXA scans for diagnosing osteoporosis and osteopenia and predicting hip fractures.

Can lifestyle changes interrupt osteoporosis and osteoporosis-related fractures? Studies have shown that exercise and increased muscle mass lead to the evolution of increased bone mass. Therefore, patients should participate in weight-bearing exercise, like as strength training or aerobic fitness. Any diseases or sensory impairments that can come in falling should be evaluated and treated. Medications (such as sedatives, narcotic analgesics, antihypertensives, and anticholinergics) should be avoided, if possible. The living and work environments should be assessed to take out safety hazards such as unloose rugs and carpets, poor lighting, and obstacles. The risk of developing a fracture also may be reduc on cessation of cigarette smoking and reduction of alcohol intake.

Is there a part for estrogen and progestin in the prevention or treatment of osteoporosis? According to the authors, the risk of long-term use of estrogen or hormone therapy is small, on the other hand they recommend that it be administered for the shortest period at the lowest possible dose. They commend that the use of hormone therapy for the prevention of osteoporosis or risk reduction of fractures be based in succession the patient's history and risk factors. Risk assessment and screening for a woman who has discontinued estrogen therapy should tread in the steps of the same criteria as for a women who is in the early stages of menopause.

Is other pharmacotherapy beneficial for the prevention and treatment of osteoporosis? Medications available for the prevention of osteoporosis include bisphosphonates (i.e., alendronate, risedronate) and selective estrogenreceptor modulators (i.e., raloxifene, tibolone, tamoxifen). Bisphosphonates inhibit osteoclast activity, which comes in reduced bone resorption and bone los These agents increase bone mineral density at the spine and hip, and bring into fractures in women who have osteoporosis at all locations by the agency of 30 to 50 percent. Upper gastrointestinal side general intents may prevent the use of bisphosphonates in patients who have gastroesophageal ebb disease and other esophageal abnormalities. Selective estrogen-receptor modulators were designed to have estrogen-like general intents on skeletal bone density and to remodel fractures without stimulating endometrial or breast tissue. The U aliment and Drug Administration (FDA) has approved raloxifene and tibolone for the prevention of osteoporosis. Studies have demonstrated that raloxifene significantly make lesss bone resorption, increases bone mineral density, and renders vertebral fractures in postmenopausal women with osteoporosis. Tamoxifen has been shown to yield slight but statistically significant reductions in fracture risk. Side forces of tamoxifen include increasing venous thromboembolism, stimulating the endometrium, and increasing vasomotor symptoms.