Sociedad Española de Investigacion Ósea y Metabolismo Mineral

Revista de Osteoporosis y Metabolismo Mineral

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Citescore: 1,06 |  Academic Accelerator: 0,194 
SCImago Journal Rank : 0,12 | Google Scholar: 0,0172

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Category: 920211301-en

Osteoporosis: definition, physiopathology and clinic

Osteoporosis poses a major health problem in modern societies, especially in women. Taking into account the aging of the Spanish population and the fact that osteoporosis an­­d fractures increase with age, with an estimate for 2029 of more than 11 million people over 65 years of age, this problem may become of the first order. Currently it is estimated that there are more than 200 million patients with osteoporosis worldwide, with increasing prevalence[1]. In Spain, the prevalence of osteoporosis in postmenopausal women over 50 years is 26.1% and in men 8.1%.
Therefore, in daily clinical practice, this condition should be diagnosed establishing the previous clinical suspicion and the patients labeled as such in order to avoid its progression and its consequences, which are fragility fractures.

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Diagnosing osteoporosis. Bone densitometry. Fracture risk estimate

The diagnosis of osteoporosis has evolved over the years along the disease’s conceptual development. The definition of osteoporosis comes from a description offered by Albright at the outset of the 1940s for postmenopausal and corticoid-induced osteoporosis. This is considered nowadays paradigm of primary and secondary osteoporosis. Its characteristics are reduced bone mass, micro-architectural disorders, unaltered mineralization and presence of fractures[1,2]. It is a histopathological definition with the secondary clinical event. Although osteoporosis is currently the most common metabolic bone disease, rickets and osteomalacia were the main metabolic bone disease from the time of Galen and well into the 20th century[3].

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Osteoporosis in men and steroids

Osteoporosis is a bone disease characterized by a decrease in bone mineral density (BMD) and an increased risk of fragility fractures. Osteoporotic fractures, particularly hip fractures, cause significant mortality and morbidity in men and lead to considerable social costs in this population, including direct medical costs and indirect costs resulting from reduced quality of life, disability and death[1].
Of all osteoporotic fractures, it is hip fractures that contribute to the highest morbidity and mortality in men. Each year about 80,000 men will have a hip fracture. Of these, one in three will die during the first year after this hip fracture and another third will fracture again[2]. However, there is a lack of awareness among healthcare professionals about the need to screen men for osteoporosis so that male osteoporosis remains largely underdiagnosed and untreated.

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Anti-resorptives in the management of osteoporosis

Antiresorptive (or antiresorptive) drugs are the cornerstone of osteoporosis treatment. For decades, they have been considered the first step in treating this disease, although more recently some have been discontinued as indication. Others do not always have to be used as the first therapy in the current sequential treatments supported by the main scientific societies. There are five classes of purely antiresorptive drugs: bisphosphonates (BF), estrogen, selective estrogen receptor modulators (SERMs), calcitonin, and monoclonal antibodies against the activating receptor for nuclear factor κB ligand (RANKL) such as denosumab. For its part, a dual-action antiresorptive and osteoforming drug (strontium ranelate) was widely used from 2004 until its marketing cessation in 2017 in Europe for the reasons that will be detailed later. The treatments to be developed here are based on studies in postmenopausal women, although they can be extrapolated to men and to glucocorticoid-induced osteoporosis, although with less evidence[3].

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Anabolic treatment of osteoporosis

Sodium fluoride (FNa) was used in the past as a bone-forming drug. Administering fluoride causes the number of osteoblasts to increase as the proliferation of osteoblastic precursors is stimulated, which leads to increased activity. In addition, it has antiresorptive capacity. The combination of osteogenic effect and inhibition of bone resorption leads to an increase in bone mineral density (BMD)[1].
Although the number of randomized clinical trials conducted with FNa is relatively limited, the salt types and dosages used in them, as well as their combination with calcium and vitamin D, make every trial very different from each other and therefore the global assessment of the results turns very difficult.
There are some studies that have shown an increase in BMD and a reduction in the risk of vertebral fractures, but in general the published results have been disappointing. Despite almost uniformly observing a statistically significant increase of BMD, these studies do not record a reduction in the risk of fractures[2].

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Solo mostrar coincidencias exactas
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11
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120181004-en
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920211302-en
Brief Original
Clinical Notes
Committees
Editorial
English
Index of Authors
Index of Communications
Letter to the Director
Letter to the Editor
Oral Communications
Original Articles
Osteology images
Position Paper
Poster Communications
Presentation
Reviews
SIBOMM News
Special Article
Special Documents

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