Epidemiologie, Diagnostik und klinisches Bild der Osteoporose

According to WHO statistics, osteoporosis is one of the ten most common diseases. It is characterised by demineralisation of bone tissue associated with structural deterioration. This leads to a disproportionate relationship between loading and load-bearing capacity and may result in atraumatic fractures. Approx. 30% of all women and approx. 10% of all men above 50 years of age suffer from osteoporosis (6 million individuals in Germany). It is estimated that 3 million of them experience osteoporosis-related fractures. The estimated costs of treating osteoporosis and its consequences (treatment of fractures, rehabilitation, care) in Germany amount to DEM 6–7 billion a year. If osteoporosis is diagnosed early it can be treated efficiently and the incidence of femoral neck and vertebral fractures could be halved, the quality of life improved and consequential costs reduced. Even if they have no history of fractures, patients suffering from osteoporosis are equally entitled to diagnosis, clinical advice and therapy as patients presenting with diabetes, hypercholesterolemia or hypertension who initially also have no clinical complaints. So far only about 20% of all patients with osteoporosis receive adequate therapy.     

Osteoporosis in men

With the prolongation of life expectancy, osteoporosis has become an increasing problem in the majority of developed countries worldwide. The paper discusses the frequency, pathogenesis, diagnostic criteria and treatment options for osteoporosis in men. Every third hip fracture occurs in men, and more than 11% of the male population over the age of 50 years suffer the fracture. Diagnostic tests for idiopathic osteoporosis are performed in men under 60 years of age without other potential risk factors of developing the disease. In the majority of cases, their low bone mineral density (BMD) is caused by a low peak bone mass. Secondary osteoporosis occurs in about 30 % of men, and involutionary osteoporosis developed in men over 60 years of age results from their decreased testosterone and IGF-1 levels. The study results showing that BMD levels in both sexes provide similar fracture risk information suggest that the existing diagnostic criteria for female osteoporosis can also be employed in men. It has been proved that biphosphonate and teriparitide therapy significantly increase BMD levels in men. The administration of androgens has been shown to be effective in men with hypogonadism, although their validity for patients with eugonadism has not yet been discussed. An improved knowledge of the bone metabolism and bone remodelling has recently opened the door to an extensive series of molecules that may play a key role in the treatment of male osteoporosis in the future.     

Die sozioökonomische Bedeutung der Osteoporose

Osteoporosis is a highly abundant disturbance of bone metabolism. The disease has gained significant public health impact, since it has been recognized as a major cause of fragility fractures among the elderly. In Germany, costs directly or indirectly related to osteoporosis are estimated at about 4–5 billion DM per year. 80% of these are due to in hospital treatment of fractures, mostly hip fractures. However, estimates of the socioeconomic burden of osteoporosis as a whole remain difficult. First, in lack of national fracture registries, cost calculations in Germany have to be mainly based on hospital discharge data. Secondly, while hip fractures can be considered a hard endpoint with almost complete capture, this is not true for most other types of osteoporotic fracture. In particular, vertebral fractures have been shown to be subject to mis- or underdiagnosis, although they are probably the most frequently occuring type of osteoporotic fracture. Third, data regarding the longterm outcome among fracture patients are scarce. It is therefore likely that costs of longterm care in nursing or older peoples' homes as a sequelae of osteoporosis are underestimated. Finally, osteoporosis-related loss of quality of life has been hardly taken into consideration so far, as the instruments allowing its assessment have just been developed. Nevertheless, the currently available data indicate that with respect to in hospital care, the socioeconomic burden of hip fracture alone compares to that of cardiovascular events (stroke, heart attack). This mainly results from an exponential increase in hip fracture incidence among women and men after the age of 70–75 years. 75% of cases are women, which is mainly due to a higher average life expectancy among women compared to men. Prevention of hip fractures appears to be a major public health goal, in view of a continuous demographic trend towards an aging population, and a separate, secular trend towards an increase in age-specific hip fracture rates reported from some European countries. As epidemiological data have pointed out the multifactorial pathogenesis of hip fracture, prevention needs to focus upon the prevention of osteoporosis and the prevention of falls among the elderly alike.     

Osteoporosis risk factors: association with use of hormone replacement therapy and with worry about osteoporosis

Among risk factors for osteoporosis, only family history was associated with worry about osteoporosis, while white race was the only factor associated with hormone replacement therapy use.

Abstract

Objectives: To determine whether postmenopausal women with risk factors for osteoporosis are more likely to use hormone replacement therapy (HRT) or to worry about osteoporosis than women without risk factors. Method: Cross-sectional survey of postmenopausal women at the Women Veteran Comprehensive Health Center. Statistical analysis was performed using the chi-square test and logistic regression analysis. Results: Of the 230 postmenopausal women who answered the questionnaire (mean age 55.7 years), 167 (72%) reported ever having used HRT and 113 (49%) worried about osteoporosis. Factors that were significantly associated (P < .05) with ever having used HRT were race, marital status, hysterectomy, worry about osteoporosis, and being aware that HRT reduces the risk of osteoporosis; however, no other risk factors for osteoporosis were associated with HRT use, nor was having the diagnosis of osteoporosis. Women who worried about osteoporosis were significantly more likely to be under age 60; to have a family history of osteoporosis, poor self-rated current health, and osteoporosis as a medical condition; to be aware that HRT reduces the risk of osteoporosis; and to have used HRT (P < .05). Conclusions: Among risk factors for osteoporosis, only family history was associated with worry about osteoporosis, while white race was the only risk factor associated with HRT use in our cohort of postmenopausal woman veterans. This may represent a lack of awareness and knowledge about osteoporosis and its sequelae and about the benefits of HRT. An understanding of patient awareness of risk factors for osteoporosis and their motivations to take HRT can be valuable when counseling women on their decision to use HRT or other medications to prevent osteoporosis.     

上海城郊某社区中老年人群骨质疏松症患病率和影响因素调查

目的调查上海城郊某社区中老年人群骨质疏松症患病率及其影响因素。方法采用分层抽样的方法抽取宝山区顾村社区2个居委和2个村委,年龄在45-75岁的社区常住居民935人,采用问卷调查和进行超声骨密度测定。结果①骨质疏松症患病率为19．11％;②女性骨质疏松症多于男性;③骨密度（BMD）与豆制品、蛋类和肉类制品摄取和腰围呈正相关,与年龄、体重、绝经年龄、哺乳次数呈负相关。结论应加强社区中老年妇女预防骨质疏松的健康教育,合理膳食,控制体重,提高中老年妇女的健康水平。     

Sociodemographic Variation in Knowledge of Osteoporosis and Locally Available Calcium-Rich Foods Among Urban Women Living on Low Incomes in Davao,Philippines

We explored knowledge of osteoporosis and locally available calcium-rich foods among 1,151 urban women in the Philippines and analyzed the cross-sectional associations of their responses to questions about knowledge with their age, educational background, and family income status. In total, 80.3% of the women had heard about osteoporosis; a higher educational background independently predicted this awareness. For knowledge about locally available calcium-rich foods, older age was a positive predictor, whereas higher educational background was a negative predictor. We believe that more emphasis should be placed on locally available foods as part of nutritional education for young urban Filipinos.     

Osteoporosis in primary biliary cirrhosis

Primary biliary cirrhosis (PBC) is an autoimmune liver disease that is typically progressive, with a significant proportion of patients going on to develop cirrhosis. It predominately affects women and typically develops in the middle years of life. In most centres the median age for presentation is in the range 55 to 60 years, with a significant proportion of patients first presenting over the age of 65. Due to earlier diagnosis, PBC has gone from being a rare disease, characterised by the complications of end-stage liver disease, to a significantly commoner disease (affecting up to 1 in 700 women over the age of 40) diagnosed often in an asymptomatic stage. Osteoporosis increases with advancing age and hence there is an increased prevalence of osteoporosis in older people. The question of whether osteoporosis occurs as a specific complication of PBC has latterly proved to be controversial. This article reviews the current literature and examines why differences occur in osteoporosis prevalence in the available studies. It becomes clear that when determining the true extent of the association between osteoporosis and PBC, conclusions must be drawn from large populations, and that when considering a disease such as osteoporosis that is common in older people, age matched values be used in order to draw these conclusions. As PBC is a disease that often presents for the first time over the age of 65, it is not surprising that osteoporosis is a common problem in a disease predominately affecting peri- or postmenopausal women.     

南昌地区成年男性骨密度现状及与吸烟关系的研究

目的 调查南昌地区健康成年男性骨密度,探讨吸烟与骨密度的关系.方法 采用法国MEDILINK公司生产的型号为OSTEOCORE2双能X线骨密度仪测量548例南昌地区健康成年男性正位腰椎(L2～L4)、左侧股骨颈及左前臂BMD,分析不同年龄组BMD及骨质疏松患病率变化.并根据吸烟指数进行分组,分析BMD与吸烟指数关系.结果 正位腰椎、股骨颈、前臂BMD峰值均出现在30～39岁年龄段,而后随年龄增加而下降,50岁以后降低更明显,骨质疏松患病率均随年龄增加而增加.吸烟指数与正位腰椎BMD呈负相关(r=-0.472,P＜0.01),与股骨颈、前臂BMD呈弱负相关(r值分别为-0.163和-0.135,P均＜0.05).结论 南昌地区男性BMD峰值出现在30～39岁年龄段,而后随年龄增加BMD下降,骨质疏松患病率增加.吸烟是骨质疏松的危险因素,为预防骨质疏松应尽早戒烟.     

Rural Women and Osteoporosis: Awareness and Educational Needs

CONTEXT: Little is known about rural women's knowledge about osteoporosis. PURPOSE: To explore what women from high-prevalence rural communities know about osteoporosis and to assess their learning preferences. METHODS: We surveyed 437 women in rural Washington and Oregon. FINDINGS: The response rate was 93% (N = 406). The mean age of respondents was 63 years (range 16-95) and 74% (n = 301) of women were postmenopausal. While 27% over age 40 (n = 111) reported having a fracture as an adult, less than half of this group (42%, n = 47) considered themselves at risk for osteoporosis. Of the 42% (n = 171) who rated their knowledge of osteoporosis good or excellent, only 18% (n = 30) answered calcium and vitamin D questions correctly. About half (53%; n = 214) exercised 3 or more times per week. Reported sources of osteoporosis information included television, magazines, health care providers, and personal contacts. Over half of the women in this study wanted more information about osteoporosis, most wanted it before age 50, and health care providers were a preferred source. Less than half of participants reported having Internet access. CONCLUSIONS: While many participants underestimated their osteoporosis risk, most women wanted to learn more about osteoporosis and health care providers remain a preferred source of information.     

Nutritional modulators of bone remodeling during aging

Bone mass declines progressively with age in both men and women from the age of approximately 30 y. Increased longevity will inevitability be associated with an increase in the incidence of osteoporosis, its associated complications, and incurred health care costs. Current pharmacologic approaches focus on inhibiting bone resorption in those with osteoporosis but do little to improve bone mass. Increased understanding of the cellular events responsible for normal bone formation has led to multiple pathways that can be targeted to positively influence bone mass. Bone morphogenetic proteins (BMPs) have been shown to stimulate bone formation, and the BMP2 gene was recently linked to osteoporosis. BMP-2 therefore represents one potential molecular target to identify new agents to simulate bone formation. Research is accumulating on the positive effects of dietary sources that stimulate the BMP2 promoter and their effects on bone formation. Flavonoids and statins occur naturally in food products and have been shown to promote bone formation. It may be possible to influence peak bone mass by dietary means and to decrease the risk of osteoporosis in later life. To ease the future burden of osteoporosis, focusing on prevention will be key, and this could include dietary interventions to stimulate bone formation.     

Public use files methodisch betrachtet

Leadership function is differently discussed regarding influences toward job holder. On the one hand it is an expression of a positive career and related to reward of performance and engagement in the enterprise. On the other hand executives are in a sandwich-position between demands of top management and employees and onsite possibilities what is to be seen as stress-producing factor. Current study examines how work design influences employability of workers over life span. Examining a sample of skilled workers the impact of owning leadership functions on this influence will be tested. Results show that owning leadership functions is related to higher learn-promotional job-design, higher-rated learning support by organization and higher scores in the self concept of competence and perceived health. Employees without leadership function have lower values in characteristics of competence and negative correlations of perceived health with age. This indicates positive impact of owning leadership function on employability.     

西安市社区中老年妇女骨质疏松症认知的现况研究

目的：了解西安市社区中老年妇女对骨质疏松症的认知情况,为当地该人群骨质疏松症的预防保健及健康教育工作提供必要的依据。方法2015年7至8月,采用现况研究方法,在西安市东、西、南、北4个区域,应用方便抽样,每个区域选择3～5个小区,对小区内居住的全部35岁以上中老年妇女进行面对面问卷调查,并对结果进行分析。结果有90％以上的被调查对象知道骨质疏松症,但了解比较多的只占5．42％。只有54．17％的妇女认为骨质疏松症是一个能够预防的疾病,且知道预防应该从小时候就开始的比例仅占11．15％。对骨质疏松症临床表现的正确认识比例不高,对诊断和治疗的药物知道更少。对引起骨质疏松症的因素,年龄增长、妇女绝经、晒太阳少以及钙缺乏的认知比例较高,在70％以上;而对长期卧床、维生素D缺乏、缺乏运动、蛋白质摄入不足的认知比例都不高;对吸烟、饮酒及遗传、疾病等的认知度则更低。被调查妇女虽然肉、蛋、奶以及豆制品、海产品的摄入比例均在90％以上,但经常摄入的比例并不高。每天钙剂补充的比例只有35．21％,维生素D补充的只有17．71％。多数（82．92％）被调查妇女骨质疏松症相关知识来自于广播、电视等大众媒体,来自亲戚朋友的比例也超过半数,而来自医务人员和社区宣传的比例并不高。年龄和文化程度影响该人群的认知度,不同年龄组妇女骨质疏松症认知水平有显著的统计学差异（ F＝76．57,P＜0．001）;不同文化程度的妇女骨质疏松症认知水平也有显著的统计学差异（ F＝71．51,P＜0．001）。结论西安市社区中老年妇女对骨质疏松症的认知整体正确率低,相关的健康行为比例不高,来自医疗卫生机构主动的、正确全面的骨质疏松症防治知识对于该人群是非常必要的。     

甘肃平凉地区中老年骨质疏松症的流行病学调查分析

目的通过流行病学调查甘肃平凉地区中老年骨质疏松症的发病状况与危险因素。方法 2013年9月至2016年5月采用分层随机抽样方式,在甘肃省平凉地区选择1 800名社区居民作为研究对象,调查所有居民的基线资料,同时进行骨质疏松的测定与判定。结果 1 800例中老年居民中共有骨质疏松患者320例,发病率为17.8%,其中男性240例,女性80例;平均年龄(61.93±7.93)岁;平均髋部骨密度为(1.33±0.22)g/cm~2。骨质疏松患者与非骨质疏松居民的性别、年龄、骨质疏松家族史、饮酒、吸烟、体质量指数、腰围等对比有明显差异(P0.05)。偏相关方法显示骨质疏松症患者的年龄、吸烟、体质量指数、腰围和骨质疏松家族史与骨密度均呈正相关(P0.05)。多因素Logistic回归分析显示年龄(OR=3.422)、吸烟(OR=2.671)、体质量指数(OR=2.681)为导致骨质疏松的独立危险因素(P0.05)。结论甘肃平凉地区中老年骨质疏松症的发病率比较高,年龄、吸烟、体质量指数为主要的危险因素,需要积极遵循个体化与整体化防控原则,从而降低骨质疏松症的发生率。     

Metaphorical mediation in women's perceptions of risk related to osteoporosis: A qualitative interview study

When risks affecting the body are identified and made visible through medical technologies, individuals need to find ways to communicate and express them through metaphorical projection. We used cognitive metaphor theory to explore women's conceptions of the risk inherent in osteoporosis. Data were drawn from focus group discussions with women who had no personal experience of osteoporosis, and individual interviews with women perceiving themselves to be at risk of osteoporosis. Women described osteoporosis as a hazard implying physical deviation from the healthy norms. This sense of risk was specifically couched in the metaphorical terms of a collapsing building and loss of the upright position. This image embraced a variety of perceptions of the body related to the hazards of osteoporosis. Findings revealed metaphors about the construction of the skeleton and the material of the bones, explaining the notion of danger. The perception of risk related to osteoporosis was framed by imagery of the destruction of the skeleton, the porous bones, frail bodies, a collapsing backbone and lack of trust in the body. Metaphors can be transformative, shaping the perception of a concrete health risk and changing the meaning of the risk. The metaphorical conception of osteoporosis may have a fundamental impact on women's perception of their bodily identity being at risk and thereby affect the image of their bodily capacities as vulnerable and create negative expectations of old age and health. Women's use of metaphors invites reflections on the use of metaphors in risk communication.     

骨质疏松知识问卷调查

目的：了解骨质疏松知识的普及程度。方法：对840例昆明市居民进行骨质疏松知识问卷调查。结果：骨质疏松知识不够普及，人们对骨质疏松知识的认识存在一些误区和盲点。结论：应对不同的年龄段人群进行专业化的骨质疏松健康教育。     

Bone mineral density in Hispanic women: a review of the literature with implications for promoting culturally relevant osteoporosis education

Osteoporosis is a disease that primarily affects postmenopausal women of all ethnicities. Demographic projections indicate that the number of Hispanics over age 65 in the U.S. will increase from 2.9 million currently, to 17.5 million in 2050. A majority will be women. Recent research has increased understanding about biocultural correlates of osteoporosis in Hispanic women, and indicates that their risk for the disease is about equal to that of non-Hispanic White (NHW) women. Although Hispanics living in the U.S. share many biological and cultural characteristics with the general population, there are important differences in disease pre-disposition and associated morbidity that present challenges to osteoporosis prevention efforts. The purpose of this article is to provide a review of selected bone density studies that have included Hispanic women, to summarize the findings, and to discuss implications of these findings for osteoporosis prevention education for this population.     

Osteoporosis among Italian women at risk: The osteolab study

Objective

The aim of the present study was to identify women at high risk of having osteoporosis according to the clinical judgment of their General Practitioners, but without a previous diagnosis of osteoporosis.

Design

Cross-sectional survey.

Participants

The General Practitioners were asked to select a sample of women aged 65 years or more who could be affected by osteoporosis but had never been diagnosed nor treated: this sample included 8,268. Moreover, 8,956 women asked to be included in the study on a voluntary basis, and were analyzed separately.

Measurements

Participants were referred to a mobile unit equipped with GE Lunar Express Ultras (Achilles), where they were administered a questionnaire and underwent a QUS examination. They were classified at high, moderate or low risk of having osteoporosis according to the 2007 International Society for Clinical Densitometry official position.

Results

The prevalence rate of women at high risk of having osteoporosis was 12.5%; 53% were considered at moderate risk. Logistic regressions revealed that age, early age at menopause, history of fractures, dysthyroidism and smoking were associated with high and moderate risk.

Conclusions

Results suggest that General Practitioners are able to identify women at risk of having osteoporosis, but often do not treat them, suggesting that osteoporosis in Italy is still a neglected condition. The strength of the association of risk factors is similar in women at high and medium risk: this may raise a debate on the validity of this classification in the Italian population.     

Osteoporosis and African American women

The incidence of osteoporosis and related fractures in African American women is half that of Caucasian women. African American women who sustain osteoporosis-related fractures have increased disability and decreased survival. Given the exponential increase in hip fracture rate among African American women over the age of 70 years, the risk of osteoporosis among this population may be underestimated. This review focuses on racial differences in women's bone mineral density (BMD) and bone metabolism and on various explanations for these observed differences. Environmental risk factors for osteoporosis and related fractures among African American women and modalities for prevention and treatment of osteoporosis are discussed. African American women begin menopause with higher BMD and have lower rates of women's bone loss after menopause, which account for their decreased incidence of osteoporosis and related fractures. The risk factors for osteoporosis among African American women are similar to those found in Caucasian women. Lifestyle interventions, such as calcium and vitamin D supplementation, smoking cessation, and increased physical activity, should be encouraged to enhance peak bone mass and to decrease bone loss. These interventions and other treatment modalities, such as hormone replacement therapy, bisphosphonates, and selective estrogen receptor modulators, should be studied further in African American women.     

Health Council report 'Osteoporosis.'Committee on Osteoporosis, National Health Council

The committee on osteoporosis of the Gezondheidsraad (Health Council) of the Netherlands judges possible preventive strategies by their ability to reduce the risk of fractures. The committee endorses the importance of life style changes related to nutrition and physical exercise. These are also important for the prevention of other health problems. The development of new health education programmes should be considered. Population screening of menopausal women is not supported, mainly because the effect of interventions on fracture risk has not been documented. Instead, the committee strongly recommends use of strategies for case finding of patients with a risk factor for osteoporosis such as oestrogen deficiency before the age of 45 years, amenorrhoea for more than a year and long term use of corticosteroids, and subsequent treatment of patients with osteoporosis. The development of broadly accepted guidelines on this subject is an important step in achieving this goal.     

Aktuelle Therapie der Osteoporose unter Berücksichtigung der auf Evidenz basierenden Medizin

Osteoporosis is characterised by demineralisation, structural deterioration and reduced load-bearing capacity of the bones. Atraumatic fractures may result. Osteoporosis is one of the ten most common diseases in Europe. In Germany, three million individuals suffer from osteoporosis-related vertebral fractures. The estimated costs of treating the consequences of fractures (hip fractures and other peripheral fractures as well as vertebral body fractures) in Germany amount to DEM six – seven billion. Only 20% of all patients with osteoporosis receive adequate treatment. It is the aim of osteoporosis therapy to prevent primary and subsequent fractures. Studies have shown that this may be achieved by modern therapies such as bisphosphonates. Due to tight budgets, the principles of evidence-based medicine should be considered when making therapeutic decisions.