J Korean Med Assoc.  2011 Mar;54(3):294-302.

Evidence-based management for osteoporosis

• Lee K

Abstract

Osteoporosis is the most common bone disease in humans, and it has caused major public health problems. Though osteoporosis affects all ages, its prevalence will increase as the population ages worldwide. In recent surveys of the Korean population, the prevalence of osteoporosis was 32.6% in women aged 50 years and above. Osteoporosis can be prevented, diagnosed easily, and treated before any fracture occurs. The active involvement of medical personnel and patients is needed. The prevention and management of osteoporosis are similar to other lifestyle-related diseases. Adequate intake of calcium and vitamin D, regular weight-bearing exercise, fall prevention, and avoidance of tobacco use and excessive alcohol intake are recommended for the general population. Bone mineral density testing and drug treatment must be considered to manage the risk factors of high risk groups. In this study, we review Korean and international research trends, and attempt to present an evidence-based strategy for the management of osteoporosis.

Keyword

Osteoporosis; Risk factors; Evidence-based practice; Prevention

MeSH Terms

Aged
Bone Density
Bone Diseases
Calcium
Evidence-Based Practice
Female
Humans
Osteoporosis
Prevalence
Public Health
Risk Factors
Tobacco
Vitamin D
Weight-Bearing
Calcium
Vitamin D

Reference

1. Korea National Statistical Office. Population projections for Korea 2001-2050: based on the 2005 population census. 2006. Daejeon: Korea National Statistical Office.

2. Min YK. Clinician's guide to prevention and treatment of osteoporosis. Korean J Bone Metab. 2008. 15:99–107.

3. Dell R, Greene D. Is osteoporosis disease management cost effective? Curr Osteoporos Rep. 2010. 8:49–55.

4. WHO fracture risk assessment tool [Internet]. World Health Organization Collaborating Centre for Metabolic Bone Diseases. 2010. cited 2010 Feb 10. Available from: http://www.shef.ac.uk/FRAX.

5. National Osteoporosis Foundation. Clinician's guide to prevention and treatment of osteoporosis. 2010. Washington, D.C.: National Osteoporosis Foundation.

6. The Korean Society of Bone Metabolism. Physician's guide for diagnosis and treatment of osteoporosis. 2010. Seoul: The Korean Society of Bone Metabolism.

7. World Health Organisation. Committee for Practice Guidelines. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis: technical report series. No. 843. 1994. Geneva: World Health Organisation.

8. NIH Consensus Development Panel on Osteoporosis Prevention, Diagnosis, and Therapy. Osteoporosis prevention, diagnosis, and therapy. JAMA. 2001. 285:785–795.

9. Kanis JA, Gluer CC. Committee of Scientific Advisors. International Osteoporosis Foundation. An update on the diagnosis and assessment of osteoporosis with densitometry. Osteoporos Int. 2000. 11:192–202.

10. Lane NE. Epidemiology, etiology, and diagnosis of osteoporosis. Am J Obstet Gynecol. 2006. 194:2 Suppl. S3–S11.

11. Brauer CA, Coca-Perraillon M, Cutler DM, Rosen AB. Incidence and mortality of hip fractures in the United States. JAMA. 2009. 302:1573–1579.

12. Looker AC, Melton LJ 3rd, Harris TB, Borrud LG, Shepherd JA. Prevalence and trends in low femur bone density among older US adults: NHANES 2005-2006 compared with NHANES III. J Bone Miner Res. 2010. 25:64–71.

13. Lim S, Koo BK, Lee EJ, Park JH, Kim MH, Shin KH, Ha YC, Cho NH, Shin CS. Incidence of hip fractures in Korea. J Bone Miner Metab. 2008. 26:400–405.

14. Ministry for Health, Welfare and Family Affairs. Korea Centers for Disease Control and Prevention. The 4th Korea National Health and Nutrition Examination Survey. 2009. Cheongwon: Korea Centers for Disease Control and Prevention.

15. Choi JY, Park SK, Cho SI, Kang D, Shin A, Shin CS, Han S. Prevalence and risk factors of osteoporosis and osteopenia in korean women: cross-sectional study. J Korean Soc Menopause. 2008. 14:35–49.

16. Kim CH, Kim YI, Choi CS, Park JY, Kim GS, Lee MS, Lee SI. Prevalence of osteoporosis in Jung-Up district, Korea. Korean J Bone Metab. 1997. 4:66–71.

17. Shin MH, Shin HY, Jung EK, Rhee JA. Prevalence of osteoporosis and related factors in the elderly women over 60 years of age. J Korean Geriatr Soc. 2002. 6:130–139.

18. Kim YI, Park JH, Lee JS, Kim JW, Yang SO, Jeon DJ, Kim MC, Jeong TH, Lee YG, Rhee BD. Prevalence and risk factors of the osteoporosis of perimenopausal women in the community population. Korean J Med. 2002. 62:11–24.

19. Lee WS, Park HM, Bae DH. Prevalence of osteoporosis in korean women. J Korean Soc Menopause. 2003. 9:340–346.

20. Cho NH, Shin C, Park C, Kimm KC. Geographic difference in the prevalence of osteoporosis in Korea. J Korean Soc Osteoporos. 2005. 3:98–109.

21. Jung SE, Yoon YS, Kim T, Kim HJ, Lee NW, Lee KW, Kim SH. Estimated prevalence of osteoporosis in Ansan, Korea. J Korean Soc Osteoporos. 2006. 4:41–48.

22. Jin LH, Kim KS, Kang MG, Ryu SY, Lee CG, Park JK, Koh SB, Eom AY. The prevalence of osteoporosis and its related factors among some rural women. J Korean Soc Matern Child Health. 2007. 11:64–77.

23. Jeon GH, Kim SR, Kim SH, Chae HD, Kim CH, Kang BM. Prevalence of osteoporosis and osteopenia in women in Kangwon province: geographical comparison study. Korean J Bone Metab. 2008. 15:135–141.

24. Khosla S, Riggs BL. Pathophysiology of age-related bone loss and osteoporosis. Endocrinol Metab Clin North Am. 2005. 34:1015–1030.

25. Gennari L, Bilezikian JP. Osteoporosis in men. Endocrinol Metab Clin North Am. 2007. 36:399–419.

26. Singer AJ, Boonen S. Osteoporosis management: translating research into optimal fracture protection II. Curr Med Res Opin. 2008. 24:1789–1796.

27. Baim S, Binkley N, Bilezikian JP, Kendler DL, Hans DB, Lewiecki EM, Silverman S. Official Positions of the International Society for Clinical Densitometry and executive summary of the 2007 ISCD Po sition Development Conference. J Clin Densitom. 2008. 11:75–91.

28. Lee KH. Diagnosis of osteoporosis. J Korean Hip Soc. 2007. 19:260–265.

29. Yang SO, Kim S, Juhng SK. Imaging diagnosis of osteoporotic fracture. J Korean Med Assoc. 2010. 53:67–75.

30. Marshall D, Johnell O, Wedel H. Meta-analysis of how well measures of bone mineral density predict occurrence of osteoporotic fractures. BMJ. 1996. 312:1254–1259.

31. Lewiecki EM, Watts NB, McClung MR, Petak SM, Bachrach LK, Shepherd JA, Downs RW Jr. Official positions of the international society for clinical densitometry. J Clin Endocrinol Metab. 2004. 89:3651–3655.

32. Lydick E, Cook K, Turpin J, Melton M, Stine R, Byrnes C. Development and validation of a simple questionnaire to facilitate identification of women likely to have low bone density. Am J Manag Care. 1998. 4:37–48.

33. Cadarette SM, Jaglal SB, Kreiger N, McIsaac WJ, Darlington GA, Tu JV. Development and validation of the Osteoporosis Risk Assessment Instrument to facilitate selection of women for bone densitometry. CMAJ. 2000. 162:1289–1294.

34. Weinstein L, Ullery B. Identification of at-risk women for osteoporosis screening. Am J Obstet Gynecol. 2000. 183:547–549.

35. Koh LK, Sedrine WB, Torralba TP, Kung A, Fujiwara S, Chan SP, Huang QR, Rajatanavin R, Tsai KS, Park HM, Reginster JY. Osteoporosis Self-Assessment Tool for Asians (OSTA) Research Group. A simple tool to identify asian women at increased risk of osteoporosis. Osteoporos Int. 2001. 12:699–705.

36. Song TJ, Choi H, Lee S, Yeon MJ, Ko JK, Lee CM, Cho YK, Kim BR. Performance of risk indeces for prediction of osteoporosis in post- and perimenopausal women. Korean J Obstet Gynecol. 2005. 48:2627–2634.

37. Cadarette SM, Jaglal SB, Murray TM, McIsaac WJ, Joseph L, Brown JP. Canadian Multicentre Osteoporosis Study. Evaluation of decision rules for referring women for bone densitometry by dual-energy x-ray absorptiometry. JAMA. 2001. 286:57–63.

38. Kanis JA. Diagnosis of osteoporosis and assessment of fracture risk. Lancet. 2002. 359:1929–1936.

39. Kanis JA, Johnell O, Oden A, Johansson H, McCloskey E. FRAX and the assessment of fracture probability in men and women from the UK. Osteoporos Int. 2008. 19:385–397.

40. Kanis JA, Oden A, Johansson H, Borgstrom F, Strom O, McCloskey E. FRAX and its applications to clinical practice. Bone. 2009. 44:734–743.

41. Kleerekoper M, Gold DT. Osteoporosis prevention and management: an evidence-based review. Clin Obstet Gynecol. 2008. 51:556–563.

42. Mayes SL. Review of postmenopausal osteoporosis pharmacotherapy. Nutr Clin Pract. 2007. 22:276–285.

43. Brixen K, Kassem M, Abrahamsen B. Prevention and treatment of osteoporosis in women: an update. Obstet Gynaecol Reprod Med. 2009. 19:157–163.

44. The Korean Nutrition Society. Dietary reference intakes for Koreans. 2010. Seoul: The Korean Nutrition Society.

45. Holick MF. McCollum Award Lecture, 1994: vitamin D-new horizons for the 21st century. Am J Clin Nutr. 1994. 60:619–630.

46. Lee HH. A role of vitamin D in postmenopausal women. J Korean Soc Menopause. 2008. 14:109–114.

47. Dawson-Hughes B, Heaney RP, Holick MF, Lips P, Meunier PJ, Vieth R. Estimates of optimal vitamin D status. Osteoporos Int. 2005. 16:713–716.

48. Ettinger B, Black DM, Mitlak BH, Knickerbocker RK, Nickelsen T, Genant HK, Christiansen C, Delmas PD, Zanchetta JR, Stakkestad J, Gluer CC, Krueger K, Cohen FJ, Eckert S, Ensrud KE, Avioli LV, Lips P, Cummings SR. Multiple Outcomes of Raloxifene Evaluation (MORE) Investigators. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. JAMA. 1999. 282:637–645.

49. Tosteson AN, Burge RT, Marshall DA, Lindsay R. Therapies for treatment of osteoporosis in US women: cost-effectiveness and budget impact considerations. Am J Manag Care. 2008. 14:605–615.

50. Park HM. Current use of drugs for osteoporosis in Korea. Korean J Obstet Gynecol. 2010. 53:152–159.

51. Aloia JF, Cohn SH, Ostuni JA, Cane R, Ellis K. Prevention of involutional bone loss by exercise. Ann Intern Med. 1978. 89:356–358.

52. Grisso JA, Kelsey JL, Strom BL, Chiu GY, Maislin G, O'Brien LA, Hoffman S, Kaplan F. Risk factors for falls as a cause of hip fracture in women. The Northeast Hip Fracture Study Group. N Engl J Med. 1991. 324:1326–1331.