Diagnosis and Treatment of Osteoporosis

What Orthopaedic Surgeons Need to Know

Elizabeth G. Matzkin, MD; Marlene DeMaio, MD; Julia F. Charles, MD, PhD; Corinna C. Franklin, MD

Disclosures

J Am Acad Orthop Surg. 2019;27(20):e902-e912. 

In This Article

Pathogenesis

Bone is living tissue and therefore can remodel and respond to stress. This phenomenon is one of the main reasons why it is imperative that bone health is addressed throughout the lifespan as osteoporosis is a preventable disease. Bone is continuously being resorbed by osteoclasts and formed by osteoblasts. It is this homeostasis that maintains BMD.[4] Bone remodeling is dependent on many factors such as parathyroid hormone (PTH), 1,25-dihydroxyvitamin D (1,25-OH2D3), calcitonin, estrogen, and testosterone. These factors and the effect they have on bone remodeling are summarized in Table 1.[5] Menopause in women results in estrogen deficiency, which in turn results in increased bone resorption as osteoclasts live longer. Bone loss is accelerated in women because men do not experience a decrease in sex hormones resulting in an increase in bone remodeling. Men do experience reduced bone formation and thinning of trabeculae with aging, but at a decreased rate compared with women.[6]

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