Osteoporosis is a common chronic disease. The most common type ofosteoporosis is the one produced by a reduction in estrogen production that follows menopause. Osteoporotic fractures, caused by increased bone fragility, are associated with an impaired quality of life, physical disability, increasing mortality and higher health care costs. The incidence of fracture increases with advancing age and is a great concern for public health, this is why osteoporosis and its complications should be diagnosed and prevented earlier everyday. This paper reviews the epidemiology of this entity, called the "silent epidemic" by some experts, new developments in its pathophysiology, roleofsexualhormones, vitamin D and parathyroid hormone on bone metabolism; furthermore, the diagnosis of osteoporosis and its new therapeutical strategies.
114° reunión del CONSEJO EJECUTIVO, Organización Mundial de la Salud. 15 de abril de 2004.
Seeman, Ego, Delmas, PierreD. Bone Quality-The Material and Structural Basis of Bone Strength and Fragility. N Engl J Med 2006; 354: 2250-2261.
Lawrence G, Raisz MD, Gideon A, Roldan. Pathogenesis of osteoporosis. Endocrinol Metab Clin N Am 2003; 32: 15-24.
Taylor BC, Schreiner PJ, Stone KL. Long-term prediction of incident hip fracture risk in elderly white women: study of osteoporotic fractures. J Am Geriatr Soc 2004; 52: 1479-1486.
Ralston SH. The genetics of osteoporosis. OJM 1997; 90: 247, 251.
Cummings SR, Browner WS, Bauer D. The Study of Osteoporotic Fractures Research Group. Endogenous hormones and the risk of hip and vertebral fractures among older women. N Engl J Med 1998; 339:733-739.
Marx SJ. Hyperparathyroid and hypoparathyroid disorders. N Engl J Med 2000; 343: 1863-1875.
Riggs BL, Sundeep K, Melton III J. Sex steroids and the construction and conservation of the adult skeleton. Endocr Rev 2002; 23: 279-302.
Hughes DE, Dai A, Tiffee JC. Estrogen promotes apoptosis of murine osteoclasts mediated by TGF. Nat Med 1996; 2: 1132-1136.
Amin S, Zhang Y, Sawin CT, Evans SR, Hannan MT, Kiel DP, et al. Association of hypogonadism and estradiol levels with bone mineral density in elderly men from the Framingham study. Ann Int Med 2000; 133: 951-963.
Slemenda C, Longscope C, Peacock M. Sex steroids, bone mass, and bone loss. J Clin Invest 1996; 97:14-18.
Sociedad Española de Investigaciones Óseas y Metabolismo Mineral-SEIOMM. Osteoporosis Postmenopáusica. Guía de Práctica Clínica. 2002.
Gimeno EJ, Muñoz-Torres M, Escobar-Jiménez F. Identification of metabolic bone disease in patients with endogenous hyperthyroidism. Role of biological markers of bone turnover. Calcif Tissue Int 1997; 61: 370-376.
Van Staa TP, Lufkens HG, Abenhaim L, Zhang B, Cooper C. Use of oral corticosteroids and risk of fractures. J Bone Miner Res 2000; 15: 993-1000.
Cummings SR, Nevitt MC, Browner WS. Risk factors for hip fracture in white women. N Engl J Med 1995; 332:767-773.
Osteoporosis Prevention, Diagnosis, and Therapy. NIH Consens Statement 2000 March 27-29;17(1): 1-36.
Kanis JA, Johnell O, Oden A, De Laet C, Garnero P, Delmas PD, et al. Biochemical indices of bone turnover and the assessment of fracture probability. Osteoporos Int 2000; 13:523-526.
Kanis JA, Borgström F, De Laet C, Johansson H, Johnell O, Jonsson B., et al. Assessment of fracture risk. Osteoporos Int 2005; 16:581-589.
Raisz, Lawrence G. Screening for Osteoporosis. N Engl J Med 2005; 353: 164-171.
Osteoporosis prevention, diagnosis, and therapy. National Institute of Health (NIH) Consensus Development Panel on Osteoporosis: Prevention, Diagnosis, and Therapy. JAMA 2001; 285: 785-795.
Shea B, Wells G, Cranney A, Zytaruk N, Adachi JD, Tugwell P, et al. Meta-analyses of therapies for postmenopausal osteoporosis. VII. Meta-analysis of calcium supplementation for the prevention of postmenopausal osteoporosis. Endocr Rev 2002; 23:552-559.
Office of the Surgeon General. Bone health and osteoporosis: a report of the Surgeon General. Rockville, Md.: Department of Health and Human Services, 2004:436.
Bischoff HA, Stahelin HB, Dick W, Akos R, Knecht M, Salis C, et al. Effects of vitamin D and calcium supplementation on falls: a randomized controlled trial. J Bone Miner Res 2003; 18:343-351.
Riggs SL, O'Fallon WM, Muhs J, O'Connor MK, Kumar R, Melton LJ. Long-term effects of calcium supplementation on serum parathyroid hormone level, bone turnover, and bone loss in elderly women. J Bone Miner Res 1998; 13: 168-174.
Trivedi DP, Doll R, Khaw KT. Effect of four-monthly oral vitamin D3 (cholecalciferol) supplementation on fractures and mortality in men and women living in the community: randomized double-blind controlled trial. BMJ 2003; 326:469.
Gregg EW, Cauley JA, Seely DG, Ensrud KE, Sauer DC. Physical activity and osteoporotic fracture risk in older women. Ann Int Med 1998; 129: 81-88.
Kelley GA, Kelley KS. Efficacy of resistance exercise on lumbar spine and femoral neck bone mineral density in premenopausal women: a meta-analysis of individual patient data. J Womens Health (Larchmt) 2004; 13:293-300.
Risk factors for longitudinal bone loss in elderly men and women: The Framingham Osteoporosis Study. J Bone Miner Res 2000; 15(4):710-20.
Alleyne M, Correa R, Gómez LA, Montalván A, Pérez R, Rubin J, et al. Factores de riesgo asociados a osteoporosis en mujeres posmenopáusicas. Revista Médico Científica 2005; 18(1): 13-17.
Harris SS. Effects of caffeine consumption on hip fracture, bone density and calcium retention. In Nutritional Aspects of Osteoporosis (ed. S Dawson-Hughes, RP Heaney). SA Publication. New York: Springer Verlag, 1998.
Rogers MJ. New insights into the molecular mechanisms of action of bisphosphonates. Curr Pharm Des 2003; 9: 2643-2658.
Hirabayashi H, Takahashi T, Fujisaki J, Masunaga T, Sato S, Hiroi J, Tokunaga Y, Kimura S, Hata T. J Controlled Release 2001; 70: 183.
Fleisch H. Bisphosphonates in bone disease: from the laboratory to the patient. 4th edition. Academic Press, California, 2000; p. 27-66.
Cranney A, Wells G, Willan A, et al. IX: Summary of meta-analyses of therapies for postmenopausal osteoporosis. Endocr Rev 2002; 23: 570-578.
Russell RG, Rogers MJ. Bisphosphonates: from the laboratory to the clinic and back again. Bone 1999; 25: 97-106.
Cramer J, Amonkar MM, Hebborn A, et al. Compliance and persistence with bisphosphonate dosing regimens among women with postmenopausal osteoporosis. Curr Med Res Opin 2005; 21: 1453-1460.
Recker RR, Gallagher R, McCosbe PE. Effect of dosing frequency on bisphosphonate medication adherence in a large longitudinal cohort of women. Mayo Clin Proc 2005; 80: 856-861.
Schnitzer T, Bone HG, Crepaldi G, Adami S, McClung M, Kiel D, et al. Therapeutic equivalence of alendronate 70 mg once-weekly and alendronate 10 mg daily in the treatment of osteoporosis. Aging (Milano) 2000; 12: 1-12.
Eastell R, Garnero P, Vrijens B, et al. Influence of patient compliance with risedronate therapy on bone turnover markers and bone mineral density response: the IMPACT study. Calcif Tissue Int 2003; 72 (Abstract p. 297).
Hamilton S, McCoy K, Taggart H. Tolerability and compliance with risedronate in clinical practice. Osteoporos Int 2003; 14: 259-262.
Lombas C, Hakim C, Zanchetta JR. Compliance with alendronate treatment in an osteoporosis clinic. J Bone Miner Res 2001; 15:S529 (Abstract M406).
Segal E, Tamir A, Ish-Shalom S. Compliance of osteoporotic patients with different treatment regimens. *Isr Med Assoc J* 2003;5:859-62.
Turbi C, Herrero-Seaumont G, Acebes JC, Torrijos A, Grana J, Miguelez R, et al. Compliance and satisfaction with raloxifene versus alendronate for the treatment of postmenopausal osteoporosis in clinical practice: An open-label, prospective, nonrandomized, observational study. *Clin Ther* 2004;26:245-56.
Reginster J, Minne HW, Sorensen OH. Randomized trial of the effects of risendronate on vertebral fractures in women with established postmenopausal osteoporosis. Vertebral Efficacy with Risendronate Therapy (VERT) Study Group. *Osteoporos Int* 2000;11:83-91.
Harris ST, Watts NS, Genant HK. Effects of risendronate treatment on vertebral and nonvertebral fractures in women with postmenopausal osteoporosis: a randomized controlled trial. Vertebral Efficacy with Risendronate Therapy (VERT) Study Group. *JAMA* 1999;282:1344-52.
Reginster JY, Adami S, Lakatos P, Greenwald M, Stepan JJ, Silverman SL, et al. Efficacy and tolerability of once-monthly oral ibandronate in postmenopausal osteoporosis: 2-year results from the MOSILE (Monthly Oral Ibandronate in Ladies) study. *Ann Rheum Dis.* In press.
Reid IR, Brown JP, Burckhardt P, Horowitz Z, Richardson P, Trechsel U, et al. Intravenous zoledronic acid in postmenopausal women with low bone mineral density. *N Engl J Med* 2002;346:653-61.
Riggs SL, Hartmann LC. Selective estrogen-receptor modulators -- mechanisms of action and application to clinical practice. *N Engl J Med* 2003;348:618-29. [Erratum, *N Engl J Med* 2003;348:1192.]
Ettinger B, Black DM, Mitlak BH, et al. Reduction of vertebral fracture risk in postmenopausal women with osteoporosis treated with raloxifene: results from a 3-year randomized clinical trial. *JAMA* 1999;282:637-45. [Erratum, *JAMA* 1999;282:2124.]
