Einstein (São Paulo) (Mar 2008)
Osteoporosis and other metabolic bone diseases in older people
Abstract
Osteoporosis is the most common bone metabolic disease in bothgenders, leading to a great impact in the quality of life and survival.When pathologic fractures occur the mortality and the disabilityincrease in all ages, mainly in elderly. So every physician whotakes care of older people must remember the importance of riskfactors for bone losses and falls. Osteoporosis is more frequentamong women, mainly in the first years of postmenopausalperiod, because of the effect of estrogenic deficiency whichincreases the bone loss. Osteoporosis in men is a consequenceof other different mechanisms that happen in the elderly, such asvitamin D deficiency, reduced calcium absorption and increasedparathyroid hormone levels. The diagnosis of osteoporosis isclinic and must be issued after the exclusion of secondary causesof bone losses, such as bone malignancy and other osteopenicdiseases. The bone mineral density test quantifies the bone lossesand is a good predictor of fractures. Radiographic evaluationmust detect bone deformities and fractures, which requirethe most effective therapeutic procedures. The antiresorptiveskeletal agents, especially the bisphosphonates and strontiumranelate, which are more efficient with less adverse effects, havesubstituted the hormonal therapy. Teriparatide is an option in thepatient with severe osteoporosis and multiple fractures. On theother hand, calcium and vitamin D supplies have to be alwaysassociated with all the therapeutic proposals.
