Osteoporose em 12 questões

Abstract

IntroductionOsteoporosis is the most common metabolic bone disease, affecting mainly postmenopausal women and older men. AimAnswer to 12 key questions regarding osteoporosis diagnosis and treatment. MethodsLiterature search in Medline database. References of the selected articles were revised and the most relevant articles were also included. Conclusions1 ‐ What is osteoporosis? It is characterized by low bone mass and deterioration of microarchitecture, with increased bone fragility and risk of fractures. 2 ‐ What are the clinical manifestations? It is clinically silent until fracture occurs. 3 ‐ What are the risk factors? The main factor is low bone mineral density (assessed by dual energy X‐ray absorptiometry ‐ DXA), but others contribute to the overall risk of fracture. 4 ‐ What are the secondary causes? Metabolic, endocrine, gastrointestinal, connective tissue diseases or drugs. They are more common in premenopausal women and men. 5 ‐ Who should be screened? All individuals over 50 years should be evaluated for the presence of clinical risk factors. 6 ‐ How to screen? By identification of risk factors that suggest performing DXA. 7 ‐ How frequently should DXA be repeated? It varies with the result of the previous test and the probability of bone loss. 8 ‐ How to evaluate osteoporotic patients? Evaluate all patients clinically and perform exams to exclude secondary causes and select the most appropriate pharmacological treatment. Some may require specific tests. 9 ‐ Who should be treated? The treatment is indicated according to the risk of fracture (calculated by FRAX® tool). 10 ‐ How to treat? Primary prevention measures are recommended since childhood. Several drugs have demonstrated efficacy, being addressed the indications to each of them. 11 ‐ How long to treat? The optimal duration remains uncertain, being suggested the concept of “drug holiday”. 12 ‐ How to monitor? Perform DXA 1 to 2 years after starting treatment. Bone biomarkers, although promising, are not recommended.