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Osteoporosis

Osteoporosis

Topic Overview

The skeletal system

Is this topic for you?

This topic talks about osteoporosis, including how to help prevent it and also how it is diagnosed and treated. For more information about how osteoporosis affects men see the topic Osteoporosis in Men.

What is osteoporosis?

Osteoporosis is a disease that affects your bones. It means that you have bones that are thin and brittle with lots of holes inside them like a sponge. This makes them easy to break. Osteoporosis can lead to broken bones (fractures) in the hip, spine, and wrist. These fractures can be disabling and may make it hard for you to live on your own.

Osteoporosis affects millions of older adults. It usually strikes after age 60. It's most common in women, but men can get it too.

What causes osteoporosis?

It's caused by a lack of bone strength or bone density . As you age, your bones get thinner naturally. But some things can make you more likely to have the severe bone thinning of osteoporosis. These things are called risk factors.

Age, gender, and body type risks
  • Your age. Your risk goes up as you get older.
  • Being a woman who has gone through menopause. After menopause, the body makes less estrogen. Estrogen protects the body from bone loss.
  • Having a slender body frame
Family history risks
  • Your family background. Osteoporosis tends to run in families.
  • Your race. People of European and Asian background are most likely to get osteoporosis.
Lifestyle risks
  • Smoking
  • Not getting enough weight-bearing exercise
  • Drinking too much alcohol
  • Not getting enough calcium and vitamin D

What are the symptoms?

Osteoporosis can be very far along before you notice it. Sometimes the first sign is a broken bone in your hip, spine, or wrist after a bump or fall.

As the disease gets worse, you may have other signs, such as pain in your back. You might notice that you are not as tall as you used to be and that you have a curved backbone .

How is osteoporosis diagnosed?

Your doctor will ask about your symptoms and do a physical exam. You may also have a test that measures your bone thickness (bone density test) and your risk for a fracture.

If the test finds that your bone thickness is less than normal but is not osteoporosis, you may have osteopenia. It's a less severe type of bone thinning.

It's important to find and treat osteoporosis early to prevent bone fractures. Experts advise bone density testing for women age 65 and older. If you have a higher risk for fractures, it's best to start getting the test sooner.

How is it treated?

Treatment for osteoporosis includes medicine to reduce bone loss and to build bone thickness. Medicine can also give you relief from pain caused by fractures or other changes to your bones.

It's important to get enough calcium and vitamin D and take prescribed medicine for the disease. You need calcium and vitamin D to build strong, healthy bones.

You can slow osteoporosis with new, healthy habits. If you smoke, quit. Get plenty of exercise. Walking, jogging, dancing, and lifting weights can make your bones stronger. Eat a healthy mix of foods that include calcium and vitamin D. Try yogurt, cheese, and milk (for calcium). Eat eggs, fatty fish, and fortified cereal (for vitamin D).

Making even small changes in how you eat and exercise, along with taking medicine, can help prevent a broken bone.

When you have osteoporosis, it's important to protect yourself from falling. Reduce your risk of breaking a bone by making your home safer. Make sure there's enough light in your home. Remove throw rugs and clutter that you may trip over. Put sturdy handrails on stairs. Try exercises to increase your strength and balance.

Frequently Asked Questions

Learning about osteoporosis:

Being diagnosed:

Getting treatment:

Living with osteoporosis:

Health Tools Health Tools help you make wise health decisions or take action to improve your health.

Health Tools help you make wise health decisions or take action to improve your health.


Decision Points focus on key medical care decisions that are important to many health problems. Decision Points focus on key medical care decisions that are important to many health problems.
  Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?
  Osteoporosis: Should I Take Bisphosphonate Medicines?

Actionsets help people take an active role in managing a health condition. Actionsets are designed to help people take an active role in managing a health condition.
  Aging Well: Making Your Home Fall-Proof
  Osteoporosis: Taking Calcium and Vitamin D

Cause

As a natural part of aging, bone tissue breaks down. It is absorbed faster than new bone is made, and bones become thinner . You are more likely to have osteoporosis if you did not reach your ideal bone thickness ( bone density ) during your childhood and teenage years.

In women, bone loss increases around menopause, when ovaries decrease production of estrogen, a hormone that protects against bone loss. So the older you get, the more likely you are to have osteoporosis.

Not getting enough calcium and vitamin D contributes to bone thinning. Also, thin bones may run in families.

Symptoms

In the early stages of osteoporosis, you probably won't have symptoms. As the disease progresses, you may have symptoms related to weakened bones, including:

  • Back pain.
  • Loss of height and stooped posture.
  • A curved upper back (dowager's hump).
  • Broken bones ( fractures ) that might occur with a minor injury, especially in the hip, spine , and wrist.
  • Compression fractures in the spine that may cause severe back pain. But sometimes these fractures cause only minor symptoms or no symptoms at all.

What Happens

In a normal, healthy adult, bone is constantly absorbed into the body and then rebuilt. During childhood and the teen years, new bone tissue is added faster than existing bone is absorbed. As a result, your bones become larger and heavier until about age 30 when you reach peak bone mass (density). The more bone mass you developed early in life, the less likely you are to get osteoporosis.

After age 30, people lose a small amount of bone each year.

A person with thinning bones may be diagnosed with lower-than-normal bone mass ( osteopenia ). Osteopenia sometimes progresses to osteoporosis.

When bones thin, they lose strength and break more easily. The bones that break most often due to osteoporosis are:

  • The spine . About half of broken bones caused by osteoporosis are bones in the spine. 1 Vertebrae that are weak because of osteoporosis may break and collapse on top of each other. (This is called a compression fracture.) These fractures of the spine can cause back pain, stooped posture, loss of height, and a curved upper back ( dowager's hump ).
  • The hip. Hip fractures are often caused by a fall. They can make it very hard for you to move around. And they usually require major surgery. After a hip fracture, you may have medical complications such as blood clots, pressure sores, or pneumonia. To learn more, see the topic Hip Fracture.
  • The wrist and forearm. Wrist fractures can make you less active and independent. 2

In women, bone loss increases when the ovaries reduce production of estrogen, a hormone that protects against bone loss.

What Increases Your Risk

The risk of osteoporosis increases with age as bones naturally become thinner. But it usually doesn't affect people until they are 60 or older.

Family and personal history

Things that increase the risk of osteoporosis include:

  • Having a family history of osteoporosis. If your mother, father, or a sibling has been diagnosed with osteoporosis or has had broken bones from a minor injury, you are more likely to get osteoporosis.
  • Completing menopause. Estrogen protects women from bone loss, and estrogen levels drop after menopause. Women whose ovaries aren't working properly or have been removed also are at risk because of lower estrogen levels.

Lifestyle risks

  • Smoking. People who smoke lose bone thickness faster than nonsmokers.
  • Alcohol use. Heavy alcohol use can decrease bone formation, and it increases the risk of falling. Heavy alcohol use is more than 2 standard drinks a day for men and more than 1 drink a day for women.
  • Getting little or no exercise. Weight-bearing exercises include walking, jogging, stair climbing, dancing, and lifting weights. They keep bones strong and healthy by working the muscles and bones against gravity. Exercise may improve your balance and decrease your risk of falling.
  • Poor diet. A diet low in foods containing calcium and vitamin D increases your risk of thinning bones.

Other things that increase risk

Other risk factors include:

  • Taking corticosteroids or certain other medicines.
  • Being inactive or bedridden for long periods of time.
  • Dieting excessively or having an eating disorder, such as anorexia nervosa.
  • Being a female athlete if you have few or irregular menstrual cycles due to low body fat.

Find out your fracture risk

The World Health Organization (WHO) has created a tool called FRAX. Your doctors might use the FRAX tool to help predict your risk of having a fracture related to osteoporosis in the next 10 years. You can use this tool too. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can enter your score. If you haven't had that test, you can leave the score blank.

When To Call a Doctor

Call your doctor right away if you:

  • Think you have a broken bone, notice a deformity after a fall, or cannot move a part of your body.
  • Have sudden, severe pain when bearing weight.

Call your doctor for an appointment if you:

  • Want to discuss your risk for osteoporosis.
  • Have symptoms of menopause or have completed menopause and want to discuss whether you should take medicine to prevent osteoporosis.
  • Have been treated for a fracture caused by a minor injury, such as a simple fall, and want to discuss your risk of osteoporosis.

If you are nearing age 65, have osteopenia , or think that you are at high risk for osteoporosis, talk with your doctor about your concerns.

Watchful waiting

If you do not have any risk factors for osteoporosis and you are already taking preventive measures, such as taking adequate calcium and vitamin D, you may only need routine screening.

Who to see

Health professionals who can evaluate your symptoms and risk of osteoporosis include:

To prepare for your appointment, see the topic Making the Most of Your Appointment.

Exams and Tests

A diagnosis of osteoporosis is based on your medical history, a physical exam, and a test to measure your bone thickness (density).

Medical history and physical exam

Your doctor will:

  • Take a medical history by asking questions about your family's health history and your own.
  • Measure your height and compare the results with past measurements.
  • Examine your body for signs of previous broken bones, such as changes in the shape of your long bones and spine.

Tests

You will have a bone density test. It helps your doctor estimate the strength of your bones.

Routine urine and blood tests can rule out other medical conditions, such as hyperparathyroidism, hyperthyroidism, and Cushing's syndrome. These conditions can cause bone loss.

Early detection

If you or your doctor thinks that you may be at risk for osteoporosis, you may have a screening test to check your bone thickness. A screening test may be a good idea if you have:

  • A fracture from a minor injury that may have been caused by osteoporosis.
  • Another medical condition that is known to cause bone thinning.
  • Risk factors for or symptoms that suggest osteoporosis.

Experts recommend that all women age 65 and older routinely have a bone density test to screen for osteoporosis. If you are at increased risk for fractures caused by osteoporosis, routine screening should start sooner. 3 The U.S. Preventive Services Task Force (USPSTF) recommends that you and your doctor check your fracture risk using a tool such as FRAX to help decide whether you should be screened for osteoporosis. Talk to your doctor about your risk factors and when to start bone density screening.

Click here to view a Decision Point. Osteoporosis: Should I Have a Dual-Energy X-Ray Absorptiometry (DXA) Test?

Using the FRAX tool

The FRAX tool was developed by the World Health Organization to help predict your risk of having a fracture related to osteoporosis in the next 10 years. The tool is meant for people who are not already being treated with medicine for osteoporosis. You can use this tool. Go to the website at www.sheffield.ac.uk/FRAX, and click on Calculation Tool. If you have had a bone density test on your hip, you can type in your score. If you have not had that test, you can leave the score blank.

Screening in younger women

Most experts recommend that the decision to screen younger women be made on an individual basis. The need for testing will depend on the risk for osteoporosis and whether the test results will help with treatment decisions.

Ultrasound tests

Ultrasound is sometimes offered at events such as health fairs as a quick screening for osteoporosis. Ultrasound by itself is not a reliable test for diagnosing osteoporosis. But if results of an ultrasound screening find low bone density, your doctor can help you decide whether you should have a bone density test.

Treatment Overview

Treatment for osteoporosis is important to prevent fractures and help you get around and function well. It usually includes lifestyle changes and medicine. It is never too late to build and then keep healthy habits that can slow bone thinning.

Lifestyle changes

Take calcium and vitamin D

Your doctor likely will recommend that you eat foods rich in calcium and vitamin D. These nutrients keep bones healthy and strong.

Your bones need vitamin D to absorb calcium. Getting more vitamin D may help prevent falls in older people who are low in vitamin D. 4 And some studies show that taking vitamin D may reduce the chances of breaking a bone. 5 Talk to your doctor about measuring your vitamin D to be sure you are getting enough.

Get weight-bearing exercise

Get regular weight-bearing exercise, such as walking, jogging, stair climbing, dancing, lifting weights, aerobics, and resistance exercises. These activities keep bones healthy by working the muscles and bones against gravity. To be most effective, weight-bearing exercises should be done for 30 minutes most days of the week. Resistance exercises should be done 2 or 3 days a week.

Limit alcohol, and don't smoke

Along with exercise and diet, your doctor will recommend that you not smoke. And it's best to limit alcohol to no more than 2 drinks a day for men and no more than 1 drink a day for women. For help with quitting smoking, see the topic Quitting Smoking.

Medicines

In some cases, your doctor will prescribe medicines such as bisphosphonates or hormones to protect against bone loss.

Follow-up visits

After you have been diagnosed with bone loss, you will need to have regular follow-up tests to monitor the disease.

Treatment for compression fractures

Compression fractures from osteoporosis can cause significant back pain that lasts for several months. Treatments to relieve your pain include over-the-counter medicines such as acetaminophen and nonsteroidal anti-inflammatory drugs as well as stronger prescription medicine.

Your doctor may also suggest a back brace or corset to support your spine.

If you have a fractured bone related to osteoporosis, treatment to slow your bone thinning becomes very important. If you have had a spinal fracture, you are at risk of having another.

Prevention

You can build strong bones and help prevent osteoporosis with weight-bearing exercise and a diet rich in calcium and vitamin D. Young women in particular need to be aware of their risk for osteoporosis. They can take steps early to slow its progress and prevent complications.

A lot of physical activity during the preteen and teen years increases bone mass and greatly reduces the risk of osteoporosis in adulthood.

Along with diet and exercise, prevention includes not smoking and limiting alcohol. For more information, see Home Treatment.

Home Treatment

You can do a lot to slow bone loss and prevent broken bones.

Get enough calcium and vitamin D

Getting enough calcium and vitamin D is one of the first steps toward preventing or reducing the effects of osteoporosis. Vitamin D helps your body absorb calcium. Calcium is found in many foods, including dairy products such as milk and yogurt.

Click here to view an Actionset. Osteoporosis: Taking Calcium and Vitamin D
Choosing supplements

If you think you may not be getting enough calcium in your diet, check with your doctor about taking calcium supplements .

Experts recommend that you choose supplements that are known brand names with proven reliability. Most brand-name calcium products are absorbed easily by the body. The U.S. Food and Drug Administration (FDA) has taken action against companies that praise the benefits of coral calcium as a superior source of calcium and a cure for disease. There is no scientific proof to support these claims.

Get exercise

Weight-bearing exercises (walking, jogging, stair climbing, dancing, or weight lifting), aerobics, and resistance exercises (using weights or elastic bands to help improve muscle strength) are all effective in increasing bone density and strength. These kinds of exercise may also help reduce the risk of falling or of breaking a bone. For more information, see the topic Fitness.

Limit alcohol use

Heavy alcohol use can decrease bone formation. It also increases the risk of falling. Heavy alcohol use is more than 2 drinks a day for men and more than 1 drink a day for women.

Don't smoke

Smoking reduces your bone density and speeds up the rate of bone loss. For information on how to stop, see the topic Quitting Smoking.

Prevent falls

Learn ways to prevent falls that might result in broken bones. Have your vision and hearing checked regularly. Wear slippers or shoes that have nonskid soles. Exercises that improve balance and coordination, such as tai chi, can also reduce your risk of falling. You can also make changes in your home to prevent falls.

Click here to view an Actionset. Aging Well: Making Your Home Fall-Proof

Medications

Medicines are used to both prevent and treat osteoporosis. Some medicines slow the rate of bone loss or increase bone thickness. Even small amounts of new bone growth can reduce your risk of broken bones.

Medicine for treatment and prevention

  • Bisphosphonates. These include alendronate (Fosamax), ibandronate (Boniva), risedronate (Actonel), and zoledronic acid (Reclast).
    Click here to view a Decision Point. Osteoporosis: Should I Take Bisphosphonate Medicines?
  • Calcitonin (Calcimar or Miacalcin). This is a naturally occurring hormone that helps regulate calcium levels in your body and is part of the bone-building process. Calcitonin also relieves pain caused by spinal compression fractures.
  • Denosumab (Prolia). It's used to treat people who are at high risk for bone fractures related to decreased bone density.
  • Teriparatide (Forteo). It's used for the treatment of men and postmenopausal women who have severe osteoporosis and who are at high risk for bone fracture.
  • Raloxifene (Evista). This medicine is a selective estrogen receptor modulator (SERM).

Hormone therapy

Hormone therapy is typically not recommended for most women who have osteoporosis. But if you are at high risk and cannot take other medicines, your doctor may recommend it under certain circumstances. If you continue to have bone loss while taking a bisphosphonate, such as alendronate (Fosamax) or risedronate (Actonel), you may need to take both bisphosphonate medicine and hormone therapy.

Hormone therapy for osteoporosis in women includes:

  • Estrogen. Estrogen without progestin (estrogen therapy, or ET) may be used to treat osteoporosis in women who have gone through menopause and do not have a uterus. Because taking estrogen alone increases the risk for cancer of the lining of the uterus (endometrial cancer), ET is only used if a woman has had her uterus removed (hysterectomy).
  • Estrogen and progestin. In rare cases, the combination of estrogen and progestin (hormone therapy, or HT) is recommended for women who have osteoporosis.

Medicine for pain from fractures

Compression fractures and other broken bones resulting from osteoporosis can cause significant pain that lasts for several months. Medicines to relieve this pain include:

  • Nonprescription acetaminophen, such as Tylenol.
  • Nonprescription nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen. If you take NSAIDs regularly, your doctor may recommend that you also take a medicine such as a proton pump inhibitor (PPI) to protect your digestive system. But there is also a chance that PPIs can help cause osteoporosis. Talk to your doctor about taking NSAIDs and PPIs for long periods of time.
  • A narcotic pain reliever, such as codeine or morphine.
  • Calcitonin , such as Calcimar or Miacalcin.

Surgery

If spinal compression fractures are causing nerve roots to be compressed, your doctor may talk with you about having surgery to stabilize the crushed spinal bones (vertebrae).

If you get a hip fracture because of osteoporosis, you may need surgery to repair your hip. For more information, see the topic Hip Fracture.

Other Treatment

Physical therapy

Your doctor may recommend physical therapy . Your physical therapist may teach you how to safely do weight-bearing exercises.

Soy products

Soy products have been tried to help reduce the chance of broken bones due to osteoporosis, but there is not strong evidence that these products help. But soy is a good source of nondairy protein, so many people still choose to include it in their diets. (For example, 1 cup of soy milk contains 7 to 11 grams of soy protein.)

There is not enough evidence to show if other natural products, such as black cohosh, work to reduce bone loss.

Other Places To Get Help

Organizations

National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS), National Institutes of Health
1 AMS Circle
Bethesda, MD  20892-3675
Phone: 1-877-22-NIAMS (1-877-226-4267) toll-free
Phone: (301) 495-4484
Fax: (301) 718-6366
TDD: (301) 565-2966
Email: niamsinfo@mail.nih.gov
Web Address: www.niams.nih.gov
 

The National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS) is a governmental institute that serves the public and health professionals by providing information, locating other information sources, and participating in a national federal database of health information. NIAMS supports research into the causes, treatment, and prevention of arthritis and musculoskeletal and skin diseases and supports the training of scientists to carry out this research.

The NIAMS website provides health information referrals to the NIAMS Clearinghouse, which has information packages about diseases.


National Institute on Aging
Building 31, Room 5C27
31 Center Drive, MSC 2292
Bethesda, MD  20892
Phone: 1-800-222-2225
Phone: (301) 496-1752
TDD: 1-800-222-4225 (TTY)
Email: niaic@nia.nih.gov
Web Address: www.nia.nih.gov
 

The National Institute on Aging (NIA), one of the centers of the U.S. National Institutes of Health, leads a broad scientific effort to understand the nature of aging and to extend the healthy, active years of life. The NIA funds research and provides information about health and research advances to the public and interested groups.


National Osteoporosis Foundation (NOF)
1150 17nd Street NW, Suite 854
Washington, DC 20036
Phone: 1-800-231-4222
(202) 223-2226
Fax: (202) 223–2237
Web Address: www.nof.org
 

The National Osteoporosis Foundation (NOF) funds research and publishes educational material about osteoporosis for consumers and health professionals. The NOF also provides information about bone density testing sites, new treatment, and local groups interested in osteoporosis. The foundation's mission is to prevent osteoporosis, promote lifelong bone health, help improve the lives of those affected by osteoporosis and related fractures, and find a cure.


NIH Osteoporosis and Related Bone Diseases—National Resource Center
2 AMS Circle
Bethesda, MD  20892-3676
Phone: 1-800-624-BONE (1-800-624-2663)
(202) 223-0344
Fax: (202) 293–2356
TDD: (202) 466-4315
Email: NIHBoneInfo@mail.nih.gov
Web Address: www.niams.nih.gov/bone
 

The NIH Osteoporosis and Related Bone Diseases—National Resource Center is a government resource center that helps health professionals, patients, and the public learn about and locate current information on metabolic bone diseases such as osteoporosis, Paget's disease, osteogenesis imperfecta, and hyperparathyroidism.


North American Menopause Society (NAMS)
5900 Landerbrook Drive
Suite 390
Mayfield Heights, OH 44124
Phone: (440) 442-7550
Fax: (440) 442-2660
Email: info@menopause.org
Web Address: www.menopause.org
 

The North American Menopause Society (NAMS) is a nonprofit organization that promotes the understanding of menopause and thereby improves the health of women as they approach menopause and beyond. NAMS members include experts from medicine, nursing, sociology, psychology, nutrition, anthropology, epidemiology, pharmacy, and education. The NAMS website has information on perimenopause, early menopause, menopause symptoms and long-term health effects of estrogen loss, and a variety of therapies.


References

Citations

  1. Chapman-Novakofski K (2012). Nutrition and bone health. In LK Mahan, S Escott-Stump, eds., Krause's Food and the Nutrition Care Process, 13th ed., pp. 531–546. St. Louis: Saunders.
  2. Edwards BJ, et al. (2010). Functional decline after incident wrist fractures—Study of Osteoporotic Fractures: Prospective cohort study. BMJ. Published July 8, 2010 (doi:10.1136/bmj.c3324).
  3. U.S. Preventive Services Task Force (2011). Screening for Osteoporosis: Recommendation Statement. Available online: http://www.uspreventiveservicestaskforce.org/uspstf10/osteoporosis/osteors.htm.
  4. Gillespie LD, et al. (2009). Interventions for preventing falls in older people living in the community. Cochrane Database of Systematic Reviews (2).
  5. Bischoff-Ferrari HA, et al. (2009). Prevention of nonvertebral fractures with oral vitamin D and dose dependency. Archives of Internal Medicine, 169(6): 551–561.

Other Works Consulted

  • American Association of Clinical Endocrinologists (2003). Medical guidelines for clinical practice for the diagnosis and treatment of postmenopausal osteoporosis. Endocrine Practice, 16(Suppl 3): 1–37.
  • Becker C (2011). Diseases of calcium metabolism and metabolic bone disease. In EG Nabel, ed., ACP Medicine, section 5, chap. 4. Hamilton, ON: BC Decker.
  • Bell KJL, et al. (2009). Value of routine monitoring of bone mineral density after starting bisphosphonate treatment: Secondary analysis of trial data. BMJ. Published online June 23, 2009 (doi:10.1136/bmj.b2266).
  • Heiss G, et al. (2008). Health risks and benefits 3 years after stopping randomized treatment with estrogen and progestin. JAMA, 299(9): 1036–1045.
  • Howe TE, et al. (2011). Exercise for preventing and treating osteoporosis in postmenopausal women. Cochrane Database of Systematic Reviews (7).
  • Liu H, et al. (2008). Screening for osteoporosis in men: A systematic review for an American College of Physicians guideline. Annals of Internal Medicine, 148(9): 685–701.
  • National Osteoporosis Foundation (accessed November 2012). Exercise for strong bones. Available online: http://www.nof.org/articles/238.
  • Nelson HD, et al. (2010). Screening for osteoporosis: An update for the U.S. Preventive Services Task Force. Annals of Internal Medicine, 153(2): 99–111.
  • Newberry SJ, et al. (2012). Treatment to Prevent Fractures in Men and Women With Low Bone Density or Osteoporosis: Update of a 2007 Report. Comparative Effectiveness Review No. 53 (AHRQ Publication No. 12-EHC023-EF). Rockville, MD: Agency for Healthcare Research and Quality. Available online:
  • North American Menopause Society (2010). Management of osteoporosis in postmenopausal women: 2010 position statement of the North American Menopause Society. Menopause, 17(1): 23–54. Also available online: http://www.menopause.org/aboutmeno/consensus.aspx.
  • Qaseem A, et al. (2008). Pharmacologic treatment of low bone density or osteoporosis to prevent fractures: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 149(6): 404–415. Also available online: http://www.acponline.org/clinical_information/guidelines/guidelines.
  • Vondracek SF, Hansen LB (2004). Current approaches to the management of osteoporosis in men. American Journal of Health-System Pharmacists, 61(17): 1801–1811.

Credits

By Healthwise Staff
Primary Medical Reviewer Kathleen Romito, MD - Family Medicine
Specialist Medical Reviewer Carla J. Herman, MD, MPH - Geriatric Medicine
Last Revised November 6, 2012

This information does not replace the advice of a doctor. Healthwise, Incorporated disclaims any warranty or liability for your use of this information. Your use of this information means that you agree to the Terms of Use. How this information was developed to help you make better health decisions.

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