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J Clin Pathol 64:1042-1050 doi:10.1136/jcp.2010.077842
  • Review

The pathogenesis, diagnosis, investigation and management of osteoporosis

Editor's Choice
  1. Geeta Hampson1,2
  1. 1Osteoporosis Screening Unit, Guy's Hospital, London, UK
  2. 2Department of Chemical Pathology, St Thomas' Hospital, London, UK
  1. Correspondence to Dr Geeta Hampson, Department of Chemical Pathology, 5th Floor, North Wing, St Thomas' Hospital, London SE1 7EH, UK; geeta.hampson{at}kcl.ac.uk
  • Accepted 29 June 2011
  • Published Online First 6 September 2011

Abstract

With an increasingly ageing population, osteoporosis and osteoporosis-related fractures is fast becoming an important public health problem placing a considerable economic burden on health service resources. This does not account for the substantial pain, disability and indeed mortality incurred after a fracture, particularly a hip fracture. Osteoporosis is a systemic skeletal disorder which results from an imbalance in bone remodeling. This leads to a reduction in bone strength and increased susceptibility to fracture. It affects up to 1 in 2 women and 1 in 5 men. In the past 2 decades, there have been significant advances in bone biology which have helped in the understanding of the pathogenesis of osteoporosis and have led to improved therapies. In developing strategies for fracture prevention, it is important to identify those individuals with the highest fracture risk who will require pharmacological intervention. Treatment is aimed at fracture prevention and includes modification of general lifestyle factors which have been linked to fractures in epidemiological studies and ensuring optimum calcium and vitamin D intake as adjunct to active anti-fracture therapy. A number of drugs are now approved for the treatment of osteoporosis. This review article will describe the pathogenesis of osteoporosis and focus on the methods currently in use for the identification of patients at high fracture risk and will highlight their usefulness and limitations. The existing anti-fracture pharmacotherapies and those in development will be reviewed. Assessment of their effectiveness including the use of biochemical markers of bone turnover in this clinical context will be reviewed.

Footnotes

  • Competing interests None.

  • Provenance and peer review Commissioned; externally peer reviewed.