![]() In the case of serotonin re-uptake inhibitors (SSRIs), association with hip fracture appears within the first year of use of this drug in both genders, especially in those patients over-70. ![]() A significantly increased risk of vertebral fractures and hip fractures has been associated with the use of proton pump inhibitors (PPI), especially if used for more than 12 months. In addition to steroid therapy, it is now well known that aromatase inhibitors and GnRH are associated with increased risk of fragility fractures. Many of these associations are derived from data obtained from epidemiological and retrospective studies, and in many cases, the incidence level is quite low. Even the intrinsic factors relating to organ disease can be involved in the development of bone fragility: the most representative example of this specific form of osteoporosis is persistent, very long-term severe forms of secondary hyperparathyroidism, which can affect up to 50% of patients after a kidney transplant, even when the transplant is functional.ĭrug osteoporosis Many types of drugs are associated with osteoporosis and fragility fractures. The main fracture-inducing factor is the immunosuppressive therapy, in particular, the use of cortisone, which is initially administered at very high doses, and, in the majority of patients, for an indefinite period other relevant risk factors common to all types of transplants (at least in the long term) are greater age and female gender. During the first 3 years after a transplant, the percentage of vertebral fractures due to bone fragility reaches a peak, and affects approximately 30–40% of patients. Bone loss is greatest in the first year after surgery, but can also persist, albeit at a slower pace, during subsequent periods. After transplant, the percentage of patients with osteoporosis increases dramatically. ![]() Organ transplant osteoporosis The estimated prevalence of fragility fractures is approximately 10–15% in patients waiting for solid organ transplants (kidney, heart, liver, and lung), due to the negative effects of the underlying condition on bone tissue. In glucocorticoid-induced osteoporosis, the risk of fractures is much higher than could be expected based on the patient’s densitometric values, and decreases rapidly after discontinuation of treatment. Moreover, in men, the BMD DXA technique is the method of choice to determine fracture risk, and it is indicated, according to EAL, at any age, if there is a major risk factor (for example, fragility fracture, prolonged steroid therapy) or in the presence of three or more of the following minor risk factors for men over the age of 60 years:Īlthough densitometric criteria for the diagnosis of osteoporosis in males are not based on levels of evidence similar to those for females, currently, the accepted diagnostic densitometric cutoff for the definition of male osteoporosis is a T-score 800 mcg/day of budesonide (or equivalent), especially if prolonged, may be associated with accelerated loss of bone mass and increased risk of fractures. Male osteoporosis is frequently secondary (about two-thirds of cases in males versus one-third in females), so it is always advisable to exclude other pathological conditions associated with osteoporosis (Table 1). Osteoporosis is a major public health problem for men, as well in fact, more than 20% of all hip fractures occur in males, and the incidence of vertebral fractures is about half that reported in women. Trauma due to a fall is by far the most frequent cause of fractures affecting long bones (femur, humerus, and radius), while it is more difficult to determine the cause and the exact time of fragility fractures of the vertebral body, which often go undiagnosed.ĭuring patient evaluation, there are some clinical history details that can suggest a vertebral fracture: recent trauma, prolonged use of corticosteroids, age, structural spinal deformity, loss of height > 6 cm, and a distance between the last rib and the iliac crest 20 cigarettes/day There are two forms of the disease: (a) primary osteoporosis, which includes juvenile, postmenopausal, and male and senile osteoporosis and (b) secondary osteoporosis, which is caused by a large number of diseases and medications.įragility fractures may occur in almost all skeletal segments, but the preferential locations are the vertebral column, the proximal ends of the femur and humerus, and the distal end of the radius (Colles fracture). Osteoporosis is a systemic skeletal disease characterized by a reduction in bone mass and qualitative skeletal changes (macro- and microarchitecture, material properties, geometry, and micro-damage) that cause an increase in bone fragility and higher fracture risk.
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