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Osteoporos

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Definition:
En systemisk skelettsjukdom med minskad benmassa och förändringar i benvävnadens mikroarkitektur som medför skört skelett och ökad risk för frakturer.
Förekomst:
I Sverige har knappt 6 % osteoporos, varav nästan 80 % är kvinnor. Förekomsten ökar kraftigt med åldern.
Symtom:
Osteoporos ger sällan några symtom innan en fraktur inträffar och den låga bentätheten är viktig att identifiera på grund av att den är en riskfaktor för kommande frakturer.
Kliniska fynd:
Fraktur efter litet eller inget trauma är det viktigaste tecknet på osteoporos men kliniska fynd kan också vara lågt BMI, längdminskning >3 cm jämfört med maxlängd som ung eller uttalad torakal kyfos som tecken på tidigare kotfrakturer.
Diagnostik:
Beslut om benspecifik läkemedelsbehandling grundas på en samlad klinisk bedömning. Särskilt stark behandlingsindikation föreligger vid fraktur i kota eller höft.
Behandling:
Benspecifika läkemedel, eventuellt med tilläggsbehandling med kalcium och D-vitamin, men också livsstilsförändringar såsom ökad fysisk aktivitet, träning av styrka och balans samt rökstopp.
  1. Consensus development conference: diagnosis, prophylaxis, and treatment of osteoporosis. Am J Med. 1993 Jun;94(6):646–50. PMID: 8506892. PubMed  
  2. Assessment of fracture risk and its application to screening for postmenopausal osteoporosis. Report of a WHO Study Group. World Health Organ Tech Rep Ser. 1994;843:1–129. PMID: 7941614. PubMed  
  3. Bandeira L, Silva BC, Bilezikian JP. Male osteoporosis. Arch Endocrinol Metab. 2022 Nov 11;66(5):739-747. doi: 10.20945/2359-3997000000563. PMID: 36382763 PubMed  
  4. Writing Group for the ISCD Position Development Conference. Position statement : executive summary. The Writing Group for the International Society for Clinical Densitometry (ISCD) Position Development Conference. J Clin Densitom. 2004 Spring;7(1):7-12. doi: 10.1385/jcd:7:1:7. PMID: 14742882 PubMed  
  5. Warriner AH, Patkar NM, Curtis JR et al. Which fractures are most attributable to osteoporosis? J Clin Epidemiol. 2011 Jan;64(1):46-53. PMID: 21130353 PubMed  
  6. Willers C, Norton N, Harvey NC, Jacobson T, Johansson H, Lorentzon M, McCloskey EV, Borgström F, Kanis JA; SCOPE review panel of the IOF. Osteoporosis in Europe: a compendium of country-specific reports. Arch Osteoporos. 2022 Jan 26;17(1):23. doi: 10.1007/s11657-021-00969-8. PMID: 35079919 PubMed  
  7. Starup-Linde J, Rosendahl SB, Storgaard M, Langdahl B. Management of osteoporosis in patients living with HIV - a systematic review and meta-analysis. J Acquir. Immune Defic Syndr 2020; 83: 1-8. pmid:31809356 PubMed  
  8. Crandall CJ, Larson JCLaCroix AZ, et al. Risk of Subsequent Fractures in Postmenopausal Women After Nontraumatic vs Traumatic Fractures. JAMA Intern Med 2021. pmid:34096979 PubMed  
  9. Nationella riktlinjer för rörelseorganens sjukdomar (hämtad 2021-10-06) www.socialstyrelsen.se  
  10. Vårdprogram för osteoporos, 2020/2021. Svenska osteoporossällskapet. Hämtad 2023-09-12 svos.se  
  11. NKK. Nationellt kliniskt kunskapsstöd. Osteoporos. Hämtad 2023-09-15 www.nationelltklinisktkunskapsstod.se  
  12. Läkemedel vid osteoporos för att förhindra benskörhetsfrakturer - behandlingsrekommendation. Läkemedelsverket, 2020 www.lakemedelsverket.se  
  13. Shevroja E, Lamy O, Kohlmeier L, Koromani F, Rivadeneira F, Hans D. Use of Trabecular Bone Score (TBS) as a Complementary Approach to Dual-energy X-ray Absorptiometry (DXA) for Fracture Risk Assessment in Clinical Practice. J Clin Densitom 2017;20:334–45. PMID: 28734710 PubMed  
  14. De Kam D, Smulders E, Weerdesteyn V, Smits-Engelsman BC. Exercise interventions to reduce fall-related fractures and their risk factors in individuals with low bone density: a systematic review of randomized controlled trials. Osteoporos Int. 2009 Dec;20(12):2111-25. PMID: 19421702 PubMed  
  15. Gillespie LD, Robertson MC, Gillespie W et al. Interventions for preventing falls in older people living in the community. Cochrane Database Syst Rev. 2012 Sep 12;(9):CD007146. doi: 10.1002/14651858.CD007146.pub3. PMID: 22972103 PubMed  
  16. Sherrington C, Whitney JC, Lord SR, et al. Effective exercise for the prevention of falls: a systematic review and meta-analysis. J Am Geriatr Soc. 2008 Dec;56(12):2234-43. PMID: 19093923. PubMed  
  17. Pirruccio K, Yoon YM, Ahn J et al. Fractures in Elderly Americans Associated With Walking Leashed Dogs. JAMA Surg. 2019 Mar 6. PMID: 30840050 PubMed  
  18. Santesso N, Carrasco-Labra A, Brignardello-Petersen R. Hip protectors for preventing hip fractures in older people. Cochrane Database Syst Rev 2014; 3: CD001255. doi:10.1002/14651858.CD001255.pub5. PMID: 24687239 PubMed  
  19. Koike T, Orito Y, Toyoda H, et al. External hip protectors are effective for the elderly with higher-than-average risk factors for hip fractures. Osteoporosis Int 2009; 20: 1613.20. PMID:19137351. PubMed  
  20. Thorin MH, Wihlborg A, Åkesson K, Gerdhem P. Smoking, smoking cessation, and fracture risk in elderly women followed for 10 years. Osteoporos Int 2016;27:249–55. PMID: 26302684 PubMed  
  21. Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int 2015;26:531–42. PMID: 25266483 PubMed  
  22. Deardorff WJ, Cenzer I, Nguyen B, Lee SJ. Time to Benefit of Bisphosphonate Therapy for the Prevention of Fractures Among Postmenopausal Women With Osteoporosis: A Meta-analysis of Randomized Clinical Trials. JAMA Intern Med. 2021 Nov 22:e216745. doi: 10.1001/jamainternmed.2021.6745. Epub ahead of print. PMID: 34807231 PubMed  
  23. Wells GA, Cranney A, Peterson J, et al. Alendronate for the primary and secondary prevention of osteoporotic fractures in postmenopausal women. Cochrane Database Syst Rev. 2008 Jan 23;(1):CD001155. doi: 10.1002/14651858.CD001155.pub2. PMID: 18253985 PubMed  
  24. Black DM, Delmas PD, Eastell R et al. Once-yearly zoledronic acid for treatment of postmenopausal osteoporosis. N Engl J Med 2007;356:1809–22. PMID: 17476007 PubMed  
  25. Freemantle N, Cooper C, Diez-Perez A et al. Results of indirect and mixed treatment comparison of fracture efficacy for osteoporosis treatments: a meta-analysis. Osteoporos Int 2013;24:209–17. PMID: 22832638 PubMed  
  26. Popp AW, Senn R, Curkovic et al. Factors associated with acute-phase response of bisphosphonate-naïve or pretreated women with osteoporosis receiving an intravenous first dose of zoledronate or ibandronate. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2017;28:1995–2002. PMID: 28299378 PubMed  
  27. Bone HG, Wagman RB, Brandi ML et al. 10 years of denosumab treatment in postmenopausal women with osteoporosis: results from the phase 3 randomised FREEDOM trial and open-label extension. Lancet Diabetes Endocrinol 2017;5:513–23. PMID: 28546097 PubMed  
  28. Cummings SR, Ferrari S, Eastell R, Gilchrist N, Jensen J-EB, McClung M, et al. Vertebral Fractures After Discontinuation of Denosumab: A Post Hoc Analysis of the Randomized Placebo-Controlled FREEDOM Trial and Its Extension. J Bone Miner Res 2018;33:190–8. PMID: 29105841 PubMed  
  29. Lorentzon M. Treating osteoporosis to prevent fractures: current concepts and future developments. J Intern Med. 2019 Apr;285(4):381-394. doi: 10.1111/joim.12873. Epub 2019 Jan 18. PMID: 30657216 PubMed  
  30. Nationella riktlinjer för rörelseorganens sjukdomar, 2021. Socialstyrelsen. www.socialstyrelsen.se  
  31. Händel MN, Cardoso I, von Bülov C, et al. Fracture risk reduction and safety by osteoporosis treatment compared with placebo or active comparator in postmenopausal women: systematic review, network meta-analysis, and meta-regression analysis of randomised clinical trials. BMJ 2023; 381: e068033. pmid:37130601 PubMed  
  32. Kendler DL, Marin F, Zerbini CAF et al. Effects of teriparatide and risedronate on new fractures in post-menopausal women with severe osteoporosis (VERO): a multicentre, double-blind, double-dummy, randomised controlled trial. Lancet. 2018 Jan 20;391(10117):230-240. doi: 10.1016/S0140-6736(17)32137-2. Epub 2017 Nov 9. Erratum in: Lancet. 2017 Nov 30;: Erratum in: Lancet. 2018 Dec 1;392(10162):2352. PMID: 29129436 PubMed  
  33. Saag KG, Petersen J, Brandi ML, Karaplis AC, Lorentzon M, Thomas T, Maddox J, Fan M, Meisner PD, Grauer A. Romosozumab or Alendronate for Fracture Prevention in Women with Osteoporosis. N Engl J Med. 2017 Oct 12;377(15):1417-1427. PMID: 28892457. PubMed  
  34. Cosman F, Crittenden DB, Adachi JD et al. Romosozumab Treatment in Postmenopausal Women with Osteoporosis. N Engl J Med. 2016 Oct 20;375(16):1532-1543. doi: 10.1056/NEJMoa1607948. Epub 2016 Sep 18. PMID: 27641143 PubMed  
  35. Nordiska Näringsrekommendationer 2012. Livsmedelsverket. www.livsmedelsverket.se  
  36. Landfeldt E, Ström O, Robbins S, Borgström F. Adherence to treatment of primary osteoporosis and its association to fractures--the Swedish Adherence Register Analysis (SARA). Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2012;23:433–43. PMID: 21286686 PubMed  
  37. Bell KJ, Hayen A, Glasziou P et al. Potential Usefulness of BMD and Bone Turnover Monitoring of Zoledronic Acid Therapy Among Women With Osteoporosis: Secondary Analysis of Randomized Controlled Trial Data. J Bone Miner Res Off J Am Soc Bone Miner Res 2016;31:1767–73. PMID: 27027655 PubMed  
  38. Austin M, Yang YC, Vittinghoff E, et al. Relationship between bone mineral density changes with denosumab treatment and risk reduction for vertebral and nonvertebral fractures. J Bone Miner Res. 2012 Mar;27(3):687-93. PMID: 22095631. PubMed  
  39. Black DM, Abrahamsen B, Bouxsein ML et al. Atypical Femur Fractures – Review of epidemiology, relationship to bisphosphonates, prevention and clinical management. Endocr Rev. 2018 Aug 29. PMID: 30169557 PubMed  
  40. Jung SY, Suh HS, Park JW, Kwon JW. Drug Holiday Patterns and Bisphosphonate-Related Osteonecrosis of the Jaw. Oral Dis. Oral Dis. 2018 Aug 28. PMID: 30153366 PubMed  
  41. Black DM, Schwartz AV, Ensrud KE et al. Effects of continuing or stopping alendronate after 5 years of treatment: the Fracture Intervention Trial Long-term Extension (FLEX): a randomized trial. JAMA 2006;296:2927–38. PMID: 17190893 PubMed  
  42. Maraka S, Kennel KA. Bisphosphonates for the prevention and treatment of osteoporosis. BMJ 2015;351:h3783. PMID: 26333528 PubMed  
  43. Adler RA, El-Hajj Fuleihan G et al. Managing Osteoporosis in Patients on Long-Term Bisphosphonate Treatment: Report of a Task Force of the American Society for Bone and Mineral Research. J Bone Miner Res Off J Am Soc Bone Miner Res 2016;31:16–35. PMID: 26350171 PubMed  
  44. Schwartz AV, Bauer DC, Cummings SR et al. Efficacy of continued alendronate for fractures in women with and without prevalent vertebral fracture: the FLEX trial. J Bone Miner Res Off J Am Soc Bone Miner Res 2010;25:976–82. PMID: 20200926 PubMed  
  45. Anagnostis P, Paschou SA, Mintziori G al. Drug holidays from bisphosphonates and denosumab in postmenopausal osteoporosis: EMAS position statement. Maturitas 2017;101:23–30. PMID: 28539165 PubMed  
  46. Abrahamsen B, Eiken P, Prieto-Alhambra D, Eastell R. Risk of hip, subtrochanteric, and femoral shaft fractures among mid and long term users of alendronate: nationwide cohort and nested case-control study. BMJ 2016;353:i3365. PMID: 27353596 PubMed  
  47. Schilcher J, Koeppen V, Aspenberg P, Michaëlsson K. Risk of atypical femoral fracture during and after bisphosphonate use. N Engl J Med 2014;371:974–6. PMID: 25184886 PubMed  
  48. Khan M, Cheung AM, Khan AA. Drug-Related Adverse Events of Osteoporosis Therapy. Endocrinol Metab Clin North Am 2017;46:181–92. PMID: 28131131 PubMed  
  49. Hayashida S, Soutome S, Yanamoto S et al. Evaluation of the Treatment Strategies for Medication-Related Osteonecrosis of the Jaws (MRONJ) and the Factors Affecting Treatment Outcome: A Multicenter Retrospective Study with Propensity Score Matching Analysis. J Bone Miner Res 2017;32:2022–9. PMID: 28585700 PubMed  
  50. Gourlay ML, Fine JP, Preisser JS, et al. Bone-density testing interval and transition to osteoporosis in older women. N Engl J Med 2012; 366: 225-33. PMID: 22256806 PubMed  
  51. Johnston CB, Dagar M. Osteoporosis in Older Adults. Med Clin North Am. 2020 Sep;104(5):873-884. doi: 10.1016/j.mcna.2020.06.004. Epub 2020 Jul 15. PMID: 32773051 PubMed  
  52. Cummings SR, Lui L-Y, Eastell R, Allen IE. Association Between Drug Treatments for Patients With Osteoporosis and Overall Mortality Rates A Meta-analysis. JAMA Intern Med 2019. pmid:31424486 PubMed  
  53. Experten svarar: Bentäthetsmätningar. Tidningen Evidens. Janusinfo. Region Stockholm. Hämtad 2020-12-16 janusinfo.se  
  • Anna Nager, docent och specialist i allmänmedicin, Karolinska institutet