Gå direkt till huvudinnehållet

Osteoporos

Senast uppdaterad: Senast reviderad:
Sakkunnig:


Definition:
En systemisk skelettsjukdom med minskad benmassa och förändringar i benvävnadens mikroarkitektur som medför skört skelett och ökad risk för frakturer.
Förekomst:
Förekomsten av osteoporos är mycket högre hos kvinnor än hos män och ökar kraftigt med åldern. I Sverige inträffar varje år cirka 60 000 lågenergifrakturer, varav 18 000 är höftfrakturer.
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:
En fraktur efter litet våld är det viktigaste tecknet på osteoporos men kliniska fynd kan också vara lågt BMI, längdminskning >3 cm jämfört med maxlängd som ung eller uttalad thorakal 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, 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. 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  
  4. Ström O, Borgström F, Åkesson K, Ljunggren Ö, Salomonsson S. Svensk Osteoporosvård - utmaningar och förändringsarbete. Quantify Research AB; 2014. www.svos.se  
  5. Svedbom A, Hernlund E, Ivergård M, et al. Osteoporosis in the European Union: a compendium of country-specific reports. Arch Osteoporos. rch Osteoporos. 2013; 8(1-2): 137. doi: 10.1007/s11657-013-0137-0. DOI  
  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. Kanis JA, Johnell O, Oden A, et al. Long-term risk of osteoporotic fracture in Malmo. Osteoporos Int. 2000;11(8):669-74. PMID: 11095169. PubMed  
  8. 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  
  9. Crndall 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  
  10. Nationella riktlinjer för rörelseorganens sjukdomar (hämtad 2021-10-06) www.socialstyrelsen.se  
  11. Ny rekommendation för läkemedelsbehandling vid osteoporos för att förhindra benskörhetsfrakturer. Nyheter Läkemedelsverket. Hämtad 2020-05-15 www.lakemedelsverket.se  
  12. Almén A , Leitz w, Nyman U. Stråldoser och riskuppskattning vid radiologisk diagnostik. Appendix III, S 544. SBU-rapport (2002): Blodpropp - förebyggande, diagnostik och behandling av venös tromboembolism. www.sbu.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. Läkemedel vid osteoporos för att förhindra benskörhetsfrakturer - behandlingsrekommendation. Läkemedelsverket, 2020 www.lakemedelsverket.se  
  15. Liu M, Guo L, Pei Y, Li N et al. Efficacy of zoledronic acid in treatment of osteoporosis in men and women-a meta-analysis. Int J Clin Exp Med 2015;8:3855–61. PMID: 26064284 PubMed  
  16. 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  
  17. Avenell A, Mak JC, O'Connell D. Vitamin D and vitamin D analogues for preventing fractures in post-menopausal women and older men. Cochrane Database Syst Rev. 2014 Apr 14;2014(4):CD000227. doi: 10.1002/14651858.CD000227.pub4. PMID: 24729336 PubMed  
  18. Weaver CM, Alexander DD, Boushey CJ et al. Calcium plus vitamin D supplementation and risk of fractures: an updated meta-analysis from the National Osteoporosis Foundation. Osteoporos Int J Establ Result Coop Eur Found Osteoporos Natl Osteoporos Found USA 2016;27:367–76. PMID: 26510847 PubMed  
  19. Chapuy MC, Arlot ME, Duboeuf F, Brun J et al. Vitamin D3 and calcium to prevent hip fractures in the elderly women. N Engl J Med 1992;327:1637–42. PMID: 1331788. PubMed  
  20. 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.
  21. 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. The Cochrane Library  
  22. 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  
  23. 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  
  24. 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 DOI  
  25. 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  
  26. 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  
  27. Zhang X, Yu Z, Yu M, Qu X. Alcohol consumption and hip fracture risk. Osteoporos Int 2015;26:531–42. PMID: 25266483 PubMed  
  28. Nordiska Näringsrekommendationer 2012. Livsmedelsverket. www.livsmedelsverket.se  
  29. Eriksen EF. Treatment of osteopenia. Rev Endocr Metab Disord 2012;13:209–23. PMID: 21710179 PubMed  
  30. Quandt SA, Thompson DE, Schneider DL et al, Fracture Intervention Trial Research Group. Effect of alendronate on vertebral fracture risk in women with bone mineral density T scores of-1.6 to -2.5 at the femoral neck: the Fracture Intervention Trial. Mayo Clin Proc 2005;80:343–9. PMID: 15757015 PubMed  
  31. Grey A, Bolland M, Mihov B et al. Duration of antiresorptive effects of low-dose zoledronate in osteopenic postmenopausal women: a randomized, placebo-controlled trial. J Bone Miner Res Off J Am Soc Bone Miner Res 2014;29:166–72. PMID: 23761303 PubMed  
  32. Grey A, Bolland MJ, Horne A et al. Duration of antiresorptive activity of zoledronate in postmenopausal women with osteopenia: a randomized, controlled multidose trial. CMAJ Can Med Assoc J 2017;189:E1130–6. PMID: 28893875 PubMed  
  33. Reid IR, Horne AM, Mihov B et al. Fracture Prevention with Zoledronate in Older Women with Osteopenia. N Engl J Med. 2018 Dec 20;379(25):2407-2416. PMID: 30575489 PubMed  
  34. 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  
  35. 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. The Cochrane Library  
  36. 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  
  37. 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  
  38. 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  
  39. 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  
  40. Romosozumab (Evenity™) nytt osteoporosläkemedel för kvinnor med mycket hög frakturrisk. Hämtad 2021-01-26 vardgivare.skane.se  
  41. 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  
  42. Lewiecki EM, Blicharski T, Goemaere S, Lippuner K, Meisner PD, Miller PD, Miyauchi A, Maddox J, Chen L, Horlait S. A Phase III Randomized Placebo-Controlled Trial to Evaluate Efficacy and Safety of Romosozumab in Men With Osteoporosis. J Clin Endocrinol Metab. 2018 Sep 1;103(9):3183-3193.PMID: 29931216.
  43. Lv F, Cai X, Yang W, Gao L, Chen L, Wu J, Ji L. Denosumab or romosozumab therapy and risk of cardiovascular events in patients with primary osteoporosis: Systematic review and meta- analysis. Bone. 2020 Jan;130:115121. PMID: 31678488. PubMed  
  44. Kharazmi M, Schilcher J, Hallberg P, Michaëlsson K. Atypisk femurfraktur en allvarlig komplikation till bisfosfonater. Lakartidningen.se 2019-09-16. www.lakartidningen.se  
  45. 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  
  46. 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  
  47. 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  
  48. Rikshöft. Rikshöft årsrapport 2016. 2017 rikshoft.se  
  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. Tsai JN, Uihlein AV, Lee H, et al. Teriparatide and denosumab, alone or combined, in women with postmenopausal osteoporosis: the DATA study randomised trial. Lancet 2013. doi:doi:10.1016/S0140-6736(13)60856-9 DOI  
  51. 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  
  52. 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  
  53. 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  
  54. 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  
  55. 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  
  56. 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  
  57. Maraka S, Kennel KA. Bisphosphonates for the prevention and treatment of osteoporosis. BMJ 2015;351:h3783. PMID: 26333528 PubMed  
  58. 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  
  59. 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  
  60. 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  
  61. 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. New England Journal of Medicine  
  62. 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  
  63. Experten svarar: Bentäthetsmätningar. Tidningen Evidens. Janusinfo. Region Stockholm. Hämtad 2020-12-16 janusinfo.se  
  • Hans Lundin, med dr, specialist i allmänmedicin vid sektionen för Allmänmedicin, Karolinska institutet