Metabolic Bone Disease and Osteoporosis

In the aging society, osteoporosis is one of the most common diseases encountered in the primary care setting. As osteoporosis is silent until a fracture occurs, it is often not recognized or properly managed. However, osteoporosis that is diagnosed based on low bone mineral density is a strong predictor of a hip or vertebral fracture. A similar analogy is that of blood pressure for stroke or LDL cholesterol for coronary artery disease. In this chapter, we review the risk assessment and diagnosis of osteoporosis, including current diagnostic tools and their limitation, and newly-developed techniques to assess bone quality. We discuss pre- and postmenopausal osteoporosis including early perimenopausal bone loss and the novel finding of the role of FSH in bone remodeling. Also, other metabolic bone diseases, including renal osteodystrophy, transplantation-related osteoporosis, prostate and breast cancer-related bone disease, and male osteoporosis as well as endocrine-related conditions such as primary hyperparathyroidism are reviewed in detail. Lastly, we review currently available treatment options including antiresorptives, anabolics, and a new monoclonal antibody, romosozumab.