Osteoporosis Defined

Peter L. Salgo, MD: Hello, and thank you for joining this AJMC® Peer Exchange titled “An Introduction of a New Class for the Treatment of Bone Health.” Bone health is maintained by the coupled process of bone resorption and bone formation. It’s called bone remodeling. Osteoporosis, or porous bone, occurs when the quality and the density of the bone is reduced. Osteoporosis makes bones fragile and it increases the risk of fractures, and often there are no symptoms until the first fracture.

Today, with our expert panel, we’re going to discuss the burden of disease and introduce new treatment options.

I’m Dr Peter Salgo. I’m a professor of medicine and anesthesiology at Columbia University College of Physicians and Surgeons in New York, and associate director of surgical intensive care at the NewYork-Presbyterian Hospital, as you might guess, in New York.

Participating today on our distinguished panel are: Claire Gill, chief mission officer of the National Osteoporosis Foundation in Arlington, Virginia; Dr Thomas Olenginski, staff attending physician of the Department of Rheumatology in the Geisinger Medical Center in Danville, Pennsylvania, HiROC [high-risk osteoporosis clinic] FLS [fracture liaison service] physician champion, and BMD [Bone Mineral Density] Committee chairperson; and Dr Andrea Singer, director of women’s primary care, director of bone densitometry, and director of the fracture liaison service in the Department of Obstetrics and Gynecology at MedStar Georgetown University Hospital in Washington, DC. She is also the chief medical officer at the National Osteoporosis Foundation.

Why don’t we get right down to it? Thank you all so much for being here.

Can somebody define osteoporosis for me, before we get going?

Claire Gill: Sure. I think you covered it quite well in your introduction.

Peter L. Salgo, MD: Well, thank you very much.

Claire Gill: Osteoporosis is porous bone, and it occurs when the bone becomes less dense and easier to break, and much more fragile. So that’s what we’re dealing with.

Peter L. Salgo, MD: But are we dealing with less bone formation, or is it more bone destruction?

Claire Gill: It can be both. So the remodeling of the bone doesn’t happen. Our bones continue to rebuild and grow throughout the lifespan. But with osteoporosis, the formation of bone is happening less than the deterioration of the bone.

Peter L. Salgo, MD: I’ve got it. So the bone’s going away, but not enough new bone is coming in to take its place?

Claire Gill: That’s correct.

Peter L. Salgo, MD: So it occurs to me, and I’m just an old country doctor here, that this could be a biphasic disease—either too much destruction or not enough replacement. Is that fair?

Andrea J. Singer, MD, FACP, CCD: That is actually fair, and there are changes that go on throughout life. If we think about when we increase bone, kids and teens are adding new bone, mainly by something we call modeling. They reach peak bone density, about 90% of peak bone density is achieved by age 20.

Peter L. Salgo, MD: So we’re all past that peak.

Andrea J. Singer, MD, FACP, CCD: When your kids tell you you’re over the hill after age 30, they are correct, from a bone perspective. The remainder, that extra 10%, accumulates until about age 30. After that, hopefully there’s stability for a while, and then age-related losses. For women, there’s a significant loss of bone following menopause, where women can lose up to 20% of their bone density in the first 5 to 7 years following menopause.