TY - JOUR AU - Søgaard, Anne Johanne PY - 2009/11/02 Y2 - 2024/03/29 TI - Osteoporose – risikofaktor eller sykdom? Definisjon, utbredelse, årsaker, diagnostisering og forebyggende tiltak JF - Norsk Epidemiologi JA - Nor J Epidemiol VL - 9 IS - 2 SE - DO - 10.5324/nje.v9i2.482 UR - https://www.ntnu.no/ojs/index.php/norepid/article/view/482 SP - AB - <strong><span style="font-family: TimesNewRomanPS-BoldMT;"><span style="font-family: TimesNewRomanPS-BoldMT;"><p align="left"> </p></span></span><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">SAMMENDRAG</span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">Vi vet foreløpig lite om utbredelsen av osteoporose i Norge – dvs. bentetthet (BMD) minst 2,5 standardavvik</p><p align="left">under gjennomsnittet for unge kvinner. Vi vet heller ikke om det har vært noen økning de siste 10-årene.</p><p align="left">Denne artikkelen gir en oversikten over emnet osteoporose – med vekt på risikofaktorer og forebyggende</p><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">tiltak, og drøfter WHOs definisjon av osteoporose. I henhold til denne er osteoporose</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span><p align="left"><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">både </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">en risikofaktor for<span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">brudd –</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span></p><p align="left"><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">og </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">en betegnelse på en tilstand som forutsetter minst ett brudd (etablert osteoporose). Definisjonen<p align="left">innebærer at diagnosen osteoporose avhenger av det normalmaterialet man sammenliker med, og medfører at</p><p align="left">en meget stor andel av norske kvinner over 70 år vil få diagnosen osteoporose. En slik medikalisering vil</p><p align="left">kunne føre til hyppige legekontroller, angst og lavere fysisk aktivitet av redsel for å falle. Osteoporose er</p><p align="left">asymptomatisk før man har fått brudd, og har ingen automatiske behandlingsmessige konsekvenser. Man kan</p><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">likevel frykte at WHOs definisjon vil tvinge frem krav om medikamentell</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span></p><p align="left"><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">forebyggende </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">behandling. Dette er<p align="left">problematisk fordi det er stor overlapping i bentetthet mellom de som får brudd og de som ikke får. Måling av</p><p align="left">BMD er imidlertid den beste metoden vi i dag har for å forutsi brudd – og er like god som blodtrykksmåling er</p><p align="left">til å forutsi slag. For å vurdere individuell risiko, bør imidlertid flere risikofaktorer for brudd kombineres. De</p><p align="left">viktigste risikofaktorene for lav bentetthet er: lav kroppsvekt/lav relativ vekt, vektreduksjon, lavt inntak av</p><p align="left">kalsium/D-vitamin, røyking, tidlig menopause, inaktivitet, høyt alkoholkonsum og genetiske faktorer. Tiltak</p><p align="left">med fokus på noen av disse har vist positiv effekt på BMD.</p><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">Søgaard AJ.</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span></p><p align="left"><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">Osteoporosis – risk factor or disease? Definition, distribution, aetiology, diagnosis and<strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"></span></span></strong></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><p align="left"> </p><p align="left"> </p><p align="left"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">ENGLISH SUMMARY</span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">At present we do not know the distribution of osteoporosis in the Norwegian population – i.e. bone mineral</p><p align="left">density (BMD) below 2.5 standard deviations of the mean of young females. Nor do we know whether or not</p><p align="left">there has been any increase in the prevalence of osteoporosis the last decades. This paper reviews research</p><p align="left">about osteoporosis – focusing on risk factors and preventive measures, and discusses the WHO definition of</p><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left">osteoporosis. Osteoporosis is, in accordance to this definition,</p></span></span></span><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><p align="left"> </p></span></span><p align="left"><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">both </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">a risk factor for fracture </span></span><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">and </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">the notion of a<p align="left">condition which presuppose a fracture (established osteoporosis). The definition implies that the diagnosis of</p><p align="left">osteoporosis depend upon the material of reference we compare with, and entail that a large majority of</p><p align="left">women above 70 years of age will have osteoporosis. This medicalization may lead to more frequent visits to</p><p align="left">physicians for control, more anxiety and less frequent physical activity because of fear of falling. Osteoporosis</p><p align="left">does not cause pain or loss of function before a fracture has occurred, and the diagnosis is not meant to initiate</p><p align="left">therapy. Nevertheless we worry that the diagnosis may have its own momentum in that direction, and enforce</p><p align="left">demands for more medicine for the purpose of prevention. This is problematic because there is a large overlap</p><p align="left">in BMD between those who will have a future fracture – and those who will not. However, measuring BMD is</p><p align="left">the best single method to predict future fracture, and is just as good as a measure of blood pressure is to predict</p><p align="left">stroke. To assess individual risk, one should, however, use more than one fracture risk factor. The most</p><p align="left">important risk factors for low BMD are: low weight/low body mass index, weight reduction, low intake of</p><p align="left">calcium/vitamin-D, smoking, early menopause, inactivity, high alcohol consumption and genetic factors.</p><p>Interventions focusing on some of these factors have been effective in increasing/not reducing BMD.</p></span></span></p></p></span></strong></span></strong><em><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-ItalicMT;">Nor J Epidemiol </span></span></em><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">1999; </span></span><strong><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;"><span style="font-size: x-small; font-family: TimesNewRomanPS-BoldMT;">9 </span></span></strong><span style="font-size: x-small; font-family: TimesNewRomanPSMT;"><span style="font-size: x-small; font-family: TimesNewRomanPSMT;">(2): 165-172</span></span></p><p align="left">prevention.</p> ER -