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Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Job Classification

In most duration tables, five job classifications are displayed. These job classifications are based on the amount of physical effort required to perform the work. The classifications correspond to the Strength Factor classifications described in the United States Department of Labor's Dictionary of Occupational Titles. The following definitions are quoted directly from that publication.

Sedentary Work Exerting up to 10 pounds (4.5 kg) of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects, including the human body. Sedentary work involves sitting most of the time, but may involve walking or standing for brief periods of time. Jobs are sedentary if walking and standing are required only occasionally and other sedentary criteria are met.

Light Work Exerting up to 20 pounds (9.1 kg) of force occasionally and/or up to 10 pounds (4.5 kg) of force frequently, and/or negligible amount of force constantly to move objects. Physical demand requirements are in excess of those for Sedentary Work. Light Work usually requires walking or standing to a significant degree. However, if the use of the arm and/or leg controls requires exertion of forces greater than that for Sedentary Work and the worker sits most the time, the job is rated Light Work.

Medium Work Exerting up to 50 (22.7 kg) pounds of force occasionally, and/or up to 25 pounds (11.3 kg) of force frequently, and/or up to 10 pounds (4.5 kg) of forces constantly to move objects.

Heavy Work Exerting up to 100 pounds (45.4 kg) of force occasionally, and/or up to 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Very Heavy Work Exerting in excess of 100 pounds (45.4 kg) of force occasionally, and/or in excess of 50 pounds (22.7 kg) of force frequently, and/or in excess of 20 pounds (9.1 kg) of force constantly to move objects.

Osteoporosis


Text Only Home | Graphic-Rich Site | Overview | Risk and Causation | Diagnosis | Treatment | Prognosis | Differential Diagnosis | Specialists | Rehabilitation | Comorbid Conditions | Complications | Factors Influencing Duration | Length of Disability | Ability to Work | Failure to Recover | Medical Codes | References

Medical Codes

ICD-9-CM:
733.00 - Osteoporosis, Unspecified
733.01 - Senile Osteoporosis; Postmenopausal Osteoporosis
733.02 - Idiopathic Osteoporosis
733.03 - Disuse Osteoporosis
733.09 - Osteoporosis, Other; Drug-induced Osteoporosis

Related Terms

  • Brittle Bone Disease

Overview

Image Description:
Osteoporosis - Profiles of two female figures, each depicted with a portion of the cervical spine, reveal: 1) normal posture and appropriate spinal alignment; and 2) a markedly hunched posture and curvature of the cervical spine.
Click to see Image

Osteoporosis is a chronic, progressive skeletal disorder in which the architecture of bone deteriorates and bone mass decreases. This results in fragile, weakened bones that fracture easily, even in the absence of trauma. Many factors contribute to the development of osteoporosis.

Bone is living material. The normal, ongoing metabolism of bone involves a delicate balance between bone formation (osteogenesis) and bone resorption (osteolysis). When more bone is resorbed than is formed, the density of the bone decreases. The bone material that remains is biochemically normal, but overall the bone is weakened and more brittle because of decreased bone mass. This increases the risk of fractures.

Peak bone mass in both men and women occurs in their early twenties followed by a period of about 20 years during which rates of bone formation and resorption are approximately equal. Beginning around age forty, there is a gradual net loss of bone. When women enter menopause, bone loss accelerates rapidly for 5 to 7 years, after which loss continues but at a slower rate. Although men also lose bone mass as they age, this loss tends to begin later in life than it does for women.

Most cases of osteoporosis in both men and women are primary (Weppner). There are three distinct types of primary osteoporosis: Type I osteoporosis, Type II (or involutional) osteoporosis, and osteoporosis of unknown cause (idiopathic). Type I osteoporosis occurs in postmenopausal women as a result of estrogen withdrawal effect or in men with testosterone deficiency, and tends to be associated with fractures in the forearm near the wrist (distal forearm) and in the vertebrae (Weppner). Type II osteoporosis is associated with normal aging processes in both men and women older than age 70. It tends to be associated with hip and pelvic fractures (Weppner). Idiopathic osteoporosis can affect children and young adults as well as older individuals. Although usually systemic, osteoporosis may be regional in certain specific circumstances. For example, when there is no weight bearing on a lower extremity for 6 to 12 weeks, “disuse” osteoporosis may occur.

Secondary osteoporosis is caused by an underlying disease process such as endocrine disorders (e.g., diabetes, thyroid problems), kidney disease, certain hereditary disorders, nutritional deficiencies (e.g., calcium, vitamin D), intestinal absorption problems, certain types of inflammatory arthritis, and some blood disorders. Secondary osteoporosis can also be caused by long-term use of some medications (e.g., steroids, chemotherapy, transplant drugs, certain medications to prevent seizures, certain hormonal treatments, lithium, heparin, overuse of aluminum-containing antacids). Other things that can contribute to development of osteoporosis include heavy alcohol consumption, tobacco use, inactivity, and immobilization (disuse). There is also evidence of a genetic component(s) that increases the risk of developing osteoporosis.

Falls, especially among older individuals, are a risk factor for osteoporosis-related fractures. Falls frequently are the result of poor balance, dizziness resulting from a sudden movement or changes in position (orthostatic hypotension), weak leg muscles, effects of sedative medications, poor vision or hearing, and confusion (cognitive impairment) (Jacobs-Kosmin).

Incidence and Prevalence: Osteoporosis is the most common metabolic bone disease (Slovik). About 34 million people in the US have low bone density of the hip, putting them at risk for developing osteoporosis (Jacobs-Kosmin). Another 25 million people in the US already have osteoporosis. The disorder is responsible for approximately 1.5 million fractures annually (Weppner), including approximately 700,000 vertebral fractures, 300,000 hip fractures, and 250,000 wrist fractures (Slovik). Institutional care, mortality, and other costs related to osteoporotic fractures are estimated to exceed $10 billion annually in the US. Approximately 200 million people worldwide or 1 in every 8 men and 1 in every 3 women are affected by osteoporosis (Jacobs-Kosmin).

Source: Medical Disability Advisor



Causation and Known Risk Factors

Age is a major risk factor. After 40 years of age, the risk for osteoporosis increases five-fold for each decade of life (Weppner). Type I osteoporosis generally affects people between 50 and 70 years of age, while Type II osteoporosis generally occurs in people 70 years of age or older. Secondary osteoporosis affects men and women equally and can occur at any age. Osteoporosis is more common in individuals of European and Asian ancestry. Low body weight and low body mass index (BMI) are also known risk factors.

Source: Medical Disability Advisor



Diagnosis

History: A thorough history focusing on known risk factors for osteoporosis is essential and should include underlying medical conditions, medication use (past and current), family history of osteoporosis, maternal history of fractures, reproductive history in women (age of menarche and menopause, contraceptive use, estrogen replacement therapy), diet (especially calcium and vitamin D intake), alcohol and tobacco use, and physical activity level.

Osteoporosis is often not diagnosed until a fracture occurs, although it may be an incidental finding during evaluation for another problem. Fractures may occur after a fall, sudden movement, lifting, jumping, or even minor events such as bumping the rib cage, coughing, or vigorous walking. Individuals may complain of pain in the area of the fracture, a change in body height if the spine is involved, weakness, and stiffness.

Physical exam: If osteoporosis is suspected, the individual should undergo a completed medical examination. Height and body weight are used to calculate the body mass index (BMI). There may be an overall loss of height or change in the ratio of upper body to lower body height. If the vertebrae are involved, there may be midline back pain with an increase in the thoracic curve (kyphosis). Exaggerated upper spine curve or thoracic kyphosis is called "dowager's hump." If there is an acute fracture of the hip or wrist, deformity, pain, tenderness over the fracture, loss of motion, and swelling may be obvious.

Tests: Laboratory tests are done to rule or confirm out other diagnoses and underlying disease processes, as well as to evaluate nutritional status. These tests usually include a complete blood count (CBC), electrolyte levels, calcium, phosphate, and liver function tests. Most blood tests (serum chemistries) involving calcium, as well as bone function studies, are normal in primary osteoporosis. Other more specialized tests may be indicated in the evaluation of secondary osteoporosis or if high bone turnover is suspected. Biochemical markers of bone turnover, measured using blood tests, reflect bone formation or resorption. These tests can be performed before and during treatment to help monitor treatment response but are not helpful in initial diagnosis. In rare cases, where a blood (hematologic) disorder is suspected, a bone marrow biopsy may be ordered.

Plain x-rays may appear normal in early osteoporosis, since 30% to 80% of the bone mineral must be lost before changes are obvious on x-ray (Jacobs-Kosmin). X-rays are used to evaluate possible fractures rather than to diagnose primary or secondary osteoporosis.

A special radiographic study, dual-energy x-ray absorptiometry (DEXA), is used to screen individuals at risk for osteoporosis, confirm the diagnosis of osteoporosis, and follow changes in bone mass over time. DEXA measures the density of the spine, hip, wrist, and total skeleton. DEXA is the most specific radiographic study for osteoporosis and is the best for predicting fracture risk. It uses a relatively low dose of radiation and is quick and non-invasive. Other radiographic methods for assessment of osteoporosis in special situations include quantitative CT scanning, which measures bone density of the spine but results in higher radiation exposure than DEXA; peripheral DEXA, which measures bone density at the wrist and is useful in screening and identifying individuals who are at very low risk for fracture; single-photon absorptiometry; dual-photon absorptiometry; and radiographic absorptiometry. Quantitative ultrasound is a low-cost portable screening method with no radiation exposure, but it lacks the accuracy and precision of other methods.

Source: Medical Disability Advisor



Treatment

Prevention is always the best treatment, and this is especially important for individuals with multiple risk factors for osteoporosis. Preventive measures may include nutritional counseling on diet and the intake of vitamins, particularly calcium and vitamin D; cessation of tobacco and alcohol use; maintenance of fitness and adequate daily weight-bearing exercise (e.g. walking, jogging); and judicious use of medications that affect bone metabolism.

Once the diagnosis of osteoporosis has been made, treatment may include calcium and vitamin D supplementation, use of bisphosphonates or calcitonin, increase in weight-bearing activity, and treatment of any underlying metabolic disease. Nonsteroidal anti-inflammatory medications can be used to treat pain. Hormone (progesterone and estrogen) replacement therapy (HRT) was once considered a first-line treatment for osteoporosis in postmenopausal women. More recent studies have found an association with an increased risk of breast cancer, heart attack (myocardial infarction), stroke (cerebral infarction), and blood clots (embolism). HRT is no longer recommended as a treatment for osteoporosis in postmenopausal women (Jacobs-Kosmin).

Pharmacologic treatments for osteoporosis include bisphosphonates, parathyroid hormone, selective estrogen receptor modulators (SERMs), and calcitonin. Bisphosphonates reduce bone resorption and increase bone mass density, thereby reducing the risk of fracture. In the US, bisphosphonates are approved for the prevention and treatment of osteoporosis in post-menopausal women, osteoporosis in men, and osteoporosis caused by treatment with steroids.

Intermittent injections of parathyroid hormone increase bone formation and therefore bone mass. Possible side effects include increased risk of certain types of bone cancer. This treatment is contraindicated in individuals at high risk for this complication (Jacobs-Kosmin). In the US, parathyroid hormone injection is approved for use in women with postmenopausal osteoporosis and men with primary osteoporosis.

Selective estrogen-receptor modulators (SERMs) may provide the benefits of estrogen without the increased risk of breast and uterine cancer. SERMs are approved in the US for prevention and treatment of postmenopausal osteoporosis but should not be used in women with a history of phlebitis.

Calcitonin therapy can increase bone mineral density and offer some pain-relieving (analgesic) effects in individuals with fractures. It is used in the prevention and treatment of osteoporosis in individuals who cannot take or do not tolerate bisphosphonates or estrogen.

Calcium and vitamin D supplementation are used in prevention and treatment of osteoporosis because many individuals consume inadequate amounts of these in their diets. Both calcium and vitamin D are essential for normal bone formation.

Treatment of fractures that result from osteoporosis may be challenging because the changes in bone metabolism that cause osteoporosis also make healing more difficult. Secondary complications may occur, especially with hip and vertebral fractures. Often with wrist fractures, the bones are not lined up properly by manipulation (reduction) because of the risk of further damage. Compression fractures of the spine may be treated with a corset or supporting brace and limited bed rest. Vertebroplasty involves injection of bone cement into the fractured vertebral body to stabilize it and reduce pain. Sometimes the injection is preceded by inflation of a balloon within the compressed vertebra in an attempt to elevate it back to its normal height. Since falls are the most common cause of osteoporotic fractures, assessment of risk factors, individual and caretaker education, and creation of a safe environment to reduce the chance of falls are imperative.

Source: Medical Disability Advisor



Prognosis

There is no single treatment or cure for osteoporosis, although drug therapies are available that slow bone deterioration and increase bone density. Increased bone density reduces risk of fracture and associated pain. Newer therapies substantially decrease the risk of certain fractures from osteoporosis. Prevention is critical in those individuals who are at high-risk.

Recovery from fractures in individuals with osteoporosis can be slow and fraught with complications, leading to a poor outcome. Osteoporosis leads to approximately 1.5 million fractures per year, 70% of which occur in women (Weppner). Among women who have had a fracture of the hip, about 50% will stay in nursing homes during the recovery period, and 14% of all individuals with hip fractures will still be in a nursing home 1 year or longer after the fracture occurred (Jacobs-Kosmin). Only 33% of all individuals who have sustained an osteoporotic fracture return to their pre-fracture level of activity and function (Jacobs-Kosmin). Twenty percent of women and 30% to 50% of men who have sustained a hip fracture secondary to osteoporosis die within 1 year of the fracture (Moyad).

Source: Medical Disability Advisor



Differential Diagnosis

Source: Medical Disability Advisor



Specialists

  • Emergency Medicine Physician
  • Endocrinologist
  • Family Physician
  • Gynecologist
  • Internal Medicine Physician
  • Nephrologist
  • Orthopedic (Orthopaedic) Surgeon
  • Physiatrist (Physical Medicine and Rehabilitation Specialist)
  • Rheumatologist

Source: Medical Disability Advisor



Rehabilitation

The primary goals of rehabilitation for osteoporosis are to educate the individual about the disease and to initiate an exercise program. The program established will depend on the underlying etiology, degree of bone loss, age and functional status of the individual. A comprehensive exercise program should focus on stretching, strengthening, impact aerobic exercise, and balance activities. It is important among this population to increase function and to prevent further bone loss and fractures (NIH Consensus Development Panel).

It should be noted that most research conducted on osteoporosis has investigated the effects of interventions on women, mainly in the postmenopausal stage. Therefore, care must be taken when applying these findings to other individual populations.

Exercise has been shown to have a positive effect on bone mineral density on both premenopausal and postmenopausal women (Heinonen; Kelley). An even greater benefit of exercise is noted in postmenopausal women when combined with pharmacological intervention (Going). Some exercise can prevent bone loss (de Jong) while other forms of exercise have been shown to increase bone mineral density. While walking has been shown to increase the bone density at the hip, exercises involving greater impact are needed to increase bone density at the spine (Bonaiuti; Wallace). The exercises performed will have an effect only on those bones specifically loaded. To facilitate a regular pattern of safe activity, supervised exercise is recommended in conjunction with a home program. When available, aquatic exercise should be considered. Once established, individuals should be strongly encouraged to continue exercising independently (Heinonen).

Other benefits of a comprehensive regular exercise program include improved quality of life and increased strength and balance, which may affect the rate of falls and related fractures in this population (Forwood).

An ergonomic evaluation may be beneficial to assess the presence of ergonomic risk factors within the workplace and to suggest modifications that ensure optimal employability of the individual.

FREQUENCY OF REHABILITATION VISITS
ClassificationSpecialistTopicVisit
NonsurgicalPhysical TherapistOsteoporosisUp to 25 visits within 10 weeks
The table above represents a range of the usual acceptable number of visits for uncomplicated cases. It provides a framework based on the duration of tissue healing time and standard clinical practice.

Source: Medical Disability Advisor



Comorbid Conditions

Source: Medical Disability Advisor



Complications

Fractures are the most common complication of osteoporosis, with associated problems of pain, immobility, and loss of function. Most individuals with osteoporotic fractures will have additional fractures within the first few years. Risk of death within 1 year is significantly increased after a hip fracture, usually because of functional limitations and complications. Decreased respiratory capacity or decreased gastrointestinal function may result from changes in posture. Progressive loss of height resulting from vertebral fracture leads to kyphosis. Vertebral changes in the lower spine can weaken the abdominal muscles, producing a protuberant abdomen. Fear of ambulation or activity, especially in those who have had a fall and fracture, can complicate the disease treatment and rehabilitation. Some fractures may result in chronic pain, deformity, and functional limitation.

Source: Medical Disability Advisor



Factors Influencing Duration

Site of fracture (e.g., hip, wrist, etc), type and treatment of fracture, underlying medical conditions, and job requirements will affect the disability period. Individuals diagnosed with osteoporosis are not generally disabled. Treatment of fractures and any underlying disease could create a disability period ranging from several days to permanent disability. Poor physical functioning is related to increased number of fractures and delayed recovery. Length of disability is influenced by the time required for the fracture to heal and job demands. Fractures in younger individuals generally heal faster.

Source: Medical Disability Advisor



Ability to Work (Return to Work Considerations)

Work restrictions include precautions to prevent falls, such as no work at heights (ladders, ropes, scaffolds) and removal of throw rugs or other objects in the work environment that could cause an individual to trip. Decreased repetitive bending, twisting, and turning may be important in fall prevention for individuals with postural hypotension. Accommodations should allow for rest periods. Individuals recovering from hip fracture may need crutches, canes, or wheelchairs, and a work space that accommodates such devices. Use of pain medications may necessitate review of company drug policies and safety issues.

Once a diagnosis of significant osteoporosis is made, heavy and very heavy work is usually not feasible. Individuals with severe osteoporosis on imaging should be given prophylactic restrictions based on risk.

Source: Medical Disability Advisor



Failure to Recover

If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case.

Regarding diagnosis:

  • What are individual’s risk factors for osteoporosis?
  • Does individual have signs and symptoms of osteoporosis?
  • Has individual had adequate testing to confirm the diagnosis?
  • Has the role of underlying medical conditions been evaluated?
  • Have conditions such as osteomalacia, metastatic cancer involving the bone, and Paget's disease, and secondary causes such as malignancies, hyperparathyroidism been ruled out?

Regarding treatment:

  • Is the individual receiving appropriate prevention and/or treatment?
  • Were calcium and vitamin D prescribed for the individual?
  • Is individual taking other pharmacologic therapy?
  • Does the individual use any over-the-counter or dietary supplements that may interfere with treatment?
  • Was weight-bearing exercise recommended to the individual?
  • Has individual’s risk for falls been assessed?
  • Has individual received education in prevention of falls?

Regarding prognosis:

  • Did individual make lifestyle changes to reduce risk factors (e.g., stopped tobacco and alcohol use)?
  • Is individual compliant with the treatment program?
  • Does individual take calcium and vitamin D as prescribed?
  • Does individual get enough sunlight (necessary for vitamin D formation)?
  • Does individual exercise as recommended by the physician?
  • Does individual practice proper body mechanics?
  • Has individual received nutritional counseling?
  • Is individual's employer able to accommodate any necessary restrictions?
  • Does individual have any conditions that might delay recovery?
  • Does individual have any complications?

Source: Medical Disability Advisor



References

Cited

Bonaiuti, D., et al. "Exercise for Preventing and Treating Osteoporosis in Postmenopausal Women." Cochrane Database of Systematic Reviews 3 (2002): CD000333. National Center for Biotechnology Information. National Library of Medicine. 1 Oct. 2008 <PMID: 12137611>.

de Jong, Z., et al. "Slowing of Bone Loss in Patients with Rheumatoid Arthritis by Long-Term High-Intensity Exercise: Results of a Randomized, Controlled Trial." Arthritis and Rheumatism 50 4 (2004): 1066-1076. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 15077288>.

Forwood, M. R., and J. A. Larsen. "Exercise Recommendations for Osteoporosis. A Position Statement of the Australian and New Zealand Bone and Mineral Society." Australian Family Physician 29 8 (2000): 761-764. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 10958022>.

Going, S., et al. "Effects of Exercise on Bone Mineral Density in Calcium-Replete Postmenopausal Women with and without Hormone Replacement Therapy." Osteoporosis Int. 14 8 (2003): 637-643. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 12844212>.

Heinonen, A., et al. "Good Maintenance of High-Impact Activity-Induced Bone Gain by Voluntary, Unsupervised Exercises: An 8-Month Follow-Up of a Randomized Controlled Trial." Journal of Bone and Mineral Research 14 1 (1999): 125-128. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 9893074>.

Jacobs-Kosmin, Dana, et al. "Osteoporosis." eMedicine. Eds. Francisco Talavera, et al. 14 Oct. 2008. Medscape. 23 Dec. 2008 <http://emedicine.com/med/topic1693.htm>.

Kelley, G. A., K. S. Kelley, and Z. V. Tran. "Exercise and Lumbar Spine Bone Mineral Density in Postmenopausal Women: A Meta-Analysis of Individual Patient Data." J Gerontol A Biol Sci Med Sci 57 9 (2002): M599-M604. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 12196498>.

Moyad, Mark A. "Preventing Male Osteoporosis: Prevalence, Risks, Diagnosis and Imaging Tests." Urologic Clinics of North America 31 2 (2004): 321-330. National Center for Biotechnology Information. National Library of Medicine. 22 Dec. 2008 <PMID: 15123411>.

NIH Consensus Dev. Panel. "Osteoporosis Prevention, Diagnosis, and Therapy." JAMA 285 286 (2001): 785-795. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 11176917>.

Slovik, David M., and Jonas Sokolof. "Osteoporosis." Essentials of Physical Medicine and Rehabilitation. Eds. Walter R. Frontera, Julie K. Silver, and Thomas Rizzo. 2nd ed. Philadelphia: Saunders, Elsevier, 2008.

Wallace, B. A., and R. G. Cumming. "Systematic Review of Randomized Trials of the Effect of Exercise on Bone Mass in Pre- and Postmenopausal Women." Calcified Tissue International 67 1 (2000): 10-18. National Center for Biotechnology Information. National Library of Medicine. 18 Oct. 2008 <PMID: 10908406>.

Weppner, Dennis M., Ruben Alvero, and . "Osteoporosis." Ferri's Clinical Advisor: Instant Diagnosis and Treatment. Eds. Mary Beth Murphy, et al. 1st ed. Philadelphia: Mosby Elsevier, 2009.

General

"Osteoporosis." MedlinePlus. 10 May. 2008. National Library of Medicine. 23 Dec. 2008 <http://www.nlm.nih.gov/medlineplus/osteoporosis.html>.

"Osteoporosis: Symptoms and Remedies." Johns Hopkins Medicine. 2008. 23 Dec. 2008 <>.

Source: Medical Disability Advisor