Osteoperosis

Osteoporosis

Disease of bone which leads to increased risk of fracture.This occurs due to reduced bone density. Osteoporosis occurs when the body fails to form enough new bone, when too much old bone is reabsorbed by the body, or both.Calcium and phosphate are two minerals that are essential for normal bone formation.

If trabecular bone is mostly affected crush fractures of vertebrae are common. If cortical bone is mostly affected, fracture of long bone is more likely.eg:femoral neck.

Osteoporosis is a big cause of death and orthopedic death expense in older women

Prevalence

· 35% of over 50 years

· Female : Male = 4 : 1

Osteoporosis is defined by the World Health Organization (WHO) as a bone mineral density that is 2.5 standard deviations or more below the mean peak bone mass (average of young, healthy adults) as measured by DXA; the term "established osteoporosis" includes the presence of a fragility fracture. The disease may be classified as primary type 1, primary type 2, or secondary.

Symptoms

There are no detectable symptoms in the early stages of disease.

At the late stages of the disease these symptoms are evident.

• Bone pain or tenderness
• Fractures with little or no trauma
• Loss of height (as much as 6 inches) over time
• Low back pain due to fractures of the spinal bones
• Neck pain due to fractures of the spinal bones
• Stooped posture or kyphosis, also called a "dowager's hump"

Signs and tests

Bone mineral density testing (specifically a densitometry or DEXA scan) measures how much bone you have. Your health care provider uses this test to predict your risk for bone fractures in the future. For information about when testing should be done.

A special type of spine CT that can show loss of bone mineral density, quantitative computed tomography (QCT), may be used in rare cases.

In severe cases, a spine or hip x-ray may show fracture or collapse of the spinal bones. However, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis.

You may need other blood and urine tests if your osteoporosis is thought to be due to a medical condition, rather than simply the usual bone loss seen with older age.

Bone mass depends on

• Peak bone mass

• Rate of bone loss

Risk factors for Osteoperosis

• female sex

• increasing age

• early menopause

• Caucasians & Asian

• lack of exercise

• immobility

• smoking

• family history

• excessive alcohol

• Nutrition

• Corticosteroids

• cytotoxic drugs

• Cyclosporine

• Heparin

Diseases which cause Osteoporosis

· Endocrine Cushing’s syndrome .

· Hyperparathyroidism

· Hypogonadism

· Acromegaly

· Type I Diabetes Mellitus

· Joint diseases

· Rheumatoid arthritis

· Coeliac disease

· Anorexia nervosa

· Clinical features

Fractures

· vertebral crust fractures

· pain

· increasing Kyphosis

· loss of height

· abdominal protuberance

· Colles’ fracture

· fracture neck of the femur

Investigations

• X-rays- Osteopenia

Fractures

· Bone density scan

· Investigations to exclude other diseases

· Biochemistry

Treatment

Aims of treatment

· Control pain from the disease

· Reduce the bone loss

· Prevent bone fractures with the medicines

· Minimize the risk of falls

Prevention > Treatment

Prevention

• diet

• exercise

• cessation of smoking

• reduce falls

• avoid drugs

Treatment

• Diet-atleast 1200 miligrams per day of calcium and 800-10 internatonal units of vitamin D3

• Drugs: Bisphosphonates,Caalcitonin

• Calcium

• Vit D

• Hormone Replacement Therapy:Androgen

• Parathyroid hormone

• Raloxifene

• Exercise-weight bearing exercises,resistance exercises,balance exercises,riding a stationary bicycle,using a rowing machine

• Stop unhealthy habits ex:Smoking

• Prevent falls

• monitoring

• related surgeries

Osteomalacia

• Inadequate mineralization of bone matrix (osteoid)

Causes

• Vit D deficiency

inadequate synthesis

low dietary intake

malabsorption(coeliac disease,intestinal ressection,chronic cholestasis)

· Renal diseases

· chronic renal failure

· renal osteodystrophy

· dialysis

· Renal tubular acidosis

Clinical Features

• Bone and muscle pain.

• Tenderness

• (fractures-rare)

• Proximal myopathy-waddling gait

Investigations

• Serum alkaline phosphatase

• plasma calcium normal or low

• reduce serum phosphate

• increase PTH

• X ray - reduce mineralization

• looser’s zones (pseudo fractures)