Osteoporosis

WHAT IS OSTEOPOROSIS?

Osteoporosis is a disease of bone in which bone mineral density (BMD) is reduced and bone microarchitecture is disrupted.

While treatment modalities are becoming available, prevention is still the most important way to reduce fracture. Due to its hormonal component, more women suffer from osteoporosis than men.

OSTEOPOROSIS SYMPTOMS

Osteoporotic fractures are those that occur under slight amount of stresses that would not normally lead to fractures in nonosteoporotic people. Typical fractures occur in the vertebral column, hip and wrist.

Collapse of vertebrae ("compression fracture") leads to chronic pain, characteristic bent stature, and decreased pulmonary function (ability to breathe) while the fractures of the long bones acutely impair mobility and may require surgery. Hip fracture, in particular, carries a poor prognosis.

While osteoporosis may occur in men, the problem is overwhelmingly prevalent in postmenopausal women.

RISK FASTORS

Risk factors for osteoporotic fracture can be split between modifiable and non-modifiable:

Nonmodifiable:

• history of fracture as an adult

• family history of fracture

• female sex advanced age

• European ancestry

• dementia

  Potentially modifiable:

• prolonged intake of the prescription drug prednisone

• tobacco smoking

• intake of soft drinks (containing phosphoric acid)

• low body weight <58 kg (127 lb)

• estrogen deficiency

• early menopause (<45 years) or bilateral oophorectomy

• prolonged premenstrual amenorrhea (>1 year)

• low calcium and vitamin D intake

• alcoholism

• impaired eyesight despite adequate correction

• recurrent falls

• inadequate physical activity (i.e. too little but also far too excessive)

• high risk of falls, poor health/frailty.

OSTEOPOROSIS DIAGNOSIS

Dual energy X-ray absorptiometry (DEXA) is considered the gold standard for diagnosis of osteoporosis. Diagnosis is made when the bone mineral density is greater than 2.5 standard deviations below that of a young adult reference population.

In order to differentiate between "primary" (post-menopausal, regardless of age, or senile - related to age) and "secondary" osteoporosis, blood tests and X-rays are usually done to rule out cancer with metastasis to the bone, multiple myeloma, Cushing's disease and other causes mentioned above.

CAUSE OF OSTEOPOROSIS

Estrogen deficiency following menopause causes a rapid reduction in BMD (Bone Mass Density).

Other hormone deficiency states can lead to osteoporosis, such as testosterone deficiency.

Glucocorticoid or thyroxine excess states also lead to osteoporosis.

Lastly, calcium and/or vitamin D deficiency from malnutrition increases the risk of osteoporosis.

List of disorders associated with osteoporosis:

• Hypogonadal states - Turner syndrome, Klinefelter syndrome, anorexia nervosa, hypothalamic amenorrhea, hyperprolactinemia.

• Endocrine disorders - Cushing's syndrome, hyperparathyroidism, thyrotoxicosis, insulin-dependent diabetes mellitus, acromegaly, adrenal insufficiency

• Nutritional and gastrointestinal disorders - malnutrition, parenteral nutrition, malabsorption syndromes, gastrectomy, severe liver disease (especially biliary cirrhosis), pernicious anemia.

• Rheumatologic disorders - rheumatoid arthritis, ankylosing spondylitis

• Hematologic disorders/malignancy - multiple myeloma, lymphoma and leukemia, mastocytosis, hemophilia, thalassemia.

• Inherited disorders - osteogenesis imperfecta, Marfan syndrome, hemochromatosis, hypophosphatasia, glycogen storage diseases, homocystinuria, Ehlers-Danlos syndrome, porphyria, Menkes' syndrome, epidermolysis bullosa.

• Iatrogenic osteoporosis, caused by the therapeutic use of glucocorticoids.

• Other disorders - immobilization, chronic obstructive pulmonary disease, pregnancy and lactation, scoliosis, multiple sclerosis, sarcoidosis, amyloidosis

  
  

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