This is a discussion of Osteoporosis regarding its definition, aetiology, types, pathogenesis, risk factors, clinical picture (symptoms and signs), diagnostic investigations, methods of prevention and treatment approach .
• Unlike osteomalacia, the defect in osteoporosis is that the bone that is present is normally mineralized but is deficient in quantity, quality and structural integrity.
• In males there is a gradual decline but females show an accelerated loss in the 10 years following the menopause.
• Osteoporosis occurs as the end result of many years mismatch between the rate of bone resorption and bone formation .
• Decreased Ca intake, reduced activity, smoking, alcohol, AI antacid, excessive caffeine, corticosteroids therapy and genetic factors.
• Type II : -Senile osteoporosis.
• Secondery osteoporosis: 2ry to the following disorders :
- Cushing's syndrome. . - Hyperthyroidism.
- Acromegally, D.M. - Rheumotoid disease.
- Chronic renal failure - Chronic liver disease.
- Rheumatoid arthritis. - Immobilization.
- Drugs e.g corticosteroids.
• Bony aches, back pain, Pathological fractures
• Loss of height due to thoracic kyphosis and collapsed vertebrae.
- The most common sites of pathological fractures are the forearm (colles fracture), spine (vertebral fracture) and femur (hip fracture).
What is meant by Osteoporosis ?
• It is defined as a decrease in the absolute amount of bone mass leading to enhanced bone fragility with increased risk of pathological fractures.• Unlike osteomalacia, the defect in osteoporosis is that the bone that is present is normally mineralized but is deficient in quantity, quality and structural integrity.
How Osteoporosis develops ? Pathogenesis
• Bone mass increases rapidly up to the age of puberty and rises slightly more in the twenties and thirties and then begins to decline around age of 40 years.• In males there is a gradual decline but females show an accelerated loss in the 10 years following the menopause.
• Osteoporosis occurs as the end result of many years mismatch between the rate of bone resorption and bone formation .
Risk factors
• Female, Family history, early menopause.• Decreased Ca intake, reduced activity, smoking, alcohol, AI antacid, excessive caffeine, corticosteroids therapy and genetic factors.
Causes and types of osteoporosis
• TypeI : -Post menopausal osteoporosis.• Type II : -Senile osteoporosis.
• Secondery osteoporosis: 2ry to the following disorders :
- Cushing's syndrome. . - Hyperthyroidism.
- Acromegally, D.M. - Rheumotoid disease.
- Chronic renal failure - Chronic liver disease.
- Rheumatoid arthritis. - Immobilization.
- Drugs e.g corticosteroids.
How to diagnose Osteoporosis ?
Clinical picture of Osteoporosis• Bony aches, back pain, Pathological fractures
• Loss of height due to thoracic kyphosis and collapsed vertebrae.
- The most common sites of pathological fractures are the forearm (colles fracture), spine (vertebral fracture) and femur (hip fracture).
Investigations to diagnose osteoporosis
• Plasma chemistry is normal (normal serum ca, P and alkaline P).
• Alkaline phosphatase may be increased following a recent fracture.
• X ray : Decreased bone density (rarefaction or osteopenia).
• DEXA scan to measure bone density by dual-energy x ray absorption scanning (DEXA), it may show osteopenia (low bone mass), osteoporosis or severe osteoporosis.
• Investigations of the cause e.g serum creatinine, blood urea, thyroid function tests, cortisol level.
How to prevent osteoporosis
Prevention of osteoporosis
• Exercise.
• Calcium supplements 1000-1500 mg/day, also diary products are recommended e.g Milk, cheese and Yogurt.
• Restriction of caffeine intake.
• Stop smoking and alcohol intake.
• Estrogen replacement therapy in early menopause.
Treatment of Osteoporosis
• Bisphosphonates, they are osteoclast antagonist e.g Alendronate 10 mg/day (osteomax or fosamax) orally at morning, it can be given 70 mg one dose/week. Bisphosphonates should be used with caution in
patient with renal impairment.
Alendronate causes oesophageal ulceration , So to minimize that side effect, The patient may take the tablets on an empty stomach before breakfast (poorly absorbed) with a full glass of water and remains upright for 30 minutes .
• Calcitonin 100 I.U every' other day by S.C or IM injection. It can be given by nasal spray 200u/day.
• Calcium 1000- 1500 mg/d orally.
• Vitamin 0 400-800 IU/d orally, altacalcidol (vit 0 analogue) can be used.
• Estrogen therapy.