OSTEOPOROSIS

 

OSTEOPOROSIS

 

 Osteon is bone and porosis is hole in Greek.

 Osteoporosis is a “ Systemic skeletal  disorder “ characterized by “ Low bone mass “ , microarchitectural deterioration of  bone tissue leading to bone fragility , and consequent increase in fracture risk .

 It leads to abnormally porous bone that is compressible , like a sponge.

 The spine , hips and wrists are common areas of bone fractures from osteoporosis.

 

Prevalence :-

 Osteoporosis is the most prevalent bone disease in the world.

 According to the International Osteoporosis Foundation, 1 in 3 women over 50 will experienced osteoporotic fractures, as will 1 in 5 men .

 Female to male ratio 1 : 6 .

 

Types of osteoporosis :-

2 types :-

a) Primary osteoporosis

I. Type-1 : Postmenopausal osteoporosis

II. Type-2 : Age – associated osteoporosis

b) Secondary osteoporosis

Loss of bone is caused by an identifiable agent or disease process such as inflammatory disorder , bone marrow cellularity disorder and corticosteroid use.

 

Clinical signs and symptoms :-

 Fractures caused by osteoporosis are often painful. Osteoporosis is often called the ‘Silent disease’ or ‘Silent thief’ as many people don’t recognize they have it until a fracture occurs.

 Back pain: Episodic, acute , low thoracic/high lumbar pain

 Compression fracture of the spine

 Bone fractures

 Decrease in height

 Kyphosis

 Dowager’s hump

 Decreased activity tolerance

 Early satiety

 

Causes :-

 Hereditary , congenital :-

·         Osteogenesis imperfecta

·         Neurologic disturbances

·         Gonadal dysgenesis

 

 Acquired ( Primary & secondary )

 Generalized :

Primary

Idiopathic

Postmenopausal

Age related

 

Secondary

Nutrition

Sedentary lifestyle ,

immobility , smoking

Gastrointestinal diseases

Malignancy

Drugs

Endocrine disorder

 

 Localized

 Inflammatory arthritis

 Fractures and immobilization in cast

 

Risk factors :-

[ National Osteoporosis Foundation Physician guidelines for risk factors for osteoporotic fracture. ]

 Current cigarette smoking

 Low body weight (<127 pounds)

 Alcoholism

 Estrogen deficiency

 Prolonged amenorrhea (>1 year)

 Early menopause (<45 year) or bilateral ovariectomy

 Lifelong low calcium intake

 Recurrent falls

 Poor health / fragility

 Inadequate physical activity

 Family history of osteoporosis

 

Physical examination :-

Osteoporosis

• Height loss

• Body weight

• Kyphosis

• Humped back

• Tooth loss

• Skinfold thickness

• Grip strength

 

Vertebral fracture

• Arm span-height difference

• Wall- occiput distance

• Rib-pelvis distance

 

No single maneuver is sufficient to rule in or rule out osteoporosis or vertebral fracture without

further testing.

 

Diagnosis :-

 Bone Mineral Density (BMD) test :-

 The most common test.

 Results are reported using T-scores.

 T-scores are relative to how much higher or lower your bone density is compared to that of a

healthy adult.

 T-score :- It is the number of standard deviation (SD) above or below a reference value.

 

Category T-score

Normal -1.0 or Above

Osteopenia(Low bone mass) -1.0 to -2.5

Osteoporosis -2.5 or Less

Severe osteoporosis -2.5 or Less with one or more fragility fracture

 

 

Laboratory Tests :-

• Blood Calcium levels

• 24-hour urine calcium measurement

• Thyroid function tests

• Parathyroid hormone levels

• Testosterone levels in men

• 25-hydroxyvitamin D test to determine whether the body has enough vitamin D

• Biochemical marker tests

 

Pharmacological option in osteoporosis :-

Antiresorption :-

 Act on osteoclasts and stabilize bone

 Calcium

 Estrogen

 Calcitonin

 Bisphosphonates

 Selective estrogen receptor modulators

 Thiazide diuretics

Formation :-

 Act on osteoblasts and increase bone formation

 Vitamin D

 Anabolic steroids

 Parathyroid hormone

 Growth factors (investigation)

 Fluoride (investigation)