Osteoporosis

Definition

Osteoporosis is the most common metabolic bone disease. The term osteoporosis is used to describe a group of bone disorders in which the absolute bone mass is less than normal. Normally, age related loss of bone mass occurs gradually. Decreased bone density due to accelerated bone loss is seen in osteoporosis. Bone mass at any age is determined by the amount of bone achieved at maturity and subsequent rate of bone loss. The condition is more frequently seen in women after menopause when the hormone levels are drastically affected. However, it can occur in both ages and sometimes earlier in life.

Symptoms

There are relatively no symptoms in patients with osteoporosis until they start developing repeated fractures even with the slightest injury. Common sites of fracture are the humerus, hip, wrists and ribs. The most common symptoms are back pain and deformity of the spine (kyphosis). Loss of height may be present. Lower back pain is due to collapse of vertebral bodies. The pain is typically acute in onset which usually occurs after sudden minor bending or jumping or after lifting something which normally would not cause pain. Some patients may only have symptomatic vertebral fractures. Generalized bone tenderness is present in associated osteomalacia.

Causes

Primary osteoporosis

Primary osteoporosis is bone mass loss in a person with no other abnormality.

  • Age related.
  • Postmenopausal.
  • Idiopathic (unknown)

Secondary osteoporosis

Secondary osteoporosis is bone mass loss that is linked to some other underlying condition.

  • Genetic.
  • Nutritional.
  • Endocrine.
  • Medication like steroids, heparin or anticonvulsant drugs use.
  • Other metabolic bone diseases.
  • Regional osteoporosis due to immobilization, posttraumatic (reflex sympathetic dystrophy).

Some of the risk factors associated with development of age-related osteoporosis are diminished amount of bone at maturity, poor skeletal development, calcium malabsorption, impaired metabolism of vitamin D, immobilization, corticosteroid therapy, lack of physical exercise, long term use of anticonvulsant therapy and excessive consumption of alcohol and tobacco.

Treatment

Prevention and early treatment of osteoporosis is the best approach to prevent the complications associated with the condition.

Calcium supplements or 1 to 1.5 gram per day along with phosphorus and vitamin D supplementation are advisable to prevent further deterioration and maintain the bone mass. An appropriate weight bearing exercise program needs to be implemented. Alcohol and tobacco are to be avoided. Periodic assessment of skeletal status is done with bone density scans.

In postmenopausal women, hormone therapy with estrogen and anabolic steroids combined with calcium supplementation and small doses of vitamin D are given. Physical activity is to be maintained. Pelvic and breast examination is done periodically to check for evidence of carcinoma. Estrogen therapy is avoided in patients with blood clotting disorders or history of ischemic heart disease.

Juvenile osteoporosis which usually occurs in children between the ages of 8 and 14 is rare and is usually self limiting. In idiopathic adult osteoporosis which is present in young man or a premenopausal woman, malabsorption of calcium is frequently present and improvement is seen upon treatment with calcium and vitamin D.

Steroid-induced osteoporosis is due to secondary hyperparathyroidism and treatment consists of withdrawal of steroids and vitamin D and calcium supplementation.

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