Osteoporosis

Brittle Bone Disease, Porous Bones

What is Osteoporosis?

Osteoporosis or porous bones, result from a change in the normal and ongoing metabolic process of bone reabsorption and formation. When more bone substance is reabsorbed than rebuilt, the density or amount of the bone decreases. The bone material that remains is biochemically normal, but overall the bone is weakened by lack of bone mass. Osteoporosis is the most common metabolic bone disease and leads to approximately 1. 3 million fractures per year. It affects women of all ages, most severely those over age 60, and predominately those who are petite, thin, fair-skinned Caucasian or Asian. Men and woman can both be affected by metabolic changes as they age, leading to age-related osteoporosis. It should be noted that younger woman are now recognized as having decreased bone density and should be included in preventive treatment programs.

The common causes are decrease in estrogen production, alcohol and cigarette use, poor nutrition, inactivity and immobilization (disuse) or over activity, long term use of glucosteroids in the treatment of another disease such as asthma or rheumatoid arthritis. There is evidence that a genetic link increases the risk of osteoporosis as well. Diseases of the thyroid gland and intestine that affect absorption of calcium and vitamins can contribute to the disease.

Osteoporosis may be regional, such as in the hands, or it may be more generalized throughout the body. It may be primary from an unknown cause or secondary, related to an underlying disease process.

How is it diagnosed?

Osteoporosis signs and symptoms

Early symptoms:

  • Backache.
  • No symptoms (often).

Late symptoms:

  • Sudden back pain with a cracking sound indicating fracture.
  • Deformed spinal column with humps.
  • Loss of height.
  • Fractures occurring with minor injury, especially of the hip or arm.

History: Most commonly, the disease is not discovered until a fracture occurs or it is an incidental finding while undergoing evaluation for another problem. Individuals present with pain, a change in body height if the spine is involved, weakness and stiffness. Individuals should be questioned about a family history of osteoporosis, underlying metabolic disease, history of steroid use, alcohol and cigarette use, and nutritional status.

Physical exam: If the vertebrae are involved, midline back pain with an increase in the thoracic curve (kyphosis) are noted. There may be a loss of height or change in the ratio of upper body to lower body height. If there is an acute fracture of the hip or wrist, deformity, pain, decreased motion and swelling will be obvious.

Tests: Laboratory tests are done to rule out other disease processes, as the studies are normal in primary osteoporosis. X-rays are used to evaluate possible fractures. Special radiographic studies to measure bone density are ordered when the episode of the fracture has resolved, or in screening examinations. The most specific is DEXA, a method able to measure the density of the spine, hip, wrist, and total skeleton. The dose of radiation is low and the examination does not require much time.

How is it treated?

In individuals who are known to have many risk factors, prevention is seen as the key treatment. This would include an evaluation for use of estrogen supplement, nutritional guidance with possible supplements, maintaining a proper balance between activity and over activity, which could negatively affect estrogen production and avoiding medications that are known to affect bone metabolism.

Once the diagnosis has been made, treatment may include estrogen supplements, nutritional supplements, increase in weight-bearing activity, treatment of any underlying metabolic disease, and nonsteroidal anti-inflammatory medications for pain control. A new treatment for osteoporosis in post- menopausal women is a drug that alters the bone resorption rate.

Treatment of fractures that result from osteoporosis may be difficult because of altered bone healing and from secondary complications, especially with hip fractures. Wrist fractures are often not manipulated because of the risk of further damage. Compression fractures of the spine are treated with a corset or supporting brace and limited bedrest.

Individual education should include decreasing risk factors and creating a safe environment to reduce the chance of falls.

Medications

Fosamax (Alendronate), Zocor (Simvastatin), Evista (Raloxifene), Premarin (Conjugated Estrogens), Actonel (Residronate), Boniva (Ibandronate)

Activity

Stay active, but avoid the risk of falls. Exercise, especially weight-bearing exercise, such as walking or running, to maintain bone strength.

Diet

Eat a normal, well-balanced diet high in protein, calcium and vitamin D or a reducing diet if you are overweight.

What might complicate it?

Decreased respiratory capacity from changes in posture, fear of ambulation or activity, complications from surgery, and side effects of medications could complicate the disease and treatment. Underlying metabolic disorders require management to prevent increased osteoporosis. Treatment of metastatic disease with radiation could increase osteoporosis, as would immobilization in the treatment of fractures.

Predicted outcome

There is no single treatment and cure for osteoporosis although new drug therapies are now available that may slow the process and increase bone density. Increased bone density reduces the occurrence of pain and risk of fracture, which would be a good outcome. Prevention is critical in those individuals who are at high risk. Recovery from fractures in individuals with osteoporosis can be slow and fraught with complications, leading to a poor outcome. The outcome of individuals with secondary osteoporosis depends on management of the underlying cause.

Alternatives

Osteomalacia, and Paget's disease can mimic primary osteoporosis. Secondary causes to be ruled out are malignancies, hyperparathyroidism, malabsorption syndromes, poor nutrition and immobilization.

Appropriate specialists

Psychiatrist or psychologist.

Last updated 6 August 2011


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