In osteoporosis, a metabolic bone disorder, the rate of bone resorption accelerates, and the rate of bone formation decelerates. The result is decreased bone, mass. Bones affected by this disease lose calcium phosphate and become porous, brittle, and abnormally vulnerable to fracture. Osteoporosis may be primary or secondary to an underlying disease.
Primary osteoporosis can be classified as idiopathic, type I, or type II. Idiopathic osteoporosis affects children and adults. Type I (or postmenopausal) osteoporosis usually affects women ages 51 to 75. Related to the loss of estrogen's protective effect on bone , type I osteoporosis results in trabecular bone loss and some cortical bone loss. Vertebral and wrist fractures are common. Type II (or senile) osteoporosis occurs most commonly between ages 70 and 85. Trabecular and cortical bone loss and consequent fractures of the proximal humerus, proximal tibia, femoral neck, and pelvis characterize type II osteoporosis.
The condition occurs because from around the age of 35 more bone cells are lost than replaced. This causes the bone density to decrease.
The first sign is commonly when a minor bump or fall causes a bone fracture. These may result in pain, disability, loss of independence, and death. Osteoporosis may cause people to 'shrink' as they get older. It causes the characteristic 'dowager's hump'.
Signs and Symptoms
In the early stages of bone loss, you usually have no pain or symptoms. But once bones have been weakened by osteoporosis, you may have signs and symptoms that include:
Differential diagnosis must exclude other causes of rarefying bone disease, especially those that affect the spine, such as metastatic carcinoma and advanced multiple myeloma.
X-ray studies show characteristic degeneration in the lower thoracolumbar vertebrae. The vertebral bodies may appear flatter and denser than usual. Loss of bone mineral appears in later disease.
Dual or single photon absorptiometry allows measurement of bone mass, which helps to assess the extremities, hips and spine
Serum calcium, phosphorus, and alkaline phosphatase levels remain within normal limits.
Parathyroid hormone levels may be elevated.
Bone biopsy shows thin, porous, but otherwise normal-looking bone.
Computed tomography scanning allows accurate assessment of spinal bone loss.
Bone scans that use a radionuclide agent display injured or diseased areas as darker portions.
To control bone loss, prevent additional fractures, and control pain, treatment is focused on a physical therapy program of gentle exercise and activity, and drug therapy to slow disease progress. Other treatment measures include supportive devices and, possibly, surgery.
Estrogen may be prescribed within 3 years after menopause to decrease the rate of bone resorption. Sodium fluoride may be given to stimulate bone formation. Calcium and vitamin D supplements may help to support normal bone metabolism. Calcitonin may be used to reduce bone resorption and slow the decline in bone mass.
Weakened vertebrae should be supported, usually with a back brace. Surgery (open reduction and internal fixation) can be used to correct pathologic fractures of the femur. Colles' fracture requires reduction and immobilization (with a cast) for 4 to 10 weeks.
You can help yourself by taking general measures such as the following:
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