Overview
Osteoporosis, or porous bone disease, is characterized by low bone mass and structural deterioration of bone tissue, resulting in reduced bone strength leading to an increased risk of fracture. The common site for osteoporotic fractures is the hip, spine & wrist.
The World Health Organization (WHO) operationally defines osteoporosis as a bone density that falls 2.5 standard deviations (SD) below the mean for healthy adults of the same age & sex.
Epidermilogy
In India, it has been presumed that 35% of postmenopausal women are at the risk of developing osteoporosis.
On average, a post-menopausal woman has a 40% to 50% chance of developing a fracture including a 15% chance of hip fracture in her lifetime.
More than 10% of hip fracture victims die within one year from various complications and nearly 50% of the survivors are incapacitated, some of them permanently.
In women, it is 3 times more common than men as they have low peak bone mass (PBM) and hormonal changes at Menopause.
Causes & Risk Factor
Although the exact cause of osteoporosis is still unknown, the process by which bone becomes porous is well understood.
Early in life, bone is broken down and replaced continuously by the process of bone remodeling.
|
Lifestyle Factors |
|||
| Low Calcium Intake | Alcohol Abuse | High Salt Intake | Vit. D Insufficiency |
| Smoking | Excess Vit. A | Immobilization | Inadequate Physical Activity |
|
Genetic Factors |
|||
| Cystic Fibrosis | Homocystinuria | Osteogenesis Imperfecta | Ehlers-Danlos Syndrome |
| Gaucher’s Disease | Ideopathic Hypercalciuria | Porphyria | Hypophosphatasia |
| Marfan Syndrome | Riley-Day Syndrome | Hemochromatosis | Panhypopituitarism |
|
Hypogonadal States |
|||
| Androgen Insensitivity | Hyperprolactinemia | Athletic Amenorrhea | Anorexia Nervosa |
| Premature Menopause | Panhypopituitarism | Premature Ovarian Failure | Turner’s & Klinefelter’s Syndromes |
|
Endocrine Disorders |
||
| Adrenal insufficiency | Cushing’s Syndrome | Diabetes Mellitus |
| Central Adiposity | Hyperparathyroidism | Thyrotoxicosis |
|
Gastrointestinal Disorders |
||
| Celiac Disease | Gastric Bypass | Primary Biliary Cirrhosis |
| Inflammatory Bowel Disease | Malabsorption | GI Surgery |
|
Hematological Disorders |
||
| Multiple Myeloma | Monoclonal Gammopathies | Sickle Cell Disease |
| Hemophilia | Leukemia & Lymphomas | Thalassemia |
|
Rheumatologic & Autoimmune Diseases |
|
| Ankylosing Spondylitis | Lupus |
| Rheumatoid Arthritis | Other Rheumatologic & Autoimmune Disease |
|
Central Nervous System Disorders |
|
| Epilepsy | Parkinson’s Disease |
| Spinal Cord Injury | Multiple Sclerosis |
|
Miscellaneous Conditions & Diseases |
|||
| HIV/AIDS | Congestive Heart Failure | Posttransplant Bone Disease | Depression |
| Sarcoidosis | Amyloidosis | End Stage Renal Disease | Weight Loss |
| Chronic Metabolic Acidosis | Hypercalciuria | Idiopathic Scoliosis | Muscular Dystrophy |
|
Medications |
|||
| Aluminum (in Antacids) | Glucocorticoids | Tamoxifen | Proton Pump Inhibitors |
| Anticoagulants (heparin) | Aromatase Inhibitors | Lithium | Depo-medroxyprogesterone |
| Anticonvulsants | Barbiturates | Chemotherapeutic Drugs | Methotrexate |
SYMPTOMS
Patients with osteoporosis are asymptomatic until a fracture occurs.
But once your bones have been weakened by osteoporosis, you might have signs and symptoms that include
- Kyphosis with Chronic Pain
- Gradual Onset of Height Loss
- A bone that breaks much easier than expected
- Back pain, caused by a fractured or collapsed vertebra
When to see a doctor?
- Early Menopause
- Prolonged Corticosteroid Therapy
- Either of your parents had hip fractures.
Diagnosis
Bone Density Testing
A bone density test is as close as your doctor can come to predicting your future bone health. The test results will show if you have osteopenia or osteoporosis, and how susceptible your bones are to fracture. A bone density test is the best way to predict fracture risk.
The test uses X-rays to measure how many grams of calcium and other bone minerals are in a square centimeter of bone. Generally, the higher the mineral content, the denser the bone is. And the denser bones are, the less likely they are to fracture.
Bone density testing uses a device called a bone densitometer. Most densitometers measure how much of a low-energy X-ray beam is absorbed as it passes through bone, in comparison to the absorption as the beam passes through the soft tissues next to the bone. The amount of X-ray energy that enters the bone is also compared with the amount of energy that leaves the bone. Denser bone absorbs more of the X-ray beam.
Central Densitometers
These machines, typically found in hospitals and medical centers, are used to measure the density of the central, stabilizing parts of the skeleton, such as the spine and hip. This type of densitometer provides the most accurate bone density testing and can predict your potential risk of fracture.
Dual-energy X-ray absorptiometry (DXA) A DXA machine uses two different X-ray beams to increase the precision of what it’s measuring. As you lie on a padded platform, two mechanical arms containing an X-ray source and detector above and below your body are aligned. DXA is most often performed on the narrow neck of the upper leg bone (femur), just below the hip joint, as well as the lumbar vertebrae, which form the lower part of the spine. DXA testing is painless and takes only a few minutes.
