Osteoporosis
Diffuse reduction in the amount of bone (osteopenia) with the
residual bone of normal composition.
Major health problem of the elderly
Relative increase in the rate of destruction
Etiology
- Primary
- Decreased estrogen Type I osteoporosis
- More common in women
- Postmenopausal period
- Most marked in trabecular bone resulting in vertebral
fractures
- Age related loss of bone >75 type II osteoporosis
- Dietary calcium is marginal with decreased efficiency of
absorption in elderly
- Caucasian
- Secondary
- Thyrotoxicosis
- Glucocorticoids
- Immobilization
- Heparin
- Multiple myeloma
- GI disorders with impaired bioavailabilty of calcium
Clinical manifestations
- Asymptomatic
- Telescoping with loss of height
- Fractures of vertebra, hip, pelvis, humerus
- Kyphosis
Diagnosis
- Radiological changes: Osteoporosis cannot be reliably detected in plain radiographs until 30% to 40% of the
bone mass is lost.
- washed out radioluscent
- preferential loss of horizontal trabeculae
- fine vertical striations
- intervertbral disc expand biconcave
- schmorl's nodules
- compression fractures
- anterior wedging
- Serum calcium, phosphorous and alkaline phosphatase are
normal
- Bone density measurements (densitometry) are the most sensitive and specific tests for osteopenia and predict the risk of fracture.
- Dual-energy x-ray absorptiometry measures with high precision the bone density of the lumbar spine and proximal femur. The most important measure is the number of standard deviations of bone density from young adult values.
- Quantitative computed tomography
Treatment
- Established disease
- Treat etiology
- Relief of pain
- Estrogen in women with added progestin to reduce danger of
endometrial cancer
- Calcium 1-1.5 gram with vit D
- Dininsh osteoclastic activity
- Calcitonin
- Bispohosphonates: Alendronate: 50% reduction in vertebral and hip fractures
- Prevention
- Exercise
- Estrogen
- Dietary calcium