Osteopenia and osteoporosis are two disorders caracterized by bone density loss.
Osteoporosis remains asymptomatic until skeletal fragility is announced with a fracture. The clinical evidence of osteoporosis depends on which bones are involved. Thoracic and lumbar vertebral fractures are extremely common and produce loss of height and various deformities; including kyphoscoliosis that can compromise respiratory functions . Pulmonary embolism and pneumonia are common complications of fracture of the femoral neck, pelvis or spine. They cause as many as 50,000 deaths annually.
Bisphosphonates for the prevention and treatment of osteoporosis BMJ 2015 Osteoporosis: now and the future Lancet 2011 52 yo F with Scleroderma, Raynauds, B12 deficiency is seen for chronic back pain. [imreference.com]
An 83-year-old woman accompanied by her 56-year-old daughter presents to the office with severe upper back pain over the past 2 days. [accessmedicine.mhmedical.com]
The following conditions and comorbidities are associated with loss of bone mineral density: - Back pain - Hypertension - Diabetes - Osteoarthritis - RA - COPD - CKD - Asthma - Hyperlipidaemia - Hyperthyroidism - Cushing's syndrome - Pituitary disease [globenewswire.com]
Once bones have weakened, signs or symptoms that may occur include back pain, loss of height that sometimes leading to the characteristic “dowager’s hump” and fractures. Osteoporosis can affect both men and women, with women being more affected. [lmh.org]
When osteopenia does cause symptoms, there may be localized bone pain and weakness in an area of breakage of bone (bone fracture). Interestingly, sometimes even bone fracture can occur without causing pain. [emedicinehealth.com]
Muscle aches & Cramps, Bone pain and Fractures: muscle and bone pain are an indicator of inadequate vitamin D, which is important in bone formation. [livinglovecommunity.com]
Th1 disease Any of the chronic inflammatory diseases caused by bacterial pathogens. can cause bone pain and quite a few of our members have reported bone pain as a Herx symptom. [mpkb.org]
Another huge advantage is that these patients often have bone pain and joint pain ... which will be relieved almost immediately after a successful parathyroid operation in about 90-95% of patients. Most claim their bone pain is completely gone. [parathyroid.com]
Review Topic QID: 3199 ML 3 Select Answer to see Preferred Response PREFERRED RESPONSE 4 (OBQ12.169) A 72-year-old woman presents with severe hip pain after stepping off of a curb. She denies any trauma or prior history of hip pain. [orthobullets.com]
It will also affect knees, hips (pain will be in the groin of the leg and inner aspect of the thigh, not on the side or buttock.) and spine. It can affect your neck and, to a lesser degree, the shoulders. [sonoranspine.com]
The hip pain begins spontaneously, without an antecedent history of trauma or infection. The pain usually progresses over the next few weeks, often becoming severe enough to produce a limp. [rad.washington.edu]
Decrease in Height
[…] in height of 2-3 cm after each vertebral compression fracture and progressive kyphosis Patients with hip fractures may demonstrate the following: Limited ROM with end-range pain on a FABER (flexion in abduction and external rotation) hip joint test Decreased [emedicine.medscape.com]
Paravertebral Muscle Spasm
muscle spasms exacerbated by activity and decreased by lying supine Patients often remain motionless in bed because of fear of causing an exacerbation of pain Acute pain usually resolves after 4-6 weeks; in the setting of multiple fractures with severe [emedicine.medscape.com]
The following investigations are required for the diagnosis of osteoporosis.
- Serum alkaline phosphatase: Serum alkaline phosphatase is usually normal but may be elevated especially after fracture.
- Serum calcium and phosphate: The serum levels of calcium and phosphate are normal.
- Serum parathyroid hormone: Serum parathyroid hormones are normal.
- X-rays: X-rays show decreased bone mineral density and may reveal one or more fractures (if present). Demineralization is most apparent in the spine and pelvis as well as the femoral head and neck. Compression of the vertebrae may also be seen.
- Bone densiometry: Bone densiometry is used to determine the density of the spine and hip bones. A score of -2.5 or less is diagnostic of osteoporosis.
The treatment plan in osteoporotic diseases is aimed at the prevention of bony fractures and improving lifestyle .
There are various options to treat osteoporotic conditions that are given below:
- Pharmacologic therapy: This approach includes administration of adequate calcium, vitamin D and anti-osteoporotic medication such as bisphosphonates, parathyroid hormone (PTH) and estrogen .
- Vertebroplasty and kyphoplasty: These are surgical procedures used for the management of vertebral compression fractures .
- Dietary measures: Patients with osteoporosis should take daily doses of 1200-1500mg of calcium and 400-800 IU of vitamin D. Premenopausal women and men younger than 50 years of age (without risk) should receive a total of 1000mg of calcium daily. Postmenopausal women and men older than 50 years of age (with risk of osteoporosis) should receive 1200mg of calcium daily in their diet .
- Exercise: Aerobic exercises such as walking and bicycling are highly recommended to maintain upright spinal posture include. Certain exercise training programs have positive impact in enhancing strength and maintaining balance of body .
The following factors contribute to osteopenia in both men and women:
- Various nutritional and metabolic disorders that do not allow the body to use sufficient vitamins and minerals can contribute to osteopenia.
- Chemotherapy and drugs such as steroids can also result in osteopenia.
- Exposure to radiation can also lead to osteopenia.
The endogenous risk factors include:
- Female gender
- Advanced age
- Asian race
- Small stature
- Thin physique
- Family history
- Early menopause
The exogenous risk factors include:
The incidence of osteoporotic lesions is 50% in women and 30% in men. In the United States, more than 10 million persons over age 50 are affected by osteoporosis and approximately 33.6 million people have osteopenia. The annual direct health care cost for osteoporotic lesions is $12 billion to $18 billion.
Bones naturally become thinner as people grow older. All people usually begin losing bone mass after the age of 30. In case of osteopenia, usually in middle age, existing bone cells are reabsorbed by the body faster than new bone is made. As this occurs, the bones lose minerals, becoming weaker with increased risk of fractures.
In osteoporosis, there is an increased bone resorption and reduced bone formation that results in reduced bone mineral density (BMD). In women after menopause, there is rapid reduction in bone mineral density as estrogen production is reduced. Estrogen affects indirectly cytokines and other growth factors in body. Estrogen deficiency thus leads to increased expression of RANKL that results to the recruitment of pro-osteoclasts as well as osteoclasts . In contrast, aging is associated with a decreased supply of osteoblasts in proportion to demand.
Calcium and Vitamin D deficiency on other hand, play an essential role in causing osteoporotic conditions. Reduced calcium levels lead to secondary hyperparathyroidism. Parathyroid hormone in turn increases calcium resorption from bones, making them brittle and porous. Other conditions that lead to bone loss include endocrinal disorders and drugs like glucocorticoids. Corticosteroids inhibit osteoblast function and enhance osteoblast apoptosis.
Osteopenia and osteoporosis are the most common metabolic bone disorders affecting over 200 million people worldwide .
Osteopenia refers to the condition in which the bone mineral density (BMD) is lower than the normal peak level.
Osteoporosis is a skeletal disorder characterized by bone mineral density even lower than that in osteopenia that results in the destruction and fracture of bones. Osteoporosis can be primary or secondary.
- Primary (Idiopathic) osteoporosis: This includes postmenopausal type I and senile osteoporosis type II. The former is due to estrogen deficiency in the body whereas the latter results from advanced age and calcium deficiency.
- Secondary osteoporosis: This may be due to some endocrine diseases, nutritional deficiencies, drugs or metabolic defects in body .
Osteopenia and osteoporosis are conditions in which the bones become thin and weak. The chances of fractures therefore, become significantly higher. The disease is more common in older age group and postmenopausal women. Usually there are no symptoms and the disease is detected after a fracture. With proper treatment, diet and lifestyle changes, the disease has a good prognosis.
- Cooper C, Campion G, Melton LJ, 3rd. Hip fractures in the elderly: a world-wide projection. Osteoporosis international : a journal established as result of cooperation between the European Foundation for Osteoporosis and the National Osteoporosis Foundation of the USA. Nov 1992;2(6):285-289.
- Ahmed SF, Elmantaser M. Secondary osteoporosis. Endocrine development. 2009;16:170-190.
- Bono CM, Einhorn TA. Overview of osteoporosis: pathophysiology and determinants of bone strength. European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society. Oct 2003;12 Suppl 2:S90-96.
- Lynn SG, Sinaki M, Westerlind KC. Balance characteristics of persons with osteoporosis. Archives of physical medicine and rehabilitation. Mar 1997;78(3):273-277.
- Kanis JA, McCloskey EV, Johansson H, Oden A, Melton LJ, 3rd, Khaltaev N. A reference standard for the description of osteoporosis. Bone. Mar 2008;42(3):467-475.
- Compston J, Bowring C, Cooper A, et al. Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas. Aug 2013;75(4):392-396.
- Kelman A, Lane NE. The management of secondary osteoporosis. Best practice & research. Clinical rheumatology. Dec 2005;19(6):1021-1037.
- Percutaneous vertebroplasty or kyphoplasty for vertebral fractures caused by osteoporosis. Technology Evaluation Center Assessment Program. Executive summary. Apr 2010;24(7):1-5.
- Sandhu SK, Hampson G. The pathogenesis, diagnosis, investigation and management of osteoporosis. Journal of clinical pathology. Dec 2011;64(12):1042-1050.
- Sinaki M. Exercise for patients with osteoporosis: management of vertebral compression fractures and trunk strengthening for fall prevention. PM & R : the journal of injury, function, and rehabilitation. Nov 2012;4(11):882-888.