Osteoporosis overview: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
The pathophysiology of [[osteoporosis]] involves an imbalance between bone resorption and bone formation | The pathophysiology of [[osteoporosis]] basically involves an imbalance between bone resorption and bone formation. Major factors that contribute to the development of [[osteoporosis]] include: estrogen deficit, and aging. The main pathway, through which these factors might lead to osteoporosis is [[Reactive oxygen species|reactive oxygen species (ROS)]] damage to [[osteocytes]]. Decreasing the capability of [[autophagy]] in [[osteocytes]] is another important issue; which make them vulnerable to [[oxidative]] stresses. | ||
==Causes== | ==Causes== | ||
Revision as of 22:10, 1 August 2017
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Osteoporosis Microchapters |
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Diagnosis |
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Treatment |
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Medical Therapy |
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Case Studies |
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Osteoporosis overview On the Web |
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American Roentgen Ray Society Images of Osteoporosis overview |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2], Raviteja Guddeti, M.B.B.S.[3]
Overview
Osteoporosis is a bone disease, characterized by lowered bone mineral density; leads to increased risk of fracture. The pathology is negative balance between old bone resorption and new bone formation. Aging, female gender, thin and small stature, Asian or Caucasian races, alcoholism, hypogonadism, and steroid abuse are among the primary risk factors associated with osteoporosis. It can be prevented with lifestyle modification, or calcium and vitamin D supplementation. Preventing falls in people with known or suspected osteoporosis is an established way to prevent fractures. Bisphosphonates, calcium, and vitamin D supplementation form the main stay of treatment.
Historical Perspective
Bone with holes, osteoporosis, is seen in over 4000 years old Egyptian mummies; showed the revealing sign of osteoporosis called "Dowager's Hump". Jean Lobstein, a French pathologist of 1830's, found that there are normal holes in every bones; but some people bones from specific age and diseases may have larger holes than normal ones. He eventually named theses kinds of bones as porous; thus the disease became osteoporosis.
Classification
There are many classification systems for osteoporosis disease. The most reliable two classification systems are based on the disease origin and severity. Based on origin, the disease classified to primary and secondary osteoporosis. There are three different severity for bone mass loss, include; osteopenia, osteoporosis, and severe osteoporosis.
Pathophysiology
The pathophysiology of osteoporosis basically involves an imbalance between bone resorption and bone formation. Major factors that contribute to the development of osteoporosis include: estrogen deficit, and aging. The main pathway, through which these factors might lead to osteoporosis is reactive oxygen species (ROS) damage to osteocytes. Decreasing the capability of autophagy in osteocytes is another important issue; which make them vulnerable to oxidative stresses.
Causes
Osteoporosis is caused by imbalance between bone resorption and bone formation. The most common causes of osteoporosis includeaging, chronic renal failure, nutritional deficiency of calcium and / or vitamin D, immobility, hyperparathyroidism, menopause, and chronic glucocorticoid abuse.
Differentiating Osteoporosis from other Diseases
Osteoporosis must be distinguished from idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria and hypermetabolic resorptive osteoporosis which can also present with similar features.
Epidemiology and Demographics
Osteoporosis is a major health problem affecting 44 million people in the United States. The disease is most common in females over the age of 50.
Risk Factors
Risk factors for osteoporosis include both non-modifiable risk factors, such as advanced age, female gender, and causcasian or asian race, and modifiable risk factors such as alcohol use, steroid use, smoking, poor diet and lack of exercise.
Natural History, Complications and Prognosis
Osteoporosis can be complicated by the development of fractures. The prognosis is good. Mortality from the disease depends on the type of fracture. The major type of fractures contributing to mortality in these patients are vertebral fractures and hip fractures.
Diagnosis
Symptoms
Osteoporosis itself has no symptoms, until a fracture due to brittle bones has already occurred. The disease state causes increased fragility of the bones and thus making them more prone to fractures. The precursor disease to osteoporosis is osteopenia, which is poor mineralization of the bone, which can only be diagnosed through medical tests.
Physical Examination
Osteoporosis is associated with the presence of fractures on physical examination.
Laboratory Findings
Laboratory tests for the diagnosis of osteoporosis include some baseline tests including a complete blood count (CBC), serum calcium, serum phosphate, alkaline phosphatase, and 25(OH) vitamin D, as well as tests for diagnosing secondary osteoporosis, which include 24 hr serum calcium, serum protein electrophoresis, and bone marrow biopsy.
Electrocardiogram
Chest X Ray
CT
MRI
Echocardiography or Ultrasound
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical therapy
Drugs, especially bisphosphonates are the main medications in the treatment of osteoporosis. However, lifestyle changes are also emphasized. No treatment can completely reverse established osteoporosis. Medical management can only halt the progression of the disease process.
Surgery
Surgical therapy is employed for fractures caused by osteoporosis. Vertebroplasty and kyphoplasty are used to treat patients with vertebral compression fractures. For fractures of the hip open reduction and internal fixation is done.