Medical symptom checker- Back pain cause -Osteoporosis

Osteoporosis

Osteoporosis is defined as reduction in the bone density which is less than 2.5 of standard deviation below the normal peak of the healthy adults. Osteoporosis will leads to fragility of the bone ( bone fragility ) and increase the risk of the fracture of the bone. ( Bone fracture).

There are primary and secondary causes of osteoporosis. The primary cause of osteoporosis is post menopausal or 50 % of cases are idiopathic or remain unknowns.

The primary causes of osteoporosis includes rheumatological causes such as ankylosing spondylitis and rheumatoid arthritis. Other causes includes drugs such as corticosteroid and heparin.Malignancy such as multiple myeloma and metastasis of the cancer may also cause osteoporosis. Endocrinological/hormonal disturbance may also cause osteoporosis such as hypogonadism , Cushing disease, primary hyperparathyroidism and thyrotoxicosis. Gastrointestinal causes such as primary biliary cirrhosis which is associated with liver disease, anorexia and malabsorption syndrome such as coeliac disease and partial gastrectomy may also contributes to osteoporosis.

Osteoporosis are associated with late menarche, early menopause, hypogonadism, lack of exposure to sunlight, alcohol,smoking, lack of exercise and family history as well as age , low BMI and low calcium intake.

In terms of epidemiology, it is common in caucasian than afro caribbean. It contributes to 200 000 cases of fracture annually in the UK mostly hip fracture. It is common in people age more than 50 years old and affect 1/3rd of women and 1/12th of men.

Patient will only complain if fracture develop as most of the case is asymptomatic until fracture of the bone develop. patient who suffer from minimal trauma mostly will suffer from femoral neck fracture, while vertebral fracture is characterized by loss of height, stooped posture and and suffers from acute back pain while lifting heavy material. Patient who fall on the outstretched hand may suffer from fracture of the distal radius or known as Colles' fracture.

On examination patient will not develop any signs until complication arises. One of the complication includes multiple fractures of the vertebral which leads to thoracic kyphosis.The vertebral fracture may also present with tenderness while palpating or during percussion. osteoporotic patient who suffers from femoral neck fracture as a result of minimal trauma may present with shortened leg that is externally rotated.

The pathology behind osteoporosis mainly involves the trabecular bone where there is a reduction in the mineral content and organic matrix of the bone. ( Trabecular bone ).

The investigations require include, blood test, x ray radiography and bone densitometry. The blood test includes calcium ions, phosphate ions and alkaline phosphate level in the blood. The level is usually normal in osteoporosis person unless the osteoporosis is caused by secondary causes.

The next investigation includes x ray radiography to detect any fracture that present if the patient is symptomatic. The radiography report is often normal as abnormality such as thinning of the cortical , radiolucency or abnormal trabeculae only detected on the x ray when more than 30% loss of bone density present. In severe cases, crush fracture and biconcave vertebrae may present. Newest technology such as isotopes bone scan has been implemented that shows micro fracture and stress on the bone.

Bone densitometry is another form of investigation. It is a dual energy x ray absorptiometry and measure the T and Z scores. The T score is a measurement on the standard deviation of the bone mineral density either it is below or above the young normal bone mineral density.It is use to define osteoporosis.

The Z score is the measurement of the standard deviation of the bone mineral density , either it is below or above the age - matched bone mineral density. Z score is used to identify the patient who require a work up or further treatment for the secondary causes of osteoporosis.

The treatment of osteoporosis involves primary prevention and medical treatment. In term of primary prevention, patient requires to avoid any excessive alcohol intake or smoking, take diet which is rich in calcium, exercise regularly ( weight bearing exercise) and hormone replacement therapy. ( Post menopausal women.

The medical treatment includes bisphosphonates such as alendronate or pyrophosphate analogues that decrease the bone turnover by producing an inhibitory effect on the osteoclast after adsorbing onto the surface of the bone.

Other medication includes nasal calcitonin which may produce side effects such as flushing and nausea and more than 1g/day of calcium supplement. Testosterone replacement and vitamin D supplements are also required. Hypogonadal men mainly requires testosterone replacement.If the patient is a female with family history of breast cancer and unwilling and unable to take estrogen raloxifene is recommended. Raloxifene is a selective estrogen receptor modulators. PTH is a new form of medication which stimulates bone formation.It is different from other medication to treat osteoporosis which are anti resorptive.

The complication includes loss of independence, pain and disability with fracture. Around 20% of cases of hip fracture will leads to long term residential care.

With treatments we can slow or stop the further loss of bone density .





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