Osteoporosis

Osteoporosis
Bone erosion
Characterized by:
Decreased function of osteoblast
Increase function of osteoclast
Resulting a decreased total amount of bone
The bone is thin and porous but well-calcified
Increased fragility or brittleness, consequently
incrreased sussceptibility to fracture

Etiology
Genetic
Osteogenesis imperfecta
Endocrine disturbance
Postmenopausal state
Senile
Disuse

Risk Factor
Male 1 : 8, Female 1 : 4
Amenorrhea, postmenopausal or artificial
Insufficient calcium intake
Eating disorder
Smoking
Excessive use of alcohol or caffein
Inadequate physical exercise
Endocrine Osteoporosis
Imbalance of anabolic and antianabolic
Antianabolic hormones: hyperparathyroidism,
hyperpituitarism, hyperthyroidism, and
hyperadrenocorticism (adrenal cortical activity
or plolonged cortisone theraphy)


Disuse Osteoporosis
Intermitten pressure of weightbearing and
tension of the muscle exert stresses and
strains to bone stimulate bone deposition by
osteoblastic activity
Decreased bone mass and increased bone
resorption disuse atrophy
Prolonged immobilization, paralysis
localized disuse
Postmenopausal and senile
Hypogonadism
Decreased calcium intake
Decreased activity disuse osteoporosis
Pathology
Trabecular or cancellous bone has much larger
surface than cortical bone like metaphysis of
long bone and vertebral bodies bone becomes
thin and sparse.
Bone become fragile and brittle
Metaphysis of long bones: neck of femur or
humerus, distal end of radius
Vertebral bodies become biconcave as the
intevertebral disc become biconveks (baloon
shape)kyphosis and loss of total height
Clinical Diagnosis
Back pain intermitten and chronic
Loss of both standing and sitting height
Disturbance of respiratory
Dorsal kyphosis Dowagers Hump

Radiology
Ro: generalized rarefaction of all bones,
deformity particularly in vertebrae
DEXA (Dual Energy X-ray Absorptiometry)
Diagnosis
Response to theraphy
Increased fracture risk
Lab Finding
Calcium serum, phosphorous and alkaline
phospatase is normal but reveal negative
calcium balance
Treatment
Main purpose prevention of further bone loss.
Estrogen HRT, prevent post menopausal osteoporosis
Calcium, prevention and theraphy
Calcitonin, inhibit osteoclast
Biphosphonate, inhibit osteoclast and increased bone
mass density
Vit D
Sodium Fluoride
Regular Exercise
Close Fitting Brace, back pain