Definition:

Osteoporosis is a disease of the bones characterized by a decrease in bone mass and structural deterioration of bone tissue, leading to bone fragility and increased susceptibility to fractures (HealthScout).

Understanding bone:

 

To understand osteoporosis you must understand bone. Bones are living tissue and are constantly being replaced by removal of old tissue and replaced with new tissue. This process is known as the, bone remodeling cycle. This occurs when small amounts of bone are lost or broken down by cells known as osteoclasts. After this small amount of bone is lost, or resorbed, a resorption pit is formed on the bone. Another type of cell, or osteoblast, moves in and replaces it with new bone. (Lane).  The body creates more bone than it loses until about the age of 30. After this, bone strength remain stable until about 50 years of age for women(when they reach menopause) and 70 years of age for men. This is when we begin to lose more bone than our bodies make.

Bone remodeling                                         

Risk Factors:

Gender: Women are at much higher risk, but men are also at risk
Age: 50+ for women and 70+ for men
Race: White and Asian women are at highest risk.
Inadequate Calcium Intake:
Insufficient Vitamin D:
Sedentary Lifestyle: Physical activity is essential for bone remodeling.
Heredity: A women whose mother has osteoporosis is more likely to have the condition.
Smoking:
Alcoholism:
Estrogen Deficiency :In women
Drop in Testosterone:  In men

Most Common Fractures:

Compression Fractures of the Spine:
 A person with osteoporosis is extremely susceptible to fractures of the spine due to the size and delicate structure of the vertebrae.  These fractures can occur by simply doing everyday activities like bending down to pick something up, sneezing or twisting. 

               Types of spine fractures:
               Crush fracture: The entire vertebrae collapses.  This kind of fracture causes loss of height.
               Wedge fracture: The front part of the vertebra is crushed but the back of the bone remains
                                           intact.  These fractures create the dowager's hump and bent-over posture
                                           characteristic of osteoporosis.
               Biconcave fracture: The midsection of the vertebra collapses.  This is often the first stage a
                                           fracture that later becomes a wedge or a crush (Nelson).

These changes are not due to the normal changes of aging.  They are due to the affects of osteoporosis.  Posture and height are affected as the dreaded symptoms of osteoporosis occur. This stooped-over posture is called kyphosis or dowager's hump.


Hip Fracture:
The most severe osteoporotic fracture is the hip fracture.  Most hip fractures result from a fall with a direct impact on the hip, causing a fracture of the femoral neck.  The diagnosis is confirmed by x-ray.

Despite good surgery, about one-third of the women do not regain their former independence, and two-thirds require nursing home care.  Only about one-quarter of women who fracture their hip regain their former mobility and over half need assistance with walking and everyday activities.  The surgery itself and other medical problems can lead to complications.  Elderly women who fracture their hip have a nearly threefold risk of dying in the first year after the fracture as women of the same age without a fracture (Lane).  Men account for one third  of the annual incidence of hip fractures: one third of these men do not survive longer than 1 year (e-radiography).
Wrist Fractures:
The wrist fracture is the other common osteoporotic fracture.  If you area female over age 45, you have a 15 percent chance of fracturing your wrist eventually.  The distal radius is the site where most wrist fractures occur.  This type of fracture is called Colles' fracture (Nelson). 

Consequences of a wrist fractures are substantial.  About 20% of patients with a wrist fracture may be hospitalized.  Potential complication of wrist fractures include secondary arthritis, chronic pain, limitation of motion, and physical deformity (e-radiography).

Symptoms:

Osteoporosis is often called the "silent disease", because bone loss occurs without symptoms.  People may not know that they have osteoporosis until their bones become so weak that a sudden strain, bump, or fall causes a bone to fracture or a vertebra to collapse (healthscout).  Back pain  is by far the most common symptom of collapse vertebral bodies (compression fractures).  Symptoms of osteoporosis usually indicate advanced stages of the disease. Kyphosis may be the first sign or symptom that osteoporosis is present.  Along with kyphosis people usually notice a loss of their overall height.  Abdominal protrusion, which occurs as a consequence of kyphosis is an unrecognized aspect of this disease.

Radiographic Appearance:

Regardless of the cause, the radiographic appearance is somewhat similar in all conditions producing osteoporosis.  Loss of mineral salts causes osteoporotic bone to become more lucent than normal.  This may be difficult to detect, because about 50% to 70% of the bone density must be lost before it can be demonstrated as a lucent area on routine radiographs.  The most striking change is cortical thinning, with irregularity and resorption of the endosteal (inner) surfaces.  As the bone density decreases, the cortex appears as a relatively dense and prominent thin line producing a picture frame pattern.  It is essential to use the lowest practical KVp.  This technique provides extremely short scale of contrast necessary to visualize the demineralized osteoprotic bones.

Prevention:

The prevention of osteoporosis is a lifetime process.  Most bone mass is developed before the age of 30.  Thereafter, the challenge is to retain the bone mass one has. Osteoporosis may not be due to bone loss alone if a person never reached peak bone density during childhood and adolescence. Thus, if by the time a person is 20 years of age, the bones have not reached their life's highest density, and as one ages with normal daily bone loss, osteoporosis can occur even without accelerated bone loss (cancersupport).  The consumption of calcium and vitamin D-rich diets and physical activity such as weight-bearing exercise are important.  If necessary, calcium supplements should be considered (HealthScout).

Treatment:

The preferred treatment for osteoporosis in women is estrogen replacement therapy(ERT) to help stop bone loss, increases bone density and cut the risk of fracture roughly in half (Healthscout).  Dietary supplements of calcium and vitamin D help reduce development of the disease process and medications aid in treating osteoporosis .  In severe cases. vertebroplasty (kyphoplasty) is done to prevent vertebral collapse.

MRI of the L-spine showing a compression fracture of T-1. 

Images of a vertebroplasty (kyphoplasty).

Interview

Statistics and Facts:
Osteoporosis affects over 10 million people in the United States each year. Another 34 million are at risk due to loss of bone mass.

A 50-year old women has a 40% chance of developing hip, vertebral or wrist fractures during her lifetime.

1 in 4 women who have a new vertebral fracture will fracture again within one year.

Fractures from osteoporosis are more commom than heart attack, stroke and breast cancer combined.

Osteoporotic hip fractures consume more hospital bed days than stroke, diabetes, or heart attack.  (Melton)



 

Work Cited

Eisenberg, Ronald L., and Nancy M. Johnson. "Skeletal System." Comprehensive Radiographic Pathology. St. Louis, MO: Mosby / Elsevier, 2007. 116-18. Print.

Harris, MD, Diagnostic Radiologist, James. "Kyphoplasty." Telephone interview. 05 Aug. 2012.

"Health Encyclopedia - Diseases and Conditions." HealthScout. N.p., n.d. Web. 06 June 20012. www.healthscout.com.

Lane, Nancy E. The Osteoporosis Book. New York: Oxford University, 1999. 9-10. Print.

Melton LJ III, Chrischillis EA, Cooper C, Lane AW, Riggs BL. Perspective: how many women have osteoporosis? J Bone Miner Res 1992; 7:1005-10.

Nelson, Miriam E., and Sarah Wernick. Strong Women, Strong Bones: Everything You Need to Know to Prevent, Treat, and Beat Osteoporosis. New York, NY: G.P. Putnam's Sons, 2000. 36. Print.

"Osteoporosis." Osteoporosis. N.p., n.d. Web. 05 Aug. 2012. <http://www.sciencephoto.com/media/260341/view>.

"Osteoporosis Symptoms." Osteoporosis Symptoms. N.p., n.d. Web. 05 Aug.2012.http://www.elderlyelder.com/osteoporosis-symptoms.html>.

"Osteoporosis." Osteoporosis. N.p., n.d. Web. 0 July 2012. http://www.e-radiography.net/ radpath/o/osteoporosis.htm.

Kolb, MD, Felix O., and Ernest H. Rosenbaum, MD. "Osteoporosis - Diagnosis and Consequences." Osteoporosis - Diagnosis and Consequences. N.p., n.d. Web. 14 June 2012.<http://cancersupportivecare.com/osteodiagnosis>.