Osteoporosis, Bone Metabolic Disease

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Osteoporosis, bone metabolic disease

Osteoporosis is considered the most frequent bone metabolic disease. Among its main characteristics, it stands out for a decrease in bone mass and an alteration of bone quality, which is in patients who suffer from greater fragility of the skeleton and, consequently, the risk of fractures. Operatively, this pathology was defined as "a bone mineral density less than 2.5 standard deviations of the bone mass peak in young individuals".

In this process of loss of bone mass, the trabeculae suffer a thinning or disappearance and the cortical thinning and increases from porosity.

The cause of quality modification is not so well known and encompasses two assumptions: alterations in bone and structural tissue that attend the decrease in bone mass and the decrease in connection between trabeculae.

These alterations, the decrease in bone mass and bone quality modifications are asymptomatic. Osteoporosis only presents manifestations when fractures are triggered.

Epidemiology

The probability of suffering an osteoporotic fracture is greater in European women than in men. As for the location, in women the most frequent is the forearm fracture, followed by the vertebral and this one of the hip.

According to the World Health Organization (WHO) it is necessary.

The aging of the population implies a greater proportion of exposed people, together with the decrease in physical activity, the increase in height and changes in environmental factors, they anticipate that in the next decades the number of fractures due to osteoporosis.

Etymology

Osteoporosis is a multifactorial pathology, being numerous genetic and environmental factors that favor its progress. In most cases, the number of factors involved and the contribution of each of them small is high. To a lesser extent, the number of factors is minimal or even unique, but influences more intensity.

The most frequent presentation of presentation is postmenopausal osteoporosis. However, men also suffer from this disease since, there are different pathological processes, pharmaceutical products and surgical interventions that contribute to their development.

Classification

Osteoporosis is classified as primary or secondary depending on the responsible cause of bone deficit.

Among primary osteoporosis they are understood:

• The most frequent, postmenopausal osteoporosis.
• The one related to age.
• Gestational and youth idiopathic.

As secondary osteoporosis they are recognized to those that are consequence of certain factors such as: sequel of drugs, associated situations or pathologies:

• By hypogonadism. Since any gonadal deficit is a bone loss.
• The resulting primary hyperparathyroidism.
• Hyperthyroidism.
• Cushing’s disease. This is related to a decrease in bone mass with the rise of fracture risk.

Manifestations

Osteoporosis has no symptoms unless the fracture appears. The most frequent fractures are: those of the hip, those of the wrist, and above all, those of the vertebrae, which give rise to various manifestations:

• Back pain. Located in the injured backbone, of variable intensity.
• Skeletal alterations. It is characteristic, that these patients have augmented dorsal kyphosis (widow hump), due to the minting of the body of the vertebrae of this region. These vertebral deformities also suppose a decrease in body size and an approximation of iliac ridges and the last ribs.

Complementary explorations

The medical history together with the physical examination of the patient are the procedures that must be performed before any diagnostic technique.

1. Anamnesis. You can indicate the risk of osteoporosis. A loss in the height of more than 10cm is almost always an indicator of fractures of the vertebral bodies in correspondence with osteoporosis.
2. Physical exploration. Only in cases where osteoporosis is in an advanced state and there are vertebral subsidence. Physical examination involves findings of the disease.

Complementary explorations such as:

• Lab tests. They allow to detect secondary causes or associated disorders.
• Radiology of the spine. They are usually performed in the dorsal and lumbar zone in lateral projection.
• Bone densitometry. It is usually applied frequently in: lumbar column and in the proximal part of the femur, less common can be done on the radius or in the entire body.
• Bone scintigraphy. Useful to diagnose fractures difficult to recognize by radiography and to perform differential diagnosis.

Prevention

It is necessary to establish preventive strategies that from early stages allow the results of osteoporosis to reduce.

At this stage, the objectives should be:

• Improve skeletal progress and maximize bone mass peak.
• Avoid the known causes of secondary osteoporosis.
• Maintain the integrity of the skeleton.
• Prevent fractures.

Treatment

• The treatment of choice consists in the indication of general measures and in pharmacological treatment, both are applied in patients with a high risk of fracture.
• As general measures, a healthy lifestyle is recommended (calcium in the diet, exposure to sunlight, fall prevention measures, physical activity, tobacco and alcohol abandonment).
• Regarding the pharmacological treatment that is administered, two types of mechanisms are distinguished, on the one hand, the “osteoforming” drugs that increase bone formation and on the other, “antirresortive” drugs that inhibit resorption.