OSTEOPOROSIS. Prepared By Dr. MOHSEN A. GHAFFAR Consultant Orthopaedic Surgery Al Jedaani Group Of Hospitals. Bone Composition. Inorganic Matter : Mineral forms approximately 70% of bone mass . About 95% of mineral phase is calcium hydroxyapatite , the
Dr. MOHSEN A. GHAFFAR
Consultant Orthopaedic Surgery
Al Jedaani Group Of Hospitals
Mineral forms approximately 70% of bone mass .
About 95% of mineral phase is calcium hydroxyapatite, the
remaining 5% bone apatite impurities containing carbonate
in high concentration and small amount of magnesium,sod-
ium, potasium, strontium , flouride and chloride .
This forms 30% of bone mass .
It is formed of water(5-8%) and organic matrix .
Organic matrix is formed of collagen and non-collagenous proteins (98%) and bone cells (2%) .
Control of bone metabolism .
nutrition of bone and ion exchange between
bone and blood .
and resposible for bone remodeling .
Two distinct processes are responsible for the architecture of bone , modeling and remodeling .
Deficiency in both organic and inorganic elements of bone , this happens when the rate of bone resorption exceeds rate of bone formation.
Deficiency in the inorganic element only ,i.e defective
mineralization , i.e abnormal bone tissue .
Osteopenia is a normal feature of ageing, so within certain limits it is a physiological process . Beyond these limits the condition is pathological and progress to osteoporosis or osteomalacia .
- Type-1(Postmenopausal): It occursin women after menopause . Estrogen deficiency plays a primary
role It is associated with vertebral crush and distal radius fractures .
- Type-2(Senile): occurs in men and women over
the age of 70, female to male ratio 2: 1
Cushing syndrome ,thyrotoxicosis , hyperparathyroidism , hypogonadism , diabetes mellitus .
Glucocorticoids,thyroxine,heparin, diuretics,cytotoxic drugs
Fracture immobilisation, bed rest , sedentary life , paralysis
Malabsorption, chronic liver disease ,organ transplantation
Sickle cell anaemia , thalassemia
Leukaemia , multiple myeloma
Osteogenesisimperfecta , homocystinuria
Osteoporosis is a silent and progressive disorder .
It is discovered only accidentally during routine check
up or after X-Ray in cases of trauma .
Components of diagnosis are:
- Complaint : pain diffuse or localized with or without trauma
- Associated Symptoms :malaise,loss of weight or height,hot
flushes,neck swelling, palpitation ,epigastric pain ,disturbed
bowel habits,renalpain,dysuria,jointpain,psychiatric upsets
- Menstrual History: amenorrhoea (menopause , pregnancy , lactation )
-Medications : glucocorticoids, thyroxine , anti-coagulant , anti-metabolites, antiacids , contraceptives
- Dietary History: daily intake of milk, protein, indigestion.
- Life style, sedentary life, smoking, alcohol .
- Family History .
- Radiolucency : is increased in the center of vertebral body
- Trabecular pattern is changed :Thin and sparse trabeculae some trabeculae are lost , porosity and thinning of the cortex
- Shape is changed (Deformity): Wedge , Biconcavity or Compression
Trabecular pattern is altered ,thin cortex, pathological
Diffuse thinning of the cortex, subperiosteal erosions , radiolucent areas or striations
- To diagnose current osteoporosis
- To establish future fracture risk
- To monitor effect of treatment
- Single photon absorptiometrySPA
- Dual photon absorptiometryDPA
- Dual X-ray absorptiometryDXA
- Quantitative computed tomography QCT
- Quantitative ultrasound measurement QUS
No specific biochemical profile for primary osteoporosis . The diagnostic importance of laboratory tests is to explore causes of secondary osteoporosis .
- Parathyroid function test
- Vitamin D metabolites
- Adrenal function tests
- Tests for malabsorbtion
- Biochemical markers of bone turnover
- Evaluation of the rate of bone turnover in case of unusual
forms of osteoporosis(young adult, idopathic osteoporosis)
- To exclude other forms of bone disease ,if the diagnosis is
- Static histomorphometry
- Dynamic histomorphometry