With advancing age, the skeleton bone starts maturing with slow rate of bone loss beginning as early as 30 years of age in both men & women. However, genetic factor plays important role in the regulation of bone mass & in the pathogenesis of osteoporosis.
Osteoporosis is the result of a disequilibrium between bone formation & bone reabsorption. Low bone mass & microarchitectural deterioration of bone tissue consequently increases bone fragility & susceptibility to fracture.
Osteoporosis is only a major risk factor for fracture, but it is not the only factor. Other factors attributing to fractures may be due to alcoholism, intake of sedative drugs, cognitive impairment, lower extremity disability, parkinsonism, dementia, blindness, vertigo.
In the early course of disease, there are no symptoms. Later stages may be manifested with loss of height, back pain,& factures. There is noticeable decrease of height with inclination of top half of the body forward & downward, referred as stoop. Reduced space between the ribs & pelvic brim causes the abdomen to protrude.
Back pain is a very common feature of osteoporosis associated with fracture,particularly vertebral fracture.Acute vertebral fracture usually presents with sudden onset severe pain felt diffusely in the back.It can be very painful followed with shock, pallor, & vomiting. This condition limits the activities,& the pain is aggravated with slightest movements, such as, coughing, sneezing, & straining. It requires short- term use of opiate analgesics, & bed rest for few days to ameliorate the pain,& induce early mobilization of the patient.
Chronic vertebral fracture are diagnosed for patients with multiple vertebral deformities with complaint of chronic back pain. Related symptoms accompany such as,loss of spinal mobility, breathlessness with reduced lung capacity,reflux esophagitis with compression of abdomen, fullness with eating, constipation, & stress incontinence. It has to be managed with long -term use of analgesics, physiotherapy, heat, ultrasound, & massage.
Most hip fractures ( > 90 % ) occur as a result of fall, & also about 50% of spine fractures are related to fall. Fall frequency increases with age.
Factors that accelerates the process of osteoporosis are; acquired inefficiences of calcium balance,including decreased intake of calcium & vitamin D, decreased solar exposure, impaired renal activation of vitamin D, & intestinal resistance to active vitamin D metabolities.
Older individuals frequently have subclinical vitaminD deficiency, & or secondary hyperparathyroidism, which may drive osteoclastic bone resorption & bone loss.
In females,during menopause oestrogen deficiency increases the rate of bone turnover, & the imbalance between resorption & formation widens. Bone loss accelerates to about 2% per year ( measured by absorptimetric techniques).
Radiological techniques, such as, bone densitometry, quantitative ultrasound, & radiographic assessment of vertebral fracture status represent essential diagnostic techniques for the assessment of osteoporosis. The introduction of DXA ( Dual energy x-ray based absorptiometry ) in daily clinical practice is a major advance in the case-finding of patients at high risk for osteoporosis,that predicts the value of bone density. Bio-chemical investigation may help to identity causes of osteoporosis, such as, testosterone levels in men, & thyroid function tests.