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30.3B: Aging and the Skeleton

In osteoporosis, bone mineral density (BMD) is reduced and the integrity of bone proteins is altered, increasing the risk of fracture.

 

LEARNING OBJECTIVES

 

Construct a diagnosis and treatment plan for osteoporosis

 

KEY TAKEAWAYS

Key Points

 

  • The risk of osteoporosis can be reduced with lifestyle changes and sometimes medication, both aimed at restoring the amounts and types of necessary bone-associated proteins.
  • Osteoporosis itself has no symptoms; its main consequence is the increased risk of bone fractures.
  • Treatments for osteoporosis include changes in diet and exercise, increased consumption of calcium and vitamin D, and prescriptions for bisphosphonates.

 

Key Terms

 

  • bisphosphonates: A class of drugs that prevents the loss of bone mass, used to treat osteoporosis and similar diseases. They are the most commonly prescribed drugs used to treat osteoporosis.
  • bone mineral density: Abbreviated BMD, the amount of mineral matter per square centimeter of bone. BMD is used in medicine as an indirect indicator of osteoporosis and fracture risk.
  • osteoporosis: A disease in which the bones become extremely porous and are subject to fracture most common in post-menopausal women.

Osteoporosis is a bone disease that leads to an increased risk of fracture. In osteoporosis, the bone mineral density (BMD) is reduced, bone microarchitecture deteriorates, and the amount and variety of proteins in bone is altered.

Types of Osteoporosis

 

(a) Osteoporotic Fractures and (b) Woman with Osteoporosis: Image shows compression fractures of the lumbar spine. Hyperkyphosis, colloquially called a “dowager’s hump,” refers to an anteriorly concave curvature of the thoracic region of the spine.

The disease may be classified as primary type one, primary type two, or secondary. The form of osteoporosis most common in women after menopause is referred to as primary type one or postmenopausal osteoporosis.

Primary type two osteoporosis or senile osteoporosis occurs after age 75 and is seen in both females and males at a ratio of two to one. Finally, secondary osteoporosis may arise at any age and affect men and women equally. This form of osteoporosis results from chronic illness or prolonged use of medications such as glucocorticoids. Osteoporosis affects 55% of Americans aged 50 and above. Of these, approximately 80% are women.

Symptoms

Osteoporosis itself has no symptoms; its main consequence is the increased risk of fractures caused by weakened bones. Osteoporotic fractures, called fragility fractures, occur in situations where healthy people would not normally break a bone. These often affect the vertebral column, rib, hip, and wrist. The underlying mechanism in all cases of osteoporosis is an imbalance between bone resorption and bone formation.

Physical deformation can occur secondary to compromised bone densities. One example is hyperkyphosis, colloquially called a “dowager’s hump,” which refers to an anteriorly concave curvature of the thoracic region of the spine.

Treatment

Osteoporosis risks can be reduced with lifestyle changes and sometimes medication. Lifestyle changes include diet, exercise, and fall prevention. Exercises to tone deambulatory muscles and improve proprioception are recommended to decrease risk for falls. In addition, the anabolic effect of exercise can sometimes prevent progression of osteoporosis. Medication includes calcium, vitamin D, and bisphosphonates.

 

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