Osteoporosis ( Bone Weakness)

What is osteoporosis?
What are the symptoms of osteoporosis?
What causes osteoporosis?
        Causes of Osteoporosis in Females
How is osteoporosis diagnosed?
How to diagnose the cause of osteoporosis
How is osteoporosis treated and prevented?
About the Doctor In charge
Our Address (Delhi Centre & Noida Centre)
How to Consult Us (at our centre or Online)

What is osteoporosis?

Osteoporosis is called when the bone becomes weak due to decrease in the amount of mineral & bony material in a particular bone. Thus bone becomes porous from inside & it has less calcium & other minerals, less strength & thus more prone to fracture & deformity.Thus osteoporotic bones are weak bones. Normally Our bones are made up of inner honeycomb mesh lameelar bone surronded by a thick outer shell called cortical bone. In osteoporosis thereis decrease density of bone and  bone becomes fragile. Thus osteoporosis leads to abnormally porous bone which is more compressible like a sponge, than hard like a brick.

The osteoporosis of bone weakens the bone leading to an increase in the risk of bone fracture. Bones that are affected by osteoporosis can fracture with only a minor fall or injury that normally would not cause a bone fracture. The fracture can be either in the form of hip or wrist fracture or collapse of the vertebra of the spine. The spine, hips, and wrists are common areas of osteoporosis-related bone fractures, although osteoporosis-related fractures can also occur in almost any skeletal bone area.

What are the symptoms of osteoporosis?

The patients with osteoporosis of bone may remain silent for decades. Many people have decreased bone mineral i.e. osteoporosis from lone time but they are not aware of it because it does not causes any symptoms in the beginning. Many patients with osteoporosis may have back pain, bone pains & stooping postures due to decrease in height of vertebra.

In many osteoporosis doesn't cause symptoms unless some acute bone fracture occurs. This causes severe acute pain in the affected areas. In most cases it often remains undetected until the time of this first broken bone. The most common fractures are of wrists, hips and spinal bones in people with osteoporosis.

In some osteoporosis fractures of spine may escape detection until years later which is then detected during a routine x-ray of spine. Therefore, patients may not be aware of their osteoporosis until they suffer a painful fracture. Then the symptoms are related to the location of the fractures as back pain when crush fracture of vertebra occurs. Some times fractures of the spinal vertebrae can cause severe "band-like" pain that radiates around from the back to the side of the body. Over the years, repeated spine fractures can cause chronic back pain as well as loss of height or curving of the spine leading to stooping forward posture which is typically seen in many older women, which gives the individual a hunched-back appearance. A fracture that occurs during the course of normal activity is called a minimal trauma fracture. For example, some patients with osteoporosis develop stress fractures of the feet while walking or stepping off a curb.

Hip fractures typically occur as a result of a fall. With osteoporosis, hip fractures can occur as a result of trivial accidents. Hip fractures may also be difficult to heal after surgical repair because of poor bone quality.

What causes osteoporosis?

For your knowledge we’ll like to explain you that there are two types of cells are constantly at work in our bones. One set builds up new bone (called osteolatic i.e. bone forming activity) while another set break down old bone( called osteoclastic i.e. bone resorption activity). Up to our mid-20s the construction cells work harder building strength into our skeleton. Thus in initial years of life there is more construction of bone than breakdown of old bone so that bone denisity as well as bone streghth keeps on increasing . Our bones achieves maximum streghth by the age of 35 years. From our 35

onwards, the demolition cells overtake and our bones gradually lose their density as a natural part of ageing. After the age of 35 year bone reoption ie.destruction supercedes the new bone formation so bone strenghth & boe mineral content including amount of bone material in a particular bone starts gradually decreasing with after the age of 35 in every body. In some people the bone resoption is very fast compared to othe people so that in few years there bone becomes very weak & becomes prone to easy fracture even on minor trauma.

There are many secondary factors in the body & there are many dieaseses which leads too rapid degradation of bone leading to significant osteoporosis more than what is expected at that age due to aging.

Causes of Osteoporosis in Females: are estrogen deficiency, hyperparathyroidism, vitamin D deficiency, multiple myeloma, idiopathic, calcium deficiency, Cortisol excess, steroid use, chronic inflammatory disease as rheumatoid arthritis, SLE, malabsorption syndrome, thyrotoxicosis, hypogonadism, hyperprolactinemia, cancers, Liver disease, alcohol use, juvenile osteoporosis, hypogonadotropic hypogonadism, Craniopharyngioma, Germinoma, Teratoma, Endodermal, Infection and other disorders: Tuberculosis, Syphilis, sarcoidosis, kallmann syndrome, idiopathic hypogonadotropic hypogonadism, Chronic debilitating disease, Pituitary other hormone-screening pituitary tumors (ACTH, thyrotropin-stimulating hormone, growth hormone), non-functional tumors (craniophyaryngioma), Empty sella syndrome, Sheehan syndrome, Panhypopituitarism, Inflammatory /infiltrative : Sarcoidosis, Hemachoromatosis. Gonadal agenesis, Gonadal dysgenesis, Turner syndrome 45, X, Mosaicism, Pure gonadal dysgenesis, 46, XX, 46,XX (Swyer syndrome), Ovarian enzymatic deficiency as 17a-Hydroxylase deficiency, 17, 20-Lyase deficiency, Premature Ovarian failure : Idiopathic – premature menopause, injury, mumps oophoritis, radiation, chemotherapy, Resistant ovary (Savage syndrome), Autoimmune disease, Galactosemia. Hyperthyroidism, overeplacement of thyroxine hormone for long term. chronic heparin uses, hyperprolactinemia, Defects in Gonadotropin Secretion or Action :Secretion of biologically inactive gonadotropin, a or ß subunit defects, FSH receptor (FSHR) mutations, Postreceptor defects (e.g. resistant ovary or savage syndrome) Associated with other Autommune disorders, Isolated, Congenital thymic aplasia Chemotherapeutic (especially alklylating) agents, Ionisinz radiation, Viral agents, Cigarette smoking, Surgical exitirpation, Idiopathic , Growth hormone deficiency, thyroid hormone excess, cortisol excess, Mineral Disorder: Vitamin D deficiency, Zinc deficiency, Calcium deficiency Rickets (Vitamin D deficiency or hypophosphatemia Chromosomal defect (as Downs's Syndrome, Turner Syndrome),  Renal tubular acidosis, kidney failure & Chronic Systemic diseases ,Chronic Renal disease : CRF, RTA , Hematologic disease :Anemia d/t Thallasemia major sickel cell anemia ,Uncontrolled Diabetes ,Cardiac disease: Cynotic heart disease, CHF d/t any cause. Malnutrition, anemia, Under nutrition (of calorie, protein, vitamin-D & Zinc) Malabsorption: Celiac diseases, chron’s disease & Chronic Giardiasis., Inborn errors of Metabolism (Mucopolysacharidosis, Galactosemia) 

How is osteoporosis diagnosed?

1) X-ray Spine:  A routine X-ray can reveal osteoporosis of the bone, which appears much thinner and lighter than normal bones. Unfortunately, by the time x-rays can detect osteoporosis, at least 30% of the bone has already been lost. In addition, x-rays are not accurate indicators of bone density. The appearance of the bone on x-ray is often affected by variations in the degree of exposure of the x-ray film. 

2)  Dexa Bone Scan: (dual energy x-ray absorptiometry scan) This is the best test the diagnosing osteoporosis. DXA measures bone density in the hip and the spine. The test takes only 5 to 15 minutes to perform, uses very little radiation exposure (less than one tenth to one hundredth the amount used on a standard chest x-ray), and is quite precise

The bone density of the patient is then compared to the average peak bone density of young adults of same sex and race. This score is called the "T score," and it expresses the bone density in terms of the number of standard deviations (SD) below peak young adult bone mass

Normal bone density is defined as bone density T score with in  – 1 standard deviation from the normal peak bone density as in adult. Osteoporosis is defined as bone density T score of –2.5 SD or below. Osteopenia (between normal and osteoporosis) is defined as bone density T score between –1 and –2.5 SD.

Who should have bone density testing?

All postmenopausal women below age 65 who have risk factors for osteoporosis.
All women aged 65 and older.
Postmenopausal women with fractures, although this is not mandatory because treatment may well be started regardless of bone density.
Women with medical conditions associated with osteoporosis.

Investigation & Diagnosis: Other Investigations to find out the cause of Osteoporosis:

Detailed History: First we take detail history about diet, past illness & other relevant history to reach on probable cause for osteoporosis, Dietary intake (in present & past) 
Any systemic disease (in present & past), History suggestive of Hyperthyroidisms, Cushing’s disease or syndromes, Growth hormones deficiency, History of steroid intake Psycho-social history, Family history of osteoporosis & osteoporotic fracture of spine or other long bones (in parents, 1st & 2nd degree relatives). Old height & any history of height loss. History suggestive of malabsorption, calcium & vitamin - D intake or any other systemic illness.

physical Examination: We look for anemia, signs of malnutrition, Rickets, Neck for goiter, then we do Systemic examination- Organomegaly & CVS, Respiratory system, Central Nervous system is examined for any cause in CNS , Fundus for Papilloedema & optic-atrophy. We also Look for signs of estrogen deficiency in women & testosterones deficiency in men or Growth hormones deficiency, Hyperthyroidisms, turner syndrome.
After detail history & examination whatever hormone deficiency is suspected is investigated. 
For this we do following tests:
Hormone test: as Estradiol in females & Testosterones in males, thyroid (Free T4, Free T3, TSH), FSH, LH, testosterone, estradiol, IGF-1, IGFBP-3,etc. 
Bio-chemical test: (Hemoglobin, ESR, GBP, Alkaline Phosphatase, Calcium, I onised Calcium, Phosphorus, Urea, Creatinine, Urine Protein, M/E ,Fasting urinary ph , Serum bicarbonate, Serum Potassium ,Serum protein, SGPT Stool Fat ,
Tests to diagnose other systemic diseases.

Other tests which may be required to find out the cause of the any of the above hormone disorders are as follows:

Chromosomal analysis is done to see the genetic structure of testis, because there are many chromosome disorders lead to hypogonadism.  
Capacity of generation of active testosterone i.e. DHT is tested. This DHT generation test is abnormal in some cases of hypogonadism
Tests to locate testis as ultrasonography or C.T. Scan abdomen is needed if testis is not palpable.  
Serum inhibin is tested which tells that whether hypogonadism is temporary or permanent.  
Serum Iron, T.I.B.C. & ferritin concentration tested for hypogonadism due to hemochromatosis.  
Combined Pituitary hormone tests is performed when suspecting pituitary disorder.  
Molecular genetic studies done in some special cases.  
Serum estrogen increased whenever testicular function decreased.  
Serum DHT is low in some conditions when generation of dihydrotestosterone is decreased.  
Assessment of androgen receptor is due when needed, dynamic tests as HCG test, response to antiestrogen & gonadotropin releasing hormone tests.

How is osteoporosis treated and prevented?: Treatment offered is treatment of cause, calcium, Vitamin D, female hormone, raloxifene, Tibolon & Biphosphonates & synthetic PTH given with good results. 
The goal of osteoporosis treatment is the prevention of bone fractures by stopping bone loss and by increasing bone formation & bone density and strength. Early detection and timely treatment of osteoporosis, can substantially decrease the risk of future fracture. Therefore, prevention of osteoporosis is as important as treatment. Osteoporosis treatment and prevention measures are:

Life style changes including quitting cigarette smoking, curtailing alcohol intake, exercising regularly, and consuming a balanced diet with adequate calcium and vitamin D;

1. Medications that stop bone loss and increase bone strength, such as alendronate, risedronate, raloxifene, ibandronate, calcitonin ;
2. Medications that increase bone formation such as teriparatide , Flouride, Strontium, Herbal Medicines etc.

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