As we all know osteoporosis is a medical condition in which the quality and strength of the bone decreases and the bones are at a higher risk of fractures. It is defined as bone mineral density(BMD) score of less than 2.5 (-2.5 or less), with scores of -1.5 to -2.5 termed as osteopenia and score more than -1.5 termed as normal.
Histologically when we see an osteoporotic bone, we see that the matrix and the mineralisation of the bone are deficient. The normal trabecular pattern of the bone is lost. This change can be noted on an X ray also.
Osteoporosis can be caused due to lifelong deficiency of calcium to the body, either because of decreased intake or with disease involving kidney function.
Osteoporosis can be seen in elderly age group, in females after menopause, prolonged immobilisation of the person or limb due to weakness, fractures or paralysis like conditions. Infection of the bone, polio, certain type of arthritis. Eating disorders. Extreme low weight of a person.
Risk factors for osteoporosis include alcoholism, smoking, long term intake of certain drugs like steroids, kidney disorders, lack of physical activity
In the initial stages patients could be asymptomatic and the diagnosis made after routine health check. Usually the symptoms include generalised body weakness, pain in the lower back and weight bearing bones, shin pain, swelling of joints and lower limb, pathological fractures, nerve compression symptoms in spine when associated with pathological fractures.
The tool used to diagnose osteoporosis objectively is an DEXA scan (Dual Emission X Ray Absorptiometry) where three different regions of the body, that is hip, spine and wrist are scanned and an estimate is made. These are interpreted with T and Z scores. It gives us an estimate of risk of fracture.
(The writer is a consultant orthopaedic & trauma surgeon at Manipal Hospital, Goa)
