The term osteoporosis is a condition in which the skeleton is subject to loss of bone mass and resistance caused by nutritional, metabolic or pathological. The skeleton is then subject to a greater risk of pathological fractures, bone density and decrease in bone micro architecture.
Osteoporosis generally is considered a disease of the bones, but some say it would be an physiological process in elderly subjects, whose presence provides still greater development of pathological fractures, a consequent decrease in the quality and life expectancy and complications due to fractures, if not properly treated. Because it is considered too easily disease (and not because of real or apparent expression of disease osteoporosis, the brittle fracture), the British Medical Journal have included in a list of "non-disease" (International Classification of Diseases-Not).
Osteoporosis is divided into primary (original) or secondary —
Primary osteoporosisAre divided into:
idiopathic osteoporosis (the rarest form of all, the cause of which is unclear)
Type I osteoporosis or post-menopausal (due to the drop in hormone production)
Type II osteoporosis or senile (due to various causes, including immobilization, reduced supply of growth hormone, testosterone, calcium, magnesium, vitamin D, vitamin K and other important micronutrients, reduced function of the enzyme 1a-hydroxylase which produces the active hormone of vitamin D (Calcitriol).
They occur mainly in the trabecular bone, which is subject to the greatest number of fractures.
Secondary osteoporosisThe secondary osteoporosis are a group full of variations, but constitute only 5% of osteoporosis. The main ones are classified as caused by:
use of drugs such as steroids (e.g., prednisone, betamethasone, methylprednisolone, beclomethasone inhaled glucocorticoids e.g., fluticasone, flunisolide), antiepileptics (phenytoin, barbiturates, valproic acid), heparins, oral anticoagulants, loop diuretics (e.g. furosemide)
low body weight
Hyperfunction (Cushing's syndrome)
COPD (chronic obstructive pulmonary disease)
reduced intestinal absorption of nutrients and vitamin D
sickle cell anemia (sickle cell)
Among the various bone diseases is the most widespread, affecting both sexes, most women after menopause, which considerably increases the risk of up to 4 times.
As regards ethnicity, although there is in all, the white race and Asian are the hardest hit, although in one study conducted in the United States it was found that the African women are the most life threatening fractures. its incidence is increasing in South America reaching Europe, while in the USA the majority of adults who have passed the age of 50 has osteoporosis, or low bone density
The form has a greater impact among the 51 and 75 years old, (II) can appear at any age and is caused by one or more risk factors listed above, there is also the idiopathic in adolescents (aged 10 to 18 years) and young adults.
The cause is loss of balance between osteoblasts and osteoclasts. The first category of cells contributes to bone formation, the second contributes to bone resorption, where osteoclasts work faster than osteoblasts, the bone deteriorates. In the menopause (the forms) there is an increased production of osteoclasts, caused by the loss of estrogen which leads to an eventual rising of cytokines, related to the production of osteoclasts. In the second form, with advancing age decreases the activity of osteoblasts.
Risk factorsThere are several risk factors that increase the likelihood of osteoporosis occur, they are divided depending on whether an event or not editable:
Age-is the highest risk factor, as in old age is normally the deterioration of bone mass. Very important for women is also the age at which leads to menopause.
Genetic factors, even if you are completely
Lack of hormones such as estrogen (for women), growth hormone, testosterone (both males and females, in form II only);
The presence of conditions such as cirrhosis, rheumatoid arthritis
Hereditary diseases: osteogenesis imperfecta, homocystinuria, renal tubular acidosis
Endocrine abnormalities, Cushing's syndrome (excess cortisol)
Diet, lack of essential minerals (magnesium, calcium, strontium, zinc, and others), proteins, vitamin d. vitamin C, vitamin K (K2), vitamins of Group B as the B9 (folic acid), B12 (cyanocobalamin), B2 (riboflavin) and others.
Low body weight, must be less than 85% of that ideal, or otherwise considered generally less than 55 kg;
Physical inactivity, ranging from sedentary lives up to paralysis;
Hypercalciuria (low urine pH, acid)
Osteoporosis manifests itself initially with a decrease in calcium tone bone mass (osteopenia). The bones more easily affected by the decrease in soda are the tone back lumbar vertebrae, femur and wrist.
Initially asymptomatic, remains such for 2/3 people. the first manifestations appear with fractures; the pain in the bones and muscles, for example, is typical of the fractures, but they may not even be felt by the individual and can also be easily minimizing the traumatic event. Usually the pain is localized to the back or to the pelvis, but it is possible that occurs wherever the location of the fracture and is sharp and worsens with efforts and load. With the development of osteopenia can manifest a vertebral collapse, a fracture of the forearm (wrist) or a femoral fracture.
The diagnosis for both osteopenia as for osteoporosis is based on five major points:
Analysis of the patient (medical history) and family (positivity for fractures);
physical examination of the patient by researching any painful points adjacent to possible fracture;
Bone mineral density (BMD) Computer (MOC), Gold-Standard test to determine bone density; commonly performed using Dual Energy X ray Absorptiometry or ultrasonography of the calcaneus (more rarely phalanges);
routine blood tests, blood tests and the main parameters of thyroid metabolism, liver, adrenal, pituitary, kidney and bone;
radiological examinations to detect any fractures (x-ray, CT or MRI).
Normal x-rays, which are used to discover the presence of fractures, does not lead to a definite diagnosis of the disease.