Conditions associated with Osteoporosis

 Conditions associated with Osteoporosis
  • Hypogonadism
  • Hyperadrenocorticism
  • Chronic steroid administration
  • Thyrotoxicosis
  • Hyperparathyroidism
  • Malabsorption
  • Scurvy
  • Calcium deficiency
  • Long period of immobilization
  • Chronic heparin administration
  • Metabolic bone diseases
  • Osteogenesis Imperfecta
  • Homocystinuria
  • Marfan’s syndrome
  • Ehlers-Danlos syndrome
  • Rheumatoid Arthritis
  • Malnutrition
  • Epilepsy
  • Primary Biliary cirrhosis
  • Chronic Obstructive pulmonary disease
  • Alcoholism
  • Menkes’ syndrome

Role of Oestrogen in Osteoporosis

Role of Oestrogen in Osteoporosis
The Role of Hormone Therapy in the Prevention and Treatment of OsteoporosisWhile one in four women over the age of 50 has osteoporosis, only one in eight men have the disease. This striking difference is largely due to the important role which the sex hormones (primarily estrogen) play in keeping women’s bones healthy.
Bone is a living tissue that is constantly renewed through a process in which old bone is removed and replaced by new bone. In Bone there are two important types of cells – Osteoblasts and Osteoclasts. Osteoclasts are bone eroding cells and Osteoblasts are bone forming cells. The bone eroding cells invade the bone and erode it creating cavities in the bone and the bone forming cells fill the cavities with new bone. This is a natural process — nature’s way of restoring bones and keeping them strong.
In younger persons with good bone health, both the cells that erode bone and those that build bone work together. But as we age the bone builders are unable to keep pace with the bone excavators, and this results in loss of bone.
Estrogen has been found to play a major role in maintaining the balance by slowing the pace of bone erosion. When a woman’s estrogen levels fall dramatically, bone loss is accelerated.
During Menopause, a woman’s estrogen significantly decreases as her ovaries  where nearly all estrogen is produced, cease to function. A woman can lose 2 to 5 % of her bone density each year during the first 5 to 10 years following menopause. However, not all women develop osteoporosis despite this accelerated bone loss. For example, a woman who enters menopause with a high bone density will be less likely to develop osteoporosis because she has more bone to start with. Other factors are also important including genetics, physical activity and nutrition.
Early Menopause
The relationship between bone health and estrogen raises great concern in women who experience premature menopause — menopause before the age of 45. Sometimes such a menopause occurs naturally, while other times it is medically induced through surgery or chemotherapy. Whatever the cause, early menopause can lead to significant bone loss.
Amenorrhea (Missed Periods)
Amenorrhea is a condition which can develop when a girl or young woman develops an eating disorder or when she is training in sports or other intensive physical activities where she over-exercises. In such cases her menstrual cycle may be disrupted and her estrogen production will decrease.
Periods of estrogen loss during this time of life — even if temporary — can have a profound effect on a woman’s bone health over her lifetime.
As a result, even if she does not develop osteoporosis early in life, she will reach menopause at a great disadvantage and be a likely candidate for postmenopausal osteoporosis.
Estrogen Halts Bone Loss
If used early enough this can prevent a woman’s bones from becoming osteoporotic. In cases where she has low bone density or has already fractured, estrogen can stabilize or even improve her bone density.
Research has provided enough evidence to make a strong case for the use of estrogen as both a preventive therapy and as a treatment for established osteoporosis.


Osteoporosis ~ Diagnosis

Osteoporosis ~ Diagnosis
To diagnose Osteoporosis we have to find out the calcium content of the bones. To put it more scientifically, the Bone Mineral Density ( BMD) has to be evaluated. The technology that is used to do this is known as Bone Densitometry.
Before the advent of BMD tests, osteoporosis was diagnosed by routine X-rays or by bone biopsy. By these methods osteoporosis could be rarely diagnosed before at least 25 % of the bone mass was lost, and by this time the disease is well advanced. Today BMD tests help in diagnosing the disease and also help in warning us from the likely hood of developing osteoporosis in the near future.
Indications for BMD tests
1. At Menopause, to decide regarding the need for Hormone therapy.
2. Those on glucocorticoids, to see if they are losing bone mass or not.
3. Recent fractures, where osteoporosis is suspected.
4. Those with osteoporosis and under treatment, to monitor the effectiveness of treatment.
5. Those with Primary Hyperparathyroidism.
6. A man with Hypogonadism.
7. Those on chemotherapy and may be losing bone mass.
The most common bone density test in use today is called  dual energy x-ray absorptiometry (DXA).
It is a non invasive procedure and the amount of radiation exposure is very little.The results are expressed in units referred to as standard deviations (SD). These SD units tell how far you differ (or deviate) from what is considered normal. If you are 2.5 SD units below normal (-2.5), you will be told that you have osteoporosis.
Heel Ultrasound: A new Technology for testing Bone Density
The test usually involves immersing your foot in a bath of warm water, allowing high frequency sound waves to pass through your heel. The test measures the density and quality of the bone in your heel. It has not yet become a standard testing procedure.

Diagnostic Classifications of Osteoporosis

Classification Definition Risk and Recommendations
Normal BMD is not more than -1 SD below the average peak bone mass of a young person (30-45) Risk of fracture is very low.
Low Bone Mass (sometimes referred to as Osteopenia) BMD is between 1 and 2.5 SD below normal (between 1 and 2.5) • Risk of fracture is usually low to moderate.
• Accelerated bone loss at menopause requires immediate intervention.
Osteoporosis BMD is greater than 2.5 SD below normal (-2.5) and there have been no fractures • Moderate to very high risk of fracture.
• Treatment is advised .
Severe Osteoporosis BMD greater than 2.5 SD below normal (-2.5) with existing fractures • Very high to extremely high risk of fracture.
• Treatment is strongly advised.

Osteoporosis – Risk Factors

Osteoporosis – Risk Factors
The following conditions predispose to loss of bone and increased susceptibility to osteoporosis and consequent fractures.

  • Women with early menopause (40-45 years)
  • Younger women with ovarian hormone failure Or bilateral oophorectomy ( removal of Ovaries ) before normal menopause.
  • Women not receiving hormonal therapy for at least 5 years after menopause.
  • Patients after prolonged corticoid treatment of more than 3 months.
  • Primary hyperparathyroidism.
  • Strong family history of osteoporosis.
  • Men with hypogonadism.
  • Patients who have received chemotherapy, especially for breast cancers and haematological cancers.
  • Certain drugs enhance bone loss and render the patient susceptible to development of osteoporosis (e.g. corticoids, anti-convulsants, excessive doses of thyroid hormone, prolonged heparin therapy and anti-cancer drugs including high doses of methotrexate.
  • Low Calcium in diet.
  • Insufficient exposure to sunlight or not enough Vitamin D in diet.
  • White or Eurasian ancestry.
  • Caffeine (consistently more than three cups a day of coffee, tea, cola).
  • Alcohol (consistently more than two drinks a day).
  • Sedentary life style or prolonged bed rest.
 Conditions associated with Osteoporosis



Bone is living tissue, not a lifeless structure, that only supports your muscles and flesh. In fact, bone, like other body tissue, changes throughout a person’s life.Bone tissue is constantly renewed through a process called remodelling in which old bone is removed and replaced by new bone. This remodelling is a natural, ongoing process that takes place in a healthy body. It is Nature’s way of seeing that old bone is discarded and replaced with new bone. Loss in bone occurs because, as we age, new bone is not laid down at the same rate as older bone is lost; the result may be a thinning of the bones, referred to as Osteoporosis.Osteoporosis is characterized by low bone mass and deterioration of bone tissue.WHO defines osteoporosis as a marked reduction in bone density, to differentiate it from osteopenia which refers to mild reduction in bone  density. In osteoporosis, the bone density is more than 2.5 standard deviations below the young normal mean (T scale <-2.5).Osteoporosis is often known as the silent thief because bone loss occurs without symptoms.True osteoporosis causes bone pain and or spontaneous fractures of the spine, hip and wrist.
Osteoporosis is usually asymptomatic until fracture develops. Older persons with a fracture, especially spontaneous fracture of the spine, wrist or femur should be investigated for osteoporosis.
One in four women over the age of 50 has osteoporosis. One in eight men over 50 also has the disease. However, the disease can strike at any age.
More women die each year as a result of osteoporotic fractures than from breast and ovarian cancer combined.
A fifty-year-old woman has at least a 40 per cent risk of an osteoporotic fracture during the remainder of her life. Up to 20 per cent of individuals, who fracture a hip, die as a result of complications. Fifty per cent of those who survive remain permanently disabled.

Osteoporosis related topics