Related articles: Osteoporosis
Definition
Osteoporosis is a metabolic disease that causes progressive bone loss; as a result, skeletal architecture is compromised and bones become brittle and more prone to fractures.
Osteoporosis is a chronic disease, which depends on many factors.
Normally, bone formation and resorption processes are closely related. Specialized cells, called osteoclasts and osteoblasts, work incessantly to control and maintain the right level of bone mineralization:
- osteoclasts reabsorb bone, demolishing small areas of old or damaged tissue;
- osteoblasts reconstruct the new structural parts of the bone and are responsible for bone mineralization.
This continuous process of renewal, called "remodeling", is regulated by parathormone (PTH), calcitonin, estrogens (but also by androgens), vitamin D, various cytokines and other local factors such as prostaglandins.
In the course of life, conditions can be created in which the amount of bone reabsorbed by the osteoclasts is greater than that produced and deposited by the osteoblasts. In essence, the amount of newly formed bone becomes insufficient to replace the demolished bone during the resorption phase. If these small deficiencies persist at the end of each remodeling cycle, osteoporosis may occur. This disease can develop in a primitive or secondary form.
Primary osteoporosis occurs in most cases in postmenopausal women and in elderly patients. Primitive osteoporosis can contribute to the natural drop in estrogen in women, a significant drop in androgens in men (andropause), decreased calcium intake, low levels of vitamin D and secondary hyperparathyroidism. Senile osteoporosis usually occurs after 65-70 years of age, in both sexes (but more frequently in women). Even the bone tissue, in fact, like any other component of our body, is destined to age and, over the years, it faces both a progressive quantitative reduction and a qualitative decline.
Secondary osteoporosis, on the other hand, can derive from other medical conditions or from the protracted use of some osteopenizing drugs, that is able to contribute to the loss of bone mass (eg corticosteroids, anti-epileptics, immunosuppressants and thyroid hormones). Among the diseases that can promote the onset of osteoporosis there are some endocrine diseases (such as Cushing's disease, hyperthyroidism and hyperparathyroidism, hypogonadism, hyperprolactinemia, diabetes mellitus) and some diseases of the gastro-intestinal system, such as malabsorption, celiac disease, Crohn's disease and chronic renal failure. Furthermore, osteoporosis can occur in the event of prolonged immobilization, calcium or vitamin D deficiency, chronic obstructive diseases of the bronchi and lungs, multiple myeloma, rheumatoid arthritis and some malignant neoplasms.
The risk of developing the disease is influenced by prolonged periods of inactivity, genetic predisposition, excessive thinness, alcohol abuse and cigarette smoking. The reduction of bone mass can be generalized and involve the whole skeleton or involve only some bone segments. Osteoporosis most frequently affects the spine, long bones and pelvis; fragility fractures occur mainly in the vertebrae, femur, wrist and humerus.
Most common symptoms and signs *
- Kidney stones
- coxalgia
- cruralgia
- Neck pain
- Knee pain
- Hip pain
- Hand and wrist pain
- Bone pain
- Back pain
- Muscle pains
- Bone fractures
- Sore legs
- hypercalcemia
- hyperkyphosis
- hyperlordosis
- Backache
- Osteopenia
- Rheumatism
- thrombocytosis
Further indications
Despite the progressive reduction of bone mass, many of those suffering from osteoporosis do not show signs or symptoms. Over time, however, the increasingly rigid and fragile bone tissue makes the skeleton unable to withstand normal stresses. Therefore, in many cases, osteoporosis is noticed only after a fracture of the hip, femur, wrist or vertebrae, caused by minimal or inadvertent trauma.
Osteoporotic patients often develop bone or muscle pain, especially in the lumbar region. Furthermore, the thinning and fragility of the bones predispose to curvature of the spine. Very common are also vertebral compression fractures, which can also go almost unnoticed.
Osteoporosis is diagnosed through targeted diagnostic tests, such as Computerized Bone Mineralometry or MOC, which assesses the density of bone mass; this test, commonly called bone densitometry, uses X-rays to assess the state of bone mineralization, thus establishing the degree of osteoporosis or the risk of its appearance.
In addition to bone densitometry, the diagnosis of osteoporosis uses other instrumental tests. The doctor can evaluate if there are recent or previous injuries with a radiographic examination or with the morphometry of the spine. Blood and urine tests instead allow us to assess the state of bone metabolism, can identify possible causative factors and are particularly useful when there is suspicion of a form of secondary osteoporosis.
Prevention and therapy of osteoporosis involves the adoption of useful measures to slow down the pathological process and reduce the risk of incurring a fracture. These measures include: integration of calcium and vitamin D, exercises to increase bone strength and muscle strength and a drug therapy to preserve bone mass (eg bisphosphonates) or stimulate the formation of new bone (eg raloxifene) .
In the presence of a form of secondary osteoporosis, the treatment must be aimed at the control and, where possible, at the elimination of the underlying cause.
