OSTEOPOROSIS : TYPES, PATHOGENESIS, CLINICAL COURSE AND MCQs

INTRODUCTION :-

1.) Osteoporosis is also called osteoarthrosis or degenerative joint disease.

2.) Osteoporosis teem denotes increased porosity of the skeleton resulting in a reduction of bone mass.

3.) It is characterized by progressive degenerative changes in the articular cartilages over the year, particularly in weight – bearing joints.

TYPES OF OSTEOPOROSIS :-

A.] PRIMARY OSTEOPOROSIS :

• It occur more in elderly people, more in women than men.
• The condition of primary osteoporosis may show longevity.
• The primary osteoporosis, wear and tear with repeated minor trauma, heredity, obesity, gaining all contribute to focal degenerative change in the articular cartilage of the joint.
• Genetic factor favoring susceptibility to develop osteoporosis have also been observed.

B.] SECONDARY OSTEOPOROSIS :

• Secondary osteoporosis can occur at any age.
• Secondary osteoporosis is the result of any previous wear and tear phenomena involving the joint such as previous injury, fracture, inflammation, loose bodies and congenital dislocation of the hip.

Fig : 1

PATHOGENESIS :-

1. Age related changes in bone cells and matrix have a strong impact on bone metabolism.
2. Osteoblasts from elderly individuals have reduced reproductive and the biosynthetic potential when compared with osteoblasts from younger individuals.
3. The end result will be skeleton populated by bone – forming cells that have a diminished capacity to make bones.
4. This form of osteoporosis also known as senile osteoporosis, is categorized as a ” low turnover variant “.
5. Reduced physical activity increase the rate of bone loss in experimental animals and humans.
6. The decreased physical activity that is associated with aging contribute to sensile osteoporosis ( condition of significantly diminished bone mass due to long standing imbalance between bone resorption and bone formation ).
7. Postmenopausal osteoporosis is characterized by a hormone – dependent acceleration of bone loss.
8. In postmenopausal osteoporosis the yearly reduction in bone mass may reach upto 2% of cortical bone and 9% of cancellous bone.
9. No surprise that 1 out of every 2 women suffers an osteoporotic fracture in contrast to 1 in40 men. Estrogen deficiency is belived to play the major role in this phenomenon.
10. Decreased estrogen level result in increased secretion of interleukin – 1 by blood monocytes. Interleukin – 1 is the most potent known stimulator of osteoclast recruvitment and activity.

Fig : 2

CLINICAL COURSE :-

1. Vertebral fractures, which frequently occur in the thoracic and lumbar region, are potentially very painful.
2. Femoral neck and wrist fractures are common.
3. Osteoporosis cannot be readily detected in plain radiographs until 30 to 40% of the bone mass is loss.
4. Osteoporosis is a difficult situation to be diagnosed because it remains asymptomatic until skeleton fragility is well advanced, it is only one of a group of osteopenic skeletal disorders characterized by “too little” bone, which can be difficult to differentiate and there is no easy, sensitive, and specific method to determine the degree of bone loss.
5. Currently, the best methods or procedure that accurately estimate the amount of bone loss are single – energy photon absorptiometry, dual energy absorptiometry and quatitative computed tomography (CT).

MULTIPLE CHOICE QUESTIONS ( MCQs ) :-

1.] At what age do we have the most bone density ?

a. Your 20s

b. Your 30s

c. Your 40s

d. Your 50s

2.] Which of these activities could cause a broken bone in someone with osteoporosis ?

a. Coughing

b. Bending

c. Sneezing

d. All of the above

3.] Which of these makes it more likely that you’ll get osteoporosis ?

a. Drinking too much alcohol

b. Family history

c. Smoking

d. All of the above

4.] Which test is used to do screening for osteoporosis ?

a. Blood test

b. Special type of X – rays

c. Urine test

d. All of the above

5.] What causes a “dowager’s hump” or stooped posture ?

a. Spinal bone spurs

b. Inflexible spine

c. Broken vertebrae

d. None of the above

6.] Which kind of exercise can help to prevent osteoporosis ?

a. Swimming

b. Running

c. Weightlifting

d. Both (a) and (c)

7.] How can osteoporosis be prevented ?

a. Eat a low fat diet

b. Exercise every day

c. Get enough calcium and vitamin – D throughout your lifetime

d. Both (b) and (c)

8.] How is osteoporosis treated ?

a. Medicines

b. Surgery

c. X – ray treatment

d. It can’t be treated

9.] Which of these medications causes rapid bone loss in the first three to six months of treatment – placing the individual at higher risk of osteoporosis and fractures ?

a. Beta blockers

b. Corticosteroids

c. Acetaminophen

d. Benzodiazepines

10.] Calcium is a key mineral that help maintain bone health. Which of this essential vitamins is needed to ensure that enough calcium is absorbed by the body ?

a. Vit. A

b. Vit. B

c. Vit. C

d. Vit. D

SOLUTIONS :-

1.] (b) Your 30s

2.] (d)

3.] (d)

4.] (b) Spinal type of X – ray

5.] (c) Broken vertebrae

6.] (d)

7.] (d)

8.] (a) Medicines

9.] (b) Corticosteroids

10.] (d) Vit. D

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REFERENCES :-

1.] Textbook Of Pathology By Harsh Mohan.

2.] Robbin’s Basic Pathology.