Osteoporosis with pathological fracture

Description of the Disease

This systemic bone disease, characterized by low bone mass and microarchitectural changes in bone tissue, leads to bone fragility and susceptibility to fractures. Age-related bone loss stems from a lack of calcium, vitamin D, and physical activity. The development of osteoporosis depends on the bone mass accumulated between the ages of 20-29, so consuming more calcium and vitamin D-rich products at that age is advisable. In older age, bone mass relies on the balance between bone formation and resorption. The progression of osteoporosis intensifies during the postmenopausal period due to the lack of female sex hormones—estrogens. In men, decreased androgen secretion results in reduced bone mass. Genetics, various diseases, medications, smoking, and nutritional disorders significantly contribute to bone loss.

Osteoporosis is one of the most common diseases in older age. For individuals aged 50, the risk of bone fractures due to osteoporosis over the remaining lifetime is 13% for men and 40% for women.

Symptoms

Initially, noticeable symptoms do not appear. Typically, the first sign is a bone fracture that occurs spontaneously or from minimal movement or trauma. Fractures happen because bones lack the strength to withstand daily activities. The bones most vulnerable at the onset of the disease are the forearm and spinal vertebrae. The most dangerous fractures affect the neck of the femur, primarily impacting individuals aged 65-70 and older. These fractures cause pain, deformity, and disability. Wrist joints also suffer similarly, while fractures of the spinal vertebrae often go unnoticed. People often ignore spinal pain or mistakenly attribute it to inflammation of the spinal nerve roots, osteochondrosis, or hernias.

As vertebral osteoporotic changes progress, a hump gradually forms, height decreases, the abdomen protrudes forward, gait becomes cautious, legs position widely, the waist disappears, and constant back pain due to bone fractures and constant muscle strain appears.

A vertebral bone fracture causes sudden pain lasting 4-6 weeks and does not require surgical treatment. In the case of multiple fractures, chronic back pain occurs.

Diagnosis

Tests for bone metabolism markers are performed – osteocalcin, bone alkaline phosphatase, type I procollagen, its degradation products, sialoproteins, etc. Conventional radiography is performed as an instrumental examination, which is useful for identifying or suspecting bone fractures. Bone mineral density tests are also performed: dual-energy X-ray absorptiometry, computed tomography, ultrasonic densitometry.

Treatment

Treatment is long-term. Physical activity is encouraged, adequate intake of calcium and vitamin D is recommended, and medications are prescribed: estrogens, calcitonin, bisphosphonates, parathyroid hormone, vitamin D analogs, etc.

Source | Author Doctor Nikas Samuolis, reviewed by Prof. Virginijus Šapoka | Vilnius University | Faculty of Medicine | Head of the Department of Internal Medicine, Family Medicine, and Oncology