{"id":1486,"date":"2024-03-12T17:08:48","date_gmt":"2024-03-12T21:08:48","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/?post_type=chapter&#038;p=1486"},"modified":"2025-10-17T19:31:06","modified_gmt":"2025-10-17T23:31:06","slug":"osteopenia-and-osteoporosis","status":"web-only","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/chapter\/osteopenia-and-osteoporosis\/","title":{"raw":"Osteopenia and Osteoporosis","rendered":"Osteopenia and Osteoporosis"},"content":{"raw":"<h1><strong>Osteopenia and Osteoporosis<\/strong><\/h1>\r\n<strong>Osteopenia<\/strong> and <strong>osteoporosis<\/strong> are characterized by <strong>reduced bone volume<\/strong> and <strong>bone mass<\/strong>.\u00a0 This makes bones porous, weak, brittle, and more susceptible to breaking.\u00a0 The name <strong>osteopenia<\/strong> comes from the Greek words <em>osteo<\/em> meaning 'bone' and <em>penia<\/em> meaning 'poverty'.\u00a0 \u00a0Likewise, the name <strong>osteoporosis<\/strong> comes from the Greek words <em>osteo<\/em> for 'bone' and <em>poros<\/em> referring to the 'pores'.\u00a0 The suffix -osis is often used in pathology as it is used to specify a 'condition' (usually a disease condition).\r\n\r\nOsteopenia and osteoporosis affect both trabecular and cortical bone, and reduce all components (organic and inorganic components) that comprise bone.\u00a0 The osteoid organic components are largely comprised of collagen, proteoglycans, and glycoproteins as well as osteocytes and other bone cells (osteoblasts, osteoclasts, and osteoprogenitor cells).\u00a0 The inorganic components of bone are comprised of calcium phosphate salts and a small amount of water.\u00a0 Additionally, bone is penetrated by blood vessels and nerves.\r\n\r\n[caption id=\"attachment_4548\" align=\"alignnone\" width=\"300\"]<a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the.jpg\"><img class=\"wp-image-4548 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-300x152.jpg\" alt=\"Comparative view of normal bone, osteopenia, and osteoporosis.  A T score is a comparative measure of bone density between the patient's bone density and that of a healthy young adult (T score of young healthy adult = 0).  A patient's T score of +\/- 1 SD is considered normal.  A T score between -1 to -2.5 is characteristic of osteopenia.  A T score lower than -2.5 is characteristic of osteoporosis.\" width=\"300\" height=\"152\" \/><\/a> Comparative view of normal bone, osteopenia, and osteoporosis. A T score is a comparative measure of bone density between the patient's bone density and that of a healthy young adult (T score of young healthy adult = 0). A patient's T score of +\/- 1 SD is considered normal. A T score between -1 to -2.5 is characteristic of osteopenia. A T score lower than -2.5 is characteristic of osteoporosis.[\/caption]\r\n\r\n<strong>Rickets<\/strong> and <strong>osteomalacia<\/strong> are different that osteopenia and osteoporosis, in that both rickets and osteomalacia are characterized by \"soft bones\".\u00a0 The affected bones contain the organic components (e.g., osteoid) but have low levels of mineralization (calcium and phosphate content), making the bones softer and more pliant.\r\n\r\nOsteopenia typically occurs to bones prior to the development of osteoporosis.\u00a0 The degree of bone loss is less than that of osteoporosis.\u00a0 Osteopenia is characterized by the loss of bone density in a manner that is asymptomatic.\r\n<h3><strong>Risk Factors - Osteoporosis<\/strong><\/h3>\r\nThere are many risk factors for the development of osteoporosis and most contribute over the course of many years.\u00a0 Age is the biggest risk factor for osteoporosis, affecting 10% of all Canadians &gt;40 years of age and &gt;21% of all post-menopausal females.\u00a0 Statistics in the USA are similar.\r\n\r\nCertainly, <strong>lifestyle factors<\/strong> are known to contribute to the development of osteoporosis.\u00a0 For example:\r\n<ul>\r\n \t<li>sedentary behaviour<\/li>\r\n \t<li>smoking<\/li>\r\n \t<li>nutritional deficits<\/li>\r\n<\/ul>\r\n<strong>Primary Osteoporosis:\u00a0<\/strong> There are 2 forms of primary osteoporosis (post-menopausal and age-associated osteoporosis).\u00a0 <strong>Post-menopausal osteoporosis<\/strong> is self explanatory in that females are more at risk of developing osteoporosis when estrogen levels decrease after menopause.\u00a0 <strong>Age-associated osteoporosis<\/strong> is common after 70 years of age for females and males as bone loss speeds up post-menopause and post-andropause.\u00a0 It is estimated that 50% of biological females and 21% of biological males will experience at least one fracture associated with osteoporosis during their life time.\u00a0 The most common bone fractures occur in the femur neck, vertebrae, and wrists.\r\n\r\n&nbsp;\r\n\r\n<strong>Secondary Osteoporosis:\u00a0<\/strong> Certain diseases, deficiencies, and medications can cause osteoporosis and in this case the term secondary osteoporosis is applied.\u00a0 <strong>Juvenile osteoporosis<\/strong> is often secondary to an underlying disease or deficiency and is characterized by an age of onset of 8-14 years.\u00a0\u00a0Examples of risk factors, conditions, and\/or diseases that can lead to osteoporosis include:\r\n\r\n<strong>1. Genetics:<\/strong>\r\n<ul>\r\n \t<li>Certain genetic conditions are depicted by mutations in genes that affect specific proteins (e.g., fibrillin and collagen) that play key roles in bone.\u00a0 Examples include: <strong>Marfan Syndrome<\/strong> and <strong>Osteogenesis Imperfecta<\/strong>\r\n<ul>\r\n \t<li><strong>Family history<\/strong> is a risk factor, suggesting the inheritance of genetic susceptibilities.\u00a0 Along the same line, genetics plays a role in the susceptibility of certain ethnicities (White and Asian) being more at risk for osteoporosis.<\/li>\r\n \t<li><strong>Thin-boned, slender females and males<\/strong> are more at risk for osteoporosis, as there is less bone to lose before structural strength is compromised.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>2. Sex Hormone Levels:<\/strong>\r\n<ul>\r\n \t<li><strong>Reduced level or duration of exposure to sex hormones<\/strong> puts one at risk for developing osteoporosis.\r\n<ul>\r\n \t<li>Amenorrhea, late menarche, early menopause, Turner Syndrome (X), Klinefelter Syndrome (XXY)<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>3. Anabolic Hormone Levels:<\/strong>\r\n<ul>\r\n \t<li><strong>Endocrine Disorders: that lead to hormone deficiencies in anabolic hormones<\/strong> (e.g., sex hormones, thyroid hormone, growth hormone, insulin)\r\n<ul>\r\n \t<li><strong>Diabetes mellitus<\/strong> is a risk factor as lack of insulin or insulin insensitivity leads to poor uptake of cellular building blocks (e.g., glucose and amino acids) that are required by bone cells.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>4. Catabolic Hormone Levels:<\/strong>\r\n<ul>\r\n \t<li><strong>Endocrine Disorders that lead to overproduction of hormones that are catabolic<\/strong> (e.g., cortisol, parathyroid hormone).<\/li>\r\n<\/ul>\r\n<strong>5. Hyperthyroidism<\/strong>\r\n<ul>\r\n \t<li>While normal levels of thyroid hormone are important for bone growth and maintenance, excess thyroid hormone in adults is reported to induce the activity of both osteoclasts and osteoblasts, with the net effect of bone loss.<\/li>\r\n<\/ul>\r\n<strong>6.\u00a0 Pregnancy,<\/strong> though occurring very rarely, is a risk factor for osteoporosis.\r\n<ul>\r\n \t<li>During pregnancy, increased bone resorption can be stimulated to support calcium needs of fetal growth and lactation.<\/li>\r\n<\/ul>\r\n<strong>7. Malabsorption Syndromes or Dietary Deficiency States:<\/strong>\r\n<ul>\r\n \t<li><strong>Celiac disease, Cystic Fibrosis, Anorexia Nervosa, Bulimia Nervosa, Gastric Bypass surgery, Alcoholism, and\/or Malnutrition<\/strong> can lead to deficiencies in vitamin D, and the vital building blocks for bone (e.g., calcium, magnesium, and amino acids.<\/li>\r\n<\/ul>\r\n<strong>8. Chronic Inflammatory Diseases:<\/strong>\r\n<ul>\r\n \t<li><strong>Systemic Lupus Erythematosus, Rheumatoid Arthritis (RA),<\/strong> and<strong> Crohn's disease <\/strong>all are characterized by increased levels of pro-inflammatory cytokines and activated white blood cells.\u00a0 It is thought that pro-inflammatory cytokines increase osteoclast activity and decrease the activity of osteoblasts making one susceptible to osteoporosis.\u00a0 Plus the repetitive damage to the bone ends with <strong>RA,<\/strong> makes those regions susceptible to osteoporosis.\u00a0 Likewise, severe <strong>osteoarthritis<\/strong> is a risk factor for osteoporosis for the same reasons (plus the <strong>immobility\/sedentary behaviour<\/strong> that can occur with OA and RA due to pain experienced on movement).<\/li>\r\n<\/ul>\r\n<strong>9. Reduced Oxygen Supply to Bones:<\/strong>\r\n<ul>\r\n \t<li><strong>Blood diseases:<\/strong> Sickle Cell anemia, chemotherapy-induced anemia, and blood cancers can lead to reduced delivery of nutrients and oxygen to bone cells, which is a risk factor for osteoporosis.<\/li>\r\n \t<li><strong>Poor oxygenation<\/strong> due to Chronic Obstructive Pulmonary Disorder (COPD, e.g., emphysema) or Chronic Heart Failure (CHF)<\/li>\r\n<\/ul>\r\n<strong>10. Reduced Weight-Bearing Activities and Sedentary Behaviour<\/strong>\r\n<ul>\r\n \t<li><strong>Immobility,<\/strong> for example reduces the activity levels of osteocytes and osteoblasts leading to less osteoid production and calcification, resulting in bone atrophy (e.g., lower bone density).<\/li>\r\n<\/ul>\r\n<strong>11. Catabolic Medications:<\/strong>\r\n<ul>\r\n \t<li>Medications (e.g., <strong>corticosteroids)<\/strong> decrease the activity levels of osteocytes and osteoblasts leading to less osteoid production and calcification, resulting in bone atrophy (e.g., lower bone density).<\/li>\r\n<\/ul>\r\n<h3><strong>Signs and Symptoms - Osteoporosis<\/strong><\/h3>\r\nOsteoporosis develops slowly and <strong>asymptomatically<\/strong> often not being diagnosed until fractures or bone pain occur.\r\n\r\n<strong>Vertebral compression fracture<\/strong>s are common, two-thirds of which are <strong>painless,<\/strong> though result in stooped posture <strong>(kyphosis)<\/strong> and <strong>loss of height<\/strong>. If <strong>pain<\/strong> does occur, it is either sharp or dull and may become worse with movement.\u00a0 Vertebral fractures can cause <strong>muscle spasms<\/strong>.\u00a0 A decrease in height of 2-3 cm occurs with each vertebral fracture\r\n\r\nFalls can result in <strong>hip fractures<\/strong>, <strong>sacral insufficiency fractures,<\/strong> <strong>Colles fractures<\/strong> (of the distal radius and possibly ulna).\r\n\r\nHip fractures are common, with the fracture most often occurring in the proximal femur (e.g., femur neck).\r\n<h3><strong>Diagnosis - Osteoporosis<\/strong><\/h3>\r\n<strong>Physical examinations<\/strong> to assess for loss of height, kyphosis, signs of fractures, and any loss of muscle strength and balance (to determine risk of frailty and falling)\r\n\r\nTypically, <strong>blood tests<\/strong> are performed to test for:\r\n<ul>\r\n \t<li>anemia (using complete blood count)<\/li>\r\n \t<li>vitamin D levels<\/li>\r\n \t<li>calcium levels<\/li>\r\n \t<li>sex hormone levels<\/li>\r\n<\/ul>\r\n<strong>Bone density<\/strong> measurements using dual-energy x-ray absorptiometry (DXA)\r\n\r\n<strong>Imaging<\/strong> (e.g., CT scan, SPECT, MRI, Ultrasonography, bone scans) can be used to find bone lesions,\r\n\r\n<strong>Bone biopsies<\/strong> can be done to exclude any bone pathologies\r\n\r\nSome tests are done to rule out other problems (e.g., with thyroid, liver, kidney, etc.) that may contribute to osteoporosis.\r\n<h3><strong>Prevention and Treatment - Osteoporosis<\/strong><\/h3>\r\nPrevention of osteoporosis is important as osteoporosis is not curable and develops over the course of one's life.\r\n\r\nBoth prevention and treatment involve lifestyle adaptations which include:\r\n<ul>\r\n \t<li>weight-bearing and muscle strengthening exercises<\/li>\r\n \t<li>healthy diet with recommended levels of calcium and vitamin D included<\/li>\r\n \t<li>limiting alcohol and caffeine consumption<\/li>\r\n \t<li>smoking cessation<\/li>\r\n<\/ul>\r\nTreatment of osteoporosis can involve anti-osteoporosis medications (e.g., bisphosphonates), vertebroplasty, orthotics, healing of fractures, hormone (e.g., estrogen) replacement therapy\r\n\r\nPhysical and occupational therapy can be helpful in addition to home adaptations to reduce risk of falls (e.g., hand rails, replacing slippery flooring)\r\n\r\nAt times treatment for depression and pain is required particularly with the development of kyphosis.\r\n\r\nAn additional goal of treatment involves keeping a person mobile as long as possible as immobility brings additional risk factors (e.g., deep vein thrombosis and pressure ulcers).\r\n\r\n&nbsp;\r\n<h1><span style=\"text-decoration: underline\"><strong>Osteopenia and Osteoporosis Summary:<\/strong><\/span><\/h1>\r\n<ul>\r\n \t<li style=\"font-weight: 400\">\u00a0Osteoporosis:\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Chronic disease of older adults.<\/li>\r\n \t<li style=\"font-weight: 400\">Old cortical and trabecular bone resorbed faster than new bone formed.<\/li>\r\n \t<li style=\"font-weight: 400\">Decrease in osteoblast activity, increase in osteoclast activity.<\/li>\r\n \t<li style=\"font-weight: 400\">Common sites: femoral neck, vertebrae, wrists.<\/li>\r\n \t<li style=\"font-weight: 400\">Hormonal influence: estrogen and testosterone levels affect osteoblast activity.<\/li>\r\n \t<li style=\"font-weight: 400\">Risk factors: aging, hormonal changes, sedentary lifestyle, smoking, glucocorticoids use, early menopause, low calcium\/vitamin D diet, genetics, excessive alcohol\/caffeine.<\/li>\r\n \t<li style=\"font-weight: 400\">Diagnosis: bone density scan, serum\/urine calcium\/phosphate levels.<\/li>\r\n \t<li style=\"font-weight: 400\">Prevention: diet, exercise, weight-bearing exercises, bisphosphonates.<\/li>\r\n \t<li style=\"font-weight: 400\">Treatment: physiotherapy, pain management, prevention of further bone loss.<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<div class=\"textbox textbox--learning-objectives\"><header class=\"textbox__header\">\r\n<p class=\"textbox__title\"><strong>Key Take Aways - Specific Learning Objectives Study Guide<\/strong><\/p>\r\n\r\n<\/header>\r\n<div class=\"textbox__content\">\r\n<h2 class=\"textbox__content\"><strong style=\"text-align: initial;font-size: 1em\">Osteopenia and Osteoporosis:<\/strong><\/h2>\r\n<div class=\"textbox__content\">\r\n\r\n<span style=\"text-align: initial;font-size: 1em\">Both are bone weakening diseases characterized by reduced bone volume due to loss of both:<\/span>\r\n<ul>\r\n \t<li>Organic bone matrix (osteoid) = collagen, glycoproteins and proteoglycans<\/li>\r\n \t<li>Inorganic bone matrix (calcium salts\/minerals) = CaPO<sub>4<\/sub><\/li>\r\n \t<li><span style=\"font-size: 1em;text-align: initial\">Osteoporosis is more severe than osteopenia and is depicted by greater loss of bone volume and bone density putting an individual at risk for low-impact bone fractures.<\/span><\/li>\r\n \t<li>Osteopenia can be treated by ensuring sufficient dietary nutrients required for bone maintenance as well as taking part in regular recommended exercises (e.g., prescribed weight-training).<\/li>\r\n \t<li>Osteoporosis is characterized by irreplaceable loss of bone microstructure and density.<\/li>\r\n<\/ul>\r\n<h2><strong style=\"text-align: initial;font-size: 1em\">Osteoporosis:<\/strong><\/h2>\r\nOsteoporosis is considered a chronic disease that affects many older adults, in which old cortical (compact) and trabecular (spongy\/cancellous) bone is being resorbed faster than new bone matrix is being made.\u00a0 The most severe loss of bone density typically occurs in the femoral neck, vertebrae, and wrist.\u00a0 Bone maintenance and synthesis is impacted by various hormone levels:\u00a0 Thyroid Hormone (TH), Cortisol, Growth Hormone (GH), estrogen and testosterone are important for maintaining osteoblast activity.\u00a0 Lower levels of estrogen and testosterone in old age, result in lower levels of osteoblast activity.\r\n<div>\r\n\r\n<strong>Risk factors:<\/strong>\r\n<ul>\r\n \t<li>age<\/li>\r\n \t<li><span style=\"font-size: 1em\">post-menopausal biological (XX) females due to lower estrogen levels<\/span><\/li>\r\n \t<li>early menopause<\/li>\r\n \t<li>sedentary lifestyle<\/li>\r\n \t<li>use of corticosteroids (e.g., glucocorticoids)<\/li>\r\n \t<li>low intake of dietary Ca<sup>++<\/sup> and\/or vitamin D<\/li>\r\n \t<li>excessive alcohol or caffeine<\/li>\r\n \t<li>smoking<\/li>\r\n \t<li>rheumatic arthritis<\/li>\r\n \t<li>diabetes mellitus<\/li>\r\n \t<li>genetics<\/li>\r\n<\/ul>\r\n<strong>Categories of Osteoporosis:<\/strong>\r\n<ul>\r\n \t<li><strong>1st Degree Osteoporosis<\/strong> = due to age related decreases in hormones (e.g., sex hormones)<\/li>\r\n \t<li><strong>2nd Degree Osteoporosis<\/strong> = due to underlying disease\r\n<ul>\r\n \t<li>Celiac disease, due to malabsorption of Ca++ and\/or vitamin D<\/li>\r\n \t<li>Hyperthyroidism, due to increased metabolic activity<\/li>\r\n \t<li>Hyperparathyroidism due to increased osteoclast activity<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<strong>Signs &amp; Symptoms:<\/strong> low-impact fractures (1.5 million\/yr in USA), hip fractures, height reduction, kyphosis, vertebral compression fractures\r\n\r\n<strong>Routine Check-Ups:\u00a0 <\/strong>regular bone mass density scan tests after the age of 50\r\n\r\n<strong>Diagnostic Evaluation:<\/strong>\r\n<ul>\r\n \t<li>monitoring bone density using dual energy X-ray absorptiometry (DEXA) or other imaging (CT scans, MRI)<\/li>\r\n \t<li>monitoring serum\/urine\u00a0 for low serum levels of Ca++, PO<sub>4<\/sub>,\u00a0 low levels of parathyroid hormone (PTH),<\/li>\r\n \t<li>assessing for bone deformities<\/li>\r\n<\/ul>\r\n<strong>Prevention: <\/strong>through avoidance of modifiable risk factors\r\n\r\n<strong>Treatment:<\/strong>\r\n<ul>\r\n \t<li>pain management<\/li>\r\n \t<li>bisphosphonates (work by decreasing osteoclast activity)<\/li>\r\n \t<li>weight-bearing exercises<\/li>\r\n \t<li>calcium carbonate and vitamin D supplementation<\/li>\r\n<\/ul>\r\n<ul>\r\n \t<li style=\"font-weight: 400\">Vitamin D Recommended Dietary Allowance for adults 19 years and older is 600 IU (15 mcg) daily for men and women, and for adults &gt;70 years it is 800 IU (20 mcg) daily.<\/li>\r\n \t<li style=\"font-weight: 400\">Caution should be used not to exceed this dosage as vitamin D can build up to excessive and harmful levels in the body.<\/li>\r\n<\/ul>\r\n<strong>Physiotherapy:<\/strong>\u00a0 to alleviate pain &amp; maintain function of muscles, tendons, and nerves, recommendations include use of proper warm-up, appropriate equipment, training.\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>","rendered":"<h1><strong>Osteopenia and Osteoporosis<\/strong><\/h1>\n<p><strong>Osteopenia<\/strong> and <strong>osteoporosis<\/strong> are characterized by <strong>reduced bone volume<\/strong> and <strong>bone mass<\/strong>.\u00a0 This makes bones porous, weak, brittle, and more susceptible to breaking.\u00a0 The name <strong>osteopenia<\/strong> comes from the Greek words <em>osteo<\/em> meaning &#8216;bone&#8217; and <em>penia<\/em> meaning &#8216;poverty&#8217;.\u00a0 \u00a0Likewise, the name <strong>osteoporosis<\/strong> comes from the Greek words <em>osteo<\/em> for &#8216;bone&#8217; and <em>poros<\/em> referring to the &#8216;pores&#8217;.\u00a0 The suffix -osis is often used in pathology as it is used to specify a &#8216;condition&#8217; (usually a disease condition).<\/p>\n<p>Osteopenia and osteoporosis affect both trabecular and cortical bone, and reduce all components (organic and inorganic components) that comprise bone.\u00a0 The osteoid organic components are largely comprised of collagen, proteoglycans, and glycoproteins as well as osteocytes and other bone cells (osteoblasts, osteoclasts, and osteoprogenitor cells).\u00a0 The inorganic components of bone are comprised of calcium phosphate salts and a small amount of water.\u00a0 Additionally, bone is penetrated by blood vessels and nerves.<\/p>\n<figure id=\"attachment_4548\" aria-describedby=\"caption-attachment-4548\" style=\"width: 300px\" class=\"wp-caption alignnone\"><a href=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the.jpg\"><img loading=\"lazy\" decoding=\"async\" class=\"wp-image-4548 size-medium\" src=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-300x152.jpg\" alt=\"Comparative view of normal bone, osteopenia, and osteoporosis.  A T score is a comparative measure of bone density between the patient's bone density and that of a healthy young adult (T score of young healthy adult = 0).  A patient's T score of +\/- 1 SD is considered normal.  A T score between -1 to -2.5 is characteristic of osteopenia.  A T score lower than -2.5 is characteristic of osteoporosis.\" width=\"300\" height=\"152\" srcset=\"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-300x152.jpg 300w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-768x390.jpg 768w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-65x33.jpg 65w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-225x114.jpg 225w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the-350x178.jpg 350w, https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-content\/uploads\/sites\/1961\/2024\/03\/Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the.jpg 850w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/a><figcaption id=\"caption-attachment-4548\" class=\"wp-caption-text\">Comparative view of normal bone, osteopenia, and osteoporosis. A T score is a comparative measure of bone density between the patient&#8217;s bone density and that of a healthy young adult (T score of young healthy adult = 0). A patient&#8217;s T score of +\/- 1 SD is considered normal. A T score between -1 to -2.5 is characteristic of osteopenia. A T score lower than -2.5 is characteristic of osteoporosis.<\/figcaption><\/figure>\n<p><strong>Rickets<\/strong> and <strong>osteomalacia<\/strong> are different that osteopenia and osteoporosis, in that both rickets and osteomalacia are characterized by &#8220;soft bones&#8221;.\u00a0 The affected bones contain the organic components (e.g., osteoid) but have low levels of mineralization (calcium and phosphate content), making the bones softer and more pliant.<\/p>\n<p>Osteopenia typically occurs to bones prior to the development of osteoporosis.\u00a0 The degree of bone loss is less than that of osteoporosis.\u00a0 Osteopenia is characterized by the loss of bone density in a manner that is asymptomatic.<\/p>\n<h3><strong>Risk Factors &#8211; Osteoporosis<\/strong><\/h3>\n<p>There are many risk factors for the development of osteoporosis and most contribute over the course of many years.\u00a0 Age is the biggest risk factor for osteoporosis, affecting 10% of all Canadians &gt;40 years of age and &gt;21% of all post-menopausal females.\u00a0 Statistics in the USA are similar.<\/p>\n<p>Certainly, <strong>lifestyle factors<\/strong> are known to contribute to the development of osteoporosis.\u00a0 For example:<\/p>\n<ul>\n<li>sedentary behaviour<\/li>\n<li>smoking<\/li>\n<li>nutritional deficits<\/li>\n<\/ul>\n<p><strong>Primary Osteoporosis:\u00a0<\/strong> There are 2 forms of primary osteoporosis (post-menopausal and age-associated osteoporosis).\u00a0 <strong>Post-menopausal osteoporosis<\/strong> is self explanatory in that females are more at risk of developing osteoporosis when estrogen levels decrease after menopause.\u00a0 <strong>Age-associated osteoporosis<\/strong> is common after 70 years of age for females and males as bone loss speeds up post-menopause and post-andropause.\u00a0 It is estimated that 50% of biological females and 21% of biological males will experience at least one fracture associated with osteoporosis during their life time.\u00a0 The most common bone fractures occur in the femur neck, vertebrae, and wrists.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>Secondary Osteoporosis:\u00a0<\/strong> Certain diseases, deficiencies, and medications can cause osteoporosis and in this case the term secondary osteoporosis is applied.\u00a0 <strong>Juvenile osteoporosis<\/strong> is often secondary to an underlying disease or deficiency and is characterized by an age of onset of 8-14 years.\u00a0\u00a0Examples of risk factors, conditions, and\/or diseases that can lead to osteoporosis include:<\/p>\n<p><strong>1. Genetics:<\/strong><\/p>\n<ul>\n<li>Certain genetic conditions are depicted by mutations in genes that affect specific proteins (e.g., fibrillin and collagen) that play key roles in bone.\u00a0 Examples include: <strong>Marfan Syndrome<\/strong> and <strong>Osteogenesis Imperfecta<\/strong>\n<ul>\n<li><strong>Family history<\/strong> is a risk factor, suggesting the inheritance of genetic susceptibilities.\u00a0 Along the same line, genetics plays a role in the susceptibility of certain ethnicities (White and Asian) being more at risk for osteoporosis.<\/li>\n<li><strong>Thin-boned, slender females and males<\/strong> are more at risk for osteoporosis, as there is less bone to lose before structural strength is compromised.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>2. Sex Hormone Levels:<\/strong><\/p>\n<ul>\n<li><strong>Reduced level or duration of exposure to sex hormones<\/strong> puts one at risk for developing osteoporosis.\n<ul>\n<li>Amenorrhea, late menarche, early menopause, Turner Syndrome (X), Klinefelter Syndrome (XXY)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>3. Anabolic Hormone Levels:<\/strong><\/p>\n<ul>\n<li><strong>Endocrine Disorders: that lead to hormone deficiencies in anabolic hormones<\/strong> (e.g., sex hormones, thyroid hormone, growth hormone, insulin)\n<ul>\n<li><strong>Diabetes mellitus<\/strong> is a risk factor as lack of insulin or insulin insensitivity leads to poor uptake of cellular building blocks (e.g., glucose and amino acids) that are required by bone cells.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>4. Catabolic Hormone Levels:<\/strong><\/p>\n<ul>\n<li><strong>Endocrine Disorders that lead to overproduction of hormones that are catabolic<\/strong> (e.g., cortisol, parathyroid hormone).<\/li>\n<\/ul>\n<p><strong>5. Hyperthyroidism<\/strong><\/p>\n<ul>\n<li>While normal levels of thyroid hormone are important for bone growth and maintenance, excess thyroid hormone in adults is reported to induce the activity of both osteoclasts and osteoblasts, with the net effect of bone loss.<\/li>\n<\/ul>\n<p><strong>6.\u00a0 Pregnancy,<\/strong> though occurring very rarely, is a risk factor for osteoporosis.<\/p>\n<ul>\n<li>During pregnancy, increased bone resorption can be stimulated to support calcium needs of fetal growth and lactation.<\/li>\n<\/ul>\n<p><strong>7. Malabsorption Syndromes or Dietary Deficiency States:<\/strong><\/p>\n<ul>\n<li><strong>Celiac disease, Cystic Fibrosis, Anorexia Nervosa, Bulimia Nervosa, Gastric Bypass surgery, Alcoholism, and\/or Malnutrition<\/strong> can lead to deficiencies in vitamin D, and the vital building blocks for bone (e.g., calcium, magnesium, and amino acids.<\/li>\n<\/ul>\n<p><strong>8. Chronic Inflammatory Diseases:<\/strong><\/p>\n<ul>\n<li><strong>Systemic Lupus Erythematosus, Rheumatoid Arthritis (RA),<\/strong> and<strong> Crohn&#8217;s disease <\/strong>all are characterized by increased levels of pro-inflammatory cytokines and activated white blood cells.\u00a0 It is thought that pro-inflammatory cytokines increase osteoclast activity and decrease the activity of osteoblasts making one susceptible to osteoporosis.\u00a0 Plus the repetitive damage to the bone ends with <strong>RA,<\/strong> makes those regions susceptible to osteoporosis.\u00a0 Likewise, severe <strong>osteoarthritis<\/strong> is a risk factor for osteoporosis for the same reasons (plus the <strong>immobility\/sedentary behaviour<\/strong> that can occur with OA and RA due to pain experienced on movement).<\/li>\n<\/ul>\n<p><strong>9. Reduced Oxygen Supply to Bones:<\/strong><\/p>\n<ul>\n<li><strong>Blood diseases:<\/strong> Sickle Cell anemia, chemotherapy-induced anemia, and blood cancers can lead to reduced delivery of nutrients and oxygen to bone cells, which is a risk factor for osteoporosis.<\/li>\n<li><strong>Poor oxygenation<\/strong> due to Chronic Obstructive Pulmonary Disorder (COPD, e.g., emphysema) or Chronic Heart Failure (CHF)<\/li>\n<\/ul>\n<p><strong>10. Reduced Weight-Bearing Activities and Sedentary Behaviour<\/strong><\/p>\n<ul>\n<li><strong>Immobility,<\/strong> for example reduces the activity levels of osteocytes and osteoblasts leading to less osteoid production and calcification, resulting in bone atrophy (e.g., lower bone density).<\/li>\n<\/ul>\n<p><strong>11. Catabolic Medications:<\/strong><\/p>\n<ul>\n<li>Medications (e.g., <strong>corticosteroids)<\/strong> decrease the activity levels of osteocytes and osteoblasts leading to less osteoid production and calcification, resulting in bone atrophy (e.g., lower bone density).<\/li>\n<\/ul>\n<h3><strong>Signs and Symptoms &#8211; Osteoporosis<\/strong><\/h3>\n<p>Osteoporosis develops slowly and <strong>asymptomatically<\/strong> often not being diagnosed until fractures or bone pain occur.<\/p>\n<p><strong>Vertebral compression fracture<\/strong>s are common, two-thirds of which are <strong>painless,<\/strong> though result in stooped posture <strong>(kyphosis)<\/strong> and <strong>loss of height<\/strong>. If <strong>pain<\/strong> does occur, it is either sharp or dull and may become worse with movement.\u00a0 Vertebral fractures can cause <strong>muscle spasms<\/strong>.\u00a0 A decrease in height of 2-3 cm occurs with each vertebral fracture<\/p>\n<p>Falls can result in <strong>hip fractures<\/strong>, <strong>sacral insufficiency fractures,<\/strong> <strong>Colles fractures<\/strong> (of the distal radius and possibly ulna).<\/p>\n<p>Hip fractures are common, with the fracture most often occurring in the proximal femur (e.g., femur neck).<\/p>\n<h3><strong>Diagnosis &#8211; Osteoporosis<\/strong><\/h3>\n<p><strong>Physical examinations<\/strong> to assess for loss of height, kyphosis, signs of fractures, and any loss of muscle strength and balance (to determine risk of frailty and falling)<\/p>\n<p>Typically, <strong>blood tests<\/strong> are performed to test for:<\/p>\n<ul>\n<li>anemia (using complete blood count)<\/li>\n<li>vitamin D levels<\/li>\n<li>calcium levels<\/li>\n<li>sex hormone levels<\/li>\n<\/ul>\n<p><strong>Bone density<\/strong> measurements using dual-energy x-ray absorptiometry (DXA)<\/p>\n<p><strong>Imaging<\/strong> (e.g., CT scan, SPECT, MRI, Ultrasonography, bone scans) can be used to find bone lesions,<\/p>\n<p><strong>Bone biopsies<\/strong> can be done to exclude any bone pathologies<\/p>\n<p>Some tests are done to rule out other problems (e.g., with thyroid, liver, kidney, etc.) that may contribute to osteoporosis.<\/p>\n<h3><strong>Prevention and Treatment &#8211; Osteoporosis<\/strong><\/h3>\n<p>Prevention of osteoporosis is important as osteoporosis is not curable and develops over the course of one&#8217;s life.<\/p>\n<p>Both prevention and treatment involve lifestyle adaptations which include:<\/p>\n<ul>\n<li>weight-bearing and muscle strengthening exercises<\/li>\n<li>healthy diet with recommended levels of calcium and vitamin D included<\/li>\n<li>limiting alcohol and caffeine consumption<\/li>\n<li>smoking cessation<\/li>\n<\/ul>\n<p>Treatment of osteoporosis can involve anti-osteoporosis medications (e.g., bisphosphonates), vertebroplasty, orthotics, healing of fractures, hormone (e.g., estrogen) replacement therapy<\/p>\n<p>Physical and occupational therapy can be helpful in addition to home adaptations to reduce risk of falls (e.g., hand rails, replacing slippery flooring)<\/p>\n<p>At times treatment for depression and pain is required particularly with the development of kyphosis.<\/p>\n<p>An additional goal of treatment involves keeping a person mobile as long as possible as immobility brings additional risk factors (e.g., deep vein thrombosis and pressure ulcers).<\/p>\n<p>&nbsp;<\/p>\n<h1><span style=\"text-decoration: underline\"><strong>Osteopenia and Osteoporosis Summary:<\/strong><\/span><\/h1>\n<ul>\n<li style=\"font-weight: 400\">\u00a0Osteoporosis:\n<ul>\n<li style=\"font-weight: 400\">Chronic disease of older adults.<\/li>\n<li style=\"font-weight: 400\">Old cortical and trabecular bone resorbed faster than new bone formed.<\/li>\n<li style=\"font-weight: 400\">Decrease in osteoblast activity, increase in osteoclast activity.<\/li>\n<li style=\"font-weight: 400\">Common sites: femoral neck, vertebrae, wrists.<\/li>\n<li style=\"font-weight: 400\">Hormonal influence: estrogen and testosterone levels affect osteoblast activity.<\/li>\n<li style=\"font-weight: 400\">Risk factors: aging, hormonal changes, sedentary lifestyle, smoking, glucocorticoids use, early menopause, low calcium\/vitamin D diet, genetics, excessive alcohol\/caffeine.<\/li>\n<li style=\"font-weight: 400\">Diagnosis: bone density scan, serum\/urine calcium\/phosphate levels.<\/li>\n<li style=\"font-weight: 400\">Prevention: diet, exercise, weight-bearing exercises, bisphosphonates.<\/li>\n<li style=\"font-weight: 400\">Treatment: physiotherapy, pain management, prevention of further bone loss.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<div class=\"textbox textbox--learning-objectives\">\n<header class=\"textbox__header\">\n<p class=\"textbox__title\"><strong>Key Take Aways &#8211; Specific Learning Objectives Study Guide<\/strong><\/p>\n<\/header>\n<div class=\"textbox__content\">\n<h2 class=\"textbox__content\"><strong style=\"text-align: initial;font-size: 1em\">Osteopenia and Osteoporosis:<\/strong><\/h2>\n<div class=\"textbox__content\">\n<p><span style=\"text-align: initial;font-size: 1em\">Both are bone weakening diseases characterized by reduced bone volume due to loss of both:<\/span><\/p>\n<ul>\n<li>Organic bone matrix (osteoid) = collagen, glycoproteins and proteoglycans<\/li>\n<li>Inorganic bone matrix (calcium salts\/minerals) = CaPO<sub>4<\/sub><\/li>\n<li><span style=\"font-size: 1em;text-align: initial\">Osteoporosis is more severe than osteopenia and is depicted by greater loss of bone volume and bone density putting an individual at risk for low-impact bone fractures.<\/span><\/li>\n<li>Osteopenia can be treated by ensuring sufficient dietary nutrients required for bone maintenance as well as taking part in regular recommended exercises (e.g., prescribed weight-training).<\/li>\n<li>Osteoporosis is characterized by irreplaceable loss of bone microstructure and density.<\/li>\n<\/ul>\n<h2><strong style=\"text-align: initial;font-size: 1em\">Osteoporosis:<\/strong><\/h2>\n<p>Osteoporosis is considered a chronic disease that affects many older adults, in which old cortical (compact) and trabecular (spongy\/cancellous) bone is being resorbed faster than new bone matrix is being made.\u00a0 The most severe loss of bone density typically occurs in the femoral neck, vertebrae, and wrist.\u00a0 Bone maintenance and synthesis is impacted by various hormone levels:\u00a0 Thyroid Hormone (TH), Cortisol, Growth Hormone (GH), estrogen and testosterone are important for maintaining osteoblast activity.\u00a0 Lower levels of estrogen and testosterone in old age, result in lower levels of osteoblast activity.<\/p>\n<div>\n<p><strong>Risk factors:<\/strong><\/p>\n<ul>\n<li>age<\/li>\n<li><span style=\"font-size: 1em\">post-menopausal biological (XX) females due to lower estrogen levels<\/span><\/li>\n<li>early menopause<\/li>\n<li>sedentary lifestyle<\/li>\n<li>use of corticosteroids (e.g., glucocorticoids)<\/li>\n<li>low intake of dietary Ca<sup>++<\/sup> and\/or vitamin D<\/li>\n<li>excessive alcohol or caffeine<\/li>\n<li>smoking<\/li>\n<li>rheumatic arthritis<\/li>\n<li>diabetes mellitus<\/li>\n<li>genetics<\/li>\n<\/ul>\n<p><strong>Categories of Osteoporosis:<\/strong><\/p>\n<ul>\n<li><strong>1st Degree Osteoporosis<\/strong> = due to age related decreases in hormones (e.g., sex hormones)<\/li>\n<li><strong>2nd Degree Osteoporosis<\/strong> = due to underlying disease\n<ul>\n<li>Celiac disease, due to malabsorption of Ca++ and\/or vitamin D<\/li>\n<li>Hyperthyroidism, due to increased metabolic activity<\/li>\n<li>Hyperparathyroidism due to increased osteoclast activity<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><strong>Signs &amp; Symptoms:<\/strong> low-impact fractures (1.5 million\/yr in USA), hip fractures, height reduction, kyphosis, vertebral compression fractures<\/p>\n<p><strong>Routine Check-Ups:\u00a0 <\/strong>regular bone mass density scan tests after the age of 50<\/p>\n<p><strong>Diagnostic Evaluation:<\/strong><\/p>\n<ul>\n<li>monitoring bone density using dual energy X-ray absorptiometry (DEXA) or other imaging (CT scans, MRI)<\/li>\n<li>monitoring serum\/urine\u00a0 for low serum levels of Ca++, PO<sub>4<\/sub>,\u00a0 low levels of parathyroid hormone (PTH),<\/li>\n<li>assessing for bone deformities<\/li>\n<\/ul>\n<p><strong>Prevention: <\/strong>through avoidance of modifiable risk factors<\/p>\n<p><strong>Treatment:<\/strong><\/p>\n<ul>\n<li>pain management<\/li>\n<li>bisphosphonates (work by decreasing osteoclast activity)<\/li>\n<li>weight-bearing exercises<\/li>\n<li>calcium carbonate and vitamin D supplementation<\/li>\n<\/ul>\n<ul>\n<li style=\"font-weight: 400\">Vitamin D Recommended Dietary Allowance for adults 19 years and older is 600 IU (15 mcg) daily for men and women, and for adults &gt;70 years it is 800 IU (20 mcg) daily.<\/li>\n<li style=\"font-weight: 400\">Caution should be used not to exceed this dosage as vitamin D can build up to excessive and harmful levels in the body.<\/li>\n<\/ul>\n<p><strong>Physiotherapy:<\/strong>\u00a0 to alleviate pain &amp; maintain function of muscles, tendons, and nerves, recommendations include use of proper warm-up, appropriate equipment, training.<\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"media-attributions clear\" prefix:cc=\"http:\/\/creativecommons.org\/ns#\" prefix:dc=\"http:\/\/purl.org\/dc\/terms\/\"><h2>Media Attributions<\/h2><ul><li >Comparative-view-of-normal-bone-osteopenia-and-osteoporosis-26-Reproduced-under-the  &copy;  <a rel=\"dc:creator\" href=\"https:\/\/www.researchgate.net\/publication\/340836563_Advances_in_Sensing_Technologies_for_Monitoring_of_Bone_Health\" property=\"cc:attributionName\">Rani, Seema & Bandyopadhyay-Ghosh, Sanchita & Ghosh, Subrata & Liu, Guozhen.<\/a>    is licensed under a  <a rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY (Attribution)<\/a> license<\/li><\/ul><\/div>","protected":false},"author":1370,"menu_order":26,"template":"","meta":{"pb_show_title":"on","pb_short_title":"Pictures coming soon!","pb_subtitle":"","pb_authors":["zoe-soon"],"pb_section_license":"cc-by-nc-sa"},"chapter-type":[48],"contributor":[60],"license":[57],"class_list":["post-1486","chapter","type-chapter","status-web-only","hentry","chapter-type-standard","contributor-zoe-soon","license-cc-by-nc-sa"],"part":41,"_links":{"self":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1486","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/users\/1370"}],"version-history":[{"count":25,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1486\/revisions"}],"predecessor-version":[{"id":4549,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1486\/revisions\/4549"}],"part":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/parts\/41"}],"metadata":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapters\/1486\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/media?parent=1486"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/pressbooks\/v2\/chapter-type?post=1486"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/contributor?post=1486"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/pressbooks.bccampus.ca\/pathophysiology\/wp-json\/wp\/v2\/license?post=1486"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}