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Osteoporosis
Osteoporosis also known as “bone thinning disease” or “brittle bone disease” is a disease of bones in which bones gradually become thinner, weaker and more brittle due to decrease in bone mass density (BMD). In Greek, “Osteo” comes from word Osteon meaning bones and “porosis” comes from word poros meaning porous or hole. This weakening of bones increases the risk of fractures particularly fractures of wrists, hips and spine (1)
SYMPTOMS
Osteoporosis is known as a silent disease because it causes no symptoms in its earlier stage. Earlier signs would be difficulty in standing and, sitting up straight and severe joint pains. The disease gradually develops and in later stage may cause pain in the bones and the muscles. Symptoms vary depending upon individual, severity and course of disease. Gradually, the deceased feels sharp pain which may not be radiating pain but worsens by doing activity that involves putting pressure of weight on that area. Pain is generally accompanied with tenderness which may subside within a week or may remain over three months. Difficulty with easy movements and acts of daily life like getting up from a chair, walking or taking shower are common signs to consider. Most common symptoms of osteoporosis are the fractures of wrist, hip and spine. Fractures signals that the disease is in its final stages and much damage has made to the bones already, making it weak and thin and most susceptible to easy fractures. Fractures occur with negligible trauma and patients fail to recall the fall or trauma that could have caused it. Spinal compression fracture may be recognized by sudden severe back pain, especially in older women. Spinal compression fractures results in loss of height and kyphosis called dowager’s hump. Spinal bone fractures cause severe back pain and neck pain. The most considerable warning sign for disease is osteopenia in which bones are only mildly thin but are most susceptible to cause osteoporosis. PROGRESSION
Progression of osteoporosis is characterized by imbalance between bone formation activity (building new bones cells - osteoblasts) and bone reabsorption (bone cell loss - osteoclasts). A relative decline in bone formation activity occurs which causes increase in bone loss. (http://resources.metapress.com/pdf-preview.axd?code=t72651647251w165&size=largest). The bone density decreases further deteriorating the microarchitecture of the bone and making them fragile and weak. Body needs calcium and phosphorous to build bones and Vitamin D to absorb the calcium from food and incorporate it into the bones. Body requires proper amounts of estrogen and testosterone to maintain BMD by promoting osteoblast activities and regulating osteoclast activities. In absence of either mineral or hormones, reabsorption takes place at higher pace than bone formation. The bone tissues resemble a honeycomb due to excessive osteoclasts, leaving holes in the bones and causing less bone-mineral density. Loss in bone density increases the risk of fractures. When bones fail to repair themselves, risk of arthritis occur which could now leave the patient seriously disabled and dependent. Although osteoporosis silently creeps into the patients and is not very painful, the weak bones are susceptible to fractures which are symptoms of pain and immobility. In case of hip fractures, patients are bed ridden for weeks and months which puts them at risks for pneumonia and blood clots. In many cases if required minerals like calcium and Vitamin D and hormones and other preventive methods are taken when osteopenia is diagnosed, osteoporosis can be slowed or halted. However, in some cases bone loss is so extensive and bone density is so low that bones progressively weaken and break. The most life threatening conditions are when the spinal bones break causing severe movement retentions and possible life time paralysis. Since it’s a silently progressing disease, most of the patients are diagnosed when