Osteoporosis is a multifactorial skeletal disease characterized by severe bone loss and disruption of skeletal micro-architecture sufficient to predispose to atraumatic fractures of the vertebral column, upper femur; distal radius, proximal humerus, pubic rami and ribs.
Postmenopausal osteoporosis (Type I) is the most common form in Caucasian and Asian women. It is due to excessive and prolonged acceleration of bone resorption following menopausal loss of estrogen secretion. Involutional osteoporosis (Type II) occurs in both sexes above age 75. It is due to a subtle, prolonged imbalance between rates of bone resorption and formation. A mixture of Types I and II are common.
Idiopathic osteoporosis is a rare form of primary osteoporosis occurring in premenopausal women and in men below age 75. Not related to secondary causes or risk factors predisposing to bone loss. The cause is unknown.
Secondary osteoporosis is severe bone loss sufficient to cause atraumatic fractures due to extrinsic factors such as corticosteroid excess, rheumatoid arthritis, chronic liver or kidney disease, malabsorption syndromes, systemic mastocytosis, hyperparathyroidism, hyperthyroidism, a variety of hypogonadal states, and others
Dietary risk factors for osteoporosis include inadequate calcium, excessive phosphate or protein; and inadequate vitamin D intake in the elderly. Physical risk factors for osteoporosis include immobilization, and a sedentary lifestyle. Social isk factors for osteoporosis include alcohol, cigarettes, and caffeine. Medical risk factors for osteoporosis include chronic diseases, and endocrine disorders. Genetic or familial risk factors include suboptimal bone mass at maturity, and "familial fast bone losers"
Drug induced risk factors for osteoporosis include corticosteroids, excess thyroid hormone replacement, chronic heparin, chemotherapy, loop diuretics, anticonvulsants, and radiation therapy.
All "routine" tests usually normal. Alkaline phosphatase (bone specific and total) may be transiently increased following fractures. Serum osteocalcin, if high, indicates high turnover type.
Urine calcium levels are normal. Serum and/or urine protein electrophoresis are normal. Thyroid function tests and urinary free cortisol normal in primary types.
Urinary pyridinium and N-telopeptide collagen crosslinks, if high, indicates high turnover type.
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