PATHOPHYSIOLOGY OF OSTEOPOROSIS

Normal bone remodeling in the adult results in gradually increased bone mass until the early 30s .Gender, race, genetics, aging, low body weight and body mass index, nutrition, lifestyle choices and physical activity influence peak bone mass and development osteoporosis. Osteoporosis is characterized by reduced bone mass, deterioration of bone matrix, and diminished bone architectural strength. Normal homeostatic bone turnover is altered; the rate of bone resorption that is maintained by osteoclasts is greater than the rate of bone formation that is maintained by osteoblasts, resulting in a reduced total bone mass. The bones become progressively porous, brittle, and fragile; they fracture easily under stresses that would not break normal bone. These increase susceptibility to fracture, which occur most commonly as compression fracture of the thoracic and lumbar spine, hip fractures. This fracture may be first clinical manifestation of osteoporosis. The gradual collapse of a vertebra may be asymptomatic; it is observed as progressive kyphosis. With the development of kyphosis there is an associated loss of height. Aged-related loss begins soon after the peak bone mass is achieved. Calcitonin, which inhibits bone resorption and promotes bone formation, is decreased. Estrogen, which inhibits bone breakdown, decreases with aging. On the other hand, parathyroid hormone (PTH) increases with aging, increasing bone turnover and resorption. The withdrawal of estrogens at menopause or with oophorectomy causes an accelerated bone resorption that continues during the postmenopausal years. Women develop osteoporosis more frequently and more extensively than men because of lower peak bone mass and effect of estrogen loss during menopause.

DIAGRAM
Predisposing factors: Age Race Gender Genetics Precipitating Factors: Nutrition Physical exercises Lifestyle Medication

Low bone mass

Deterioration of bone matrix

Diminished bone architectural strength

Bone resorption Osteoclasts Reduced total bone mass

Bone formation Osteoblasts

Porous

Brittle

Fragile

If treated
Lifestyle changes @Quitting cigarette smoking @Stop excessive alcohol intake @exercising regularly @balanced diet

If not treated Lead to complication Fracture Thoracic Lumbar spine Hip fractures

Medication @Risedronate @Alendronate @Raloxifene @Ibandronate @Teriparatide

RECOVERY