A- Type I:
– Postmenopausal osteoporosis. Occurs between 50 and 70 years
– Six times more common in women than in men
– Key predilection trabecular bone
– Fracture of the distal radius and vertebral collapse
B- Type II:
– Osteoporosis senile; comes after 70 years
– 2 times more common in women than in men
– It touches trabecular and cortical bone
– Results from postmenopausal osteopenia and especially bone loss associated with aging.
– It manifests itself mainly by the fracture of the proximal femur, pelvis and progressive partial vertebral fractures (kyphosis)
In fact, there is a pathophysiological continuity between these two types
2- Factors Risk of Osteoporosis:
* Constitutional: White Race, family history, small size and low weight
* Nutrition: Deficiency in calcium, vitamin D deficiency, protein deficiency
* Toxic: Tobacco, alcohol, drugs (corticosteroids, anticonvulsants, thyroid hormones
* Menopause: Early, surgery (oophorectomy), without hormonal treatment.
* Endocrine: Hyperadrenocorticism, hypogonadism, hyperthyroidism, hyperparathyroidism
* Activity: Physical inactivity and immobilization
3- Laboratory Tests:
A- Systematic Reviews:
– VS; CRP; blood count
– Electrophoresis of serum proteins
– creatinine
– Serum calcium, phosphorus, alkaline phosphatase
B- Comments:
These laboratory tests are usually normal in primary osteoporosis apart from the usual but transient elevation of alkaline phosphatase in the immediate waning of vertebral collapse.
The aim is to look for other osteopathies fractures (myeloma, primary hyperparathyroidism, osteomalacia)
4- Radiography:
A- Principles:
The most useful radiographs are:
– The face of cliche Basin
– The cliché of the lumbar spine, dorsal and lumbar hinge (F + P), supine
– Myeloma Suspicion -> Rx skull (F + P)
B- radiological signs:
– Striated appearance and combed in the vertical direction of the vertebral bodies
– Gradual Clearing the trabecular meshwork (uninhabited part of the body) and cortical thinning.
– Spinal Deformities: typically sitting in the thoracolumbar junction or lumbar spine (see below).
– Later moved Integrity; level <T4; preservation of the cortical
Vertebral deformities:
* Settling anterior wedge
* Vertebra biconcave
* Vertebra pancake (flattened)
5- Secondary Osteoporosis:
Glucocorticoid-induced osteoporosis: It is the most common and most severe; prolonged corticosteroid therapy context (asthma) +++
Male hypogonadism: Klinefelter Syndrome; hyperprolactinemia; pituitary origin; Hemochromatosis …
Dysthyroidism: Hypothyroidism (replacement therapy); hyperthyroidism (increased activity of osteoclasts)
6- Differential diagnosis:
Renal osteodystrophy: Quickly remove the assay of plasma creatinine, urea and serum calcium
Primary hyperparathyroidism: hypercalcemia; Abnormal elevation of PTH
Osteomalacia: See below
Myeloma: Bone pain; elevated ESR; geode with a punch (especially the skull)
Bone metastases: Achievement of the posterior wall, osteolysis and demineralization, VS sometimes high osteocondensation
osteomalacia:
– Installation of progressive inguinal femoral and buttock pain, chest and shoulder
– Trouble walking (waddling gait duck) by weak muscle belts
– Aspect blur of bone contours on Rx; cracks of Looser-Milkman (long bones, pelvis)
– Biology: hypocalcemia; hypophosphatemia, elevated alkaline phosphatase, hypocalciuria, elevated PTH
Note :
* Bone loss is related to a decrease (age-related) of bone formation; to which is added in women of Microarchi-tectural changes related to menopause => acceleration of bone turnover with many homes of osteoclastic resorption.
* Osteoporosis is defined by BMD values <2.5 standard deviations in women
* During aging, there is a very common vitamin D deficiency causing secondary hyperparathyroidism stimulating bone reabsorption.
7- Clinic:
* The settlements high cervical and dorsal are not osteoporotic
* The most common fractures: vertebral fracture and femoral neck fracture and the lower end of the radius
8- Biology:
The systematic review has to realize:
* Blood count, ESR, CRP, protein electrophoresis immunoelectrophoresis urine => remove myeloma
* TSH
* Serum calcium, phosphorus, creatinine
* 1 marker bone formation: serum osteocalcin, alkaline phosphatase
* 1 marker of bone resorption: serum CTX, NTX
9- bone X-ray:
Vertebral osteoporotic fractures meet several criteria:
* Decrease the height of the spine
* Respect the posterior wall
* Respect of the posterior arch
* Absence of osteolysis
* Absence of soft tissue damage
There are several types of osteoporotic FV
– Concave Vertebrae: depression of a vertebral endplate
– Vertebra biconcave: sinking of two endplates
– Vertebra wedge: with decreasing size of the posterior wall
– Vertebra pancake: full settlement
The spine is often the site of a bone hypertransparence diffuse vertebral body with a brushed appearance (loss of horizontal trabecular responsible for one aspect of striation) or mourning border (hollow horns and well highlighted by the conservation endplate ). Deformation (kyphosis, scoliosis).
+ CT: absence of osteolysis
+ Scan: hyperfixation