![]() ![]() Single photon and x-ray absorptiometry (SPA)ĭual energy x-ray absorptiometry ( DEXA ) Multiple x-ray based, gamma-ray based and ultrasonic methods are available: In tubular bones (especially metacarpals), there will be thinning of the cortexĬortical thickness <25% of the whole thickness of the metacarpal signifies osteoporosis (normally 25-33%)īone mineral density (BMD) measurement is the method of estimation of calcium hydroxyapatite. Loss of trabeculae in the proximal femur area, which is explained by Singh's index (and can also be seen in the calcaneum) Prominent vertical (primary) trabeculae with thinning of horizontal/secondary trabeculae in vertebral bodies Loss of cortical bone and trabecular bone ( ghost vertebra)Ĭompression fractures and vertebra plana ( Genant classification of vertebral fractures) Not a sensitive modality, as more than 30-50% bone loss is required to appreciate decreased bone density on a radiograph Nevertheless, dual energy x-ray absorptiometry (DEXA) is the gold standard of diagnosing osteoporosis 10. Bones like the vertebra, long bones (proximal femur), calcaneum and tubular bones are usually looked at for evidence of osteoporosis. There is a different list of secondary causes for juvenile osteoporosis with some overlap with adult causes.ĭecreased bone density can be appreciated by decreased cortical thickness and loss of bony trabeculae in the early stages in radiography. Duchenne muscular dystrophy) - can be due to inherent derangement in calcium metabolism or due to steroid treatment 9. steroids, phenytoin, some ART such as tenofovir disoproxil fumarate) COPD, chronic liver disease, multiple sclerosis, celiac disease) 7 Cushing syndrome, hyperthyroidism, hyperparathyroidism, diabetes mellitus) 7Ĭhronic illness (e.g. Secondary (type 3): occurs due to a range of causes includingĮndocrine disease (e.g. Senile (type 2): occurs in the elderly proportionate loss of cortical and cancellous bones affecting long bones Postmenopausal (type 1): occurs in 50-65-year-olds females disproportionate loss of cancellous bone as compared to cortical bone resulting in more involvement of cancellous bone-rich areas, like vertebrae and ends of long bones Osteoporosis can be localized or diffuse and be divided into: osteomalacia in which the mineral-to-osteoid ratio is decreased). Hence the mineral-to-osteoid ratio is normal (cf. ![]() There is no microstructural and biochemical change as occurs in osteomalacia or rickets. Osteoporosis is essentially decreased bony tissue per unit volume of bone. Osteoporosis per se is asymptomatic and is most often diagnosed when individuals are evaluated based on risk factors or following presentation with fragility fracture. ![]() HIV/AIDS, especially with some antiretroviral therapy (ART) (e.g. Other causes of secondary osteoporosis, including The following risk factors, in addition to femoral neck bone mineral density, are used in FRAX (Fracture Risk Assessment Tool), which calculates a 10-year probability of major osteoporotic fracture (hip, clinical spine, humerus, or wrist fracture) and hip fracture 11:īody mass index (lower body mass carries higher risk)ĭaily alcohol consumption of at least 3 unitsĮver long-term use of oral glucocorticoids (more than 3 months at a dose equivalent to as least 5 mg daily prednisolone) The WHO diagnostic criterion for osteoporosis is not sufficient to identify patients who are at high risk of fracture. ![]()
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