Defining Osteoporosis

Osteoporosis is derived from osteo and porous, osteo meaning bone, and the mean porous
with holes or porous. Thus, osteoporosis is bone loss, which is characteristic of the disease have
a low bone mass or less, accompanied by disturbances of bone and micro-architectural
deterioration of bone tissue, which can lead to bone fragility. According to the WHO
International Consensus Development Conference on osteoporosis is a disease with characteristic
properties of low bone mass, accompanied by changes in bone microarchitecture, and bone tissue
deterioration, which ultimately lead to increased bone fragility due to the risk of fractures.
When the bones of the body lose calcium, become weak, and break easily, it is called
osteoporosis. Bones may become so weak that they break during everyday activities such as
bending over or walking.
Osteoporosis is a disorder in which a decrease in total bone mass. There are changes in
the normal homeostasis of bone turnover, rate of bone resorption greater than the rate of bone
formation, bone mass decreased pengakibatkan total. Progressively become porous bones, brittle
and easily broken; bones become easier with the stress fracture that will not cause any effect on
normal bone.
Osteoporosis is a metabolic bone disease most frequently encountered. The disease is
often without complaint in which bone density decreases progressive destruction of bone
microarchitecture, so the bones become fragile, easily broken and do not etrdeteksi until fracture
occurred. Osteoporosis is a worldwide health problem and the incidence in whites by 13% with
the same age. Actually not only the disruption of calcium homeostasis as one
a risk factor for osteoporosis, but there are many factors factors others who have the role /
contribution, including the deficiency or insufficiency of vitamin D.
Osteoporosis Mekanism

Osteoporosis is an abnormality in the

process of bone remodeling in which bone
resorption exceeds bone formation causes loss of
bone mass. Bone mineralization still occurs.
Described by the balance of bone remodeling
function of osteoblasts and osteoclasts. Although
the stalled growth, bone remodeling continues.
This dynamic process involves resorbsi on one surface of the bone and deposition of bone
formation on the opposite side. This is influenced by weight bearing and gravity, as well as
issues such as systemic disease. Cellular processes carried out by cell specific bone and
modulated by local and systemic hormones and peptides.
Bone remodeling occurs at each surface of the bone and continues throughout life. If it
remains in the adult bone mass, indicating a balance between bone formation and resorption.
This balance is carried out by osteoblasts and osteoclasts in bone remodeling unit. Remodeling is
needed to maintain bone strength.

Differences in bone in normal individuals with those who have osteoporosis :

Classification of Osteoporosis
1. Primary osteoporosis
Primary osteoporosis associated with aging and decreased gonadal hormone activity.
Primary osteoporosis is divided into two types. Type I (high turnover osteoporosis) in the
form of a rapid decline in bone mass due to increased resorbsi of osteoclasts and type II
(low turnover osteoporosis) due to a gradual increase in osteoclast activity in people with
chronic pain or insufficiency intake. The following risk factors for primary osteoporosis :
Caucasians or Asian race
Family history of osteoporosis
History of anorexia nervosa and / or amenorrhoea
Peak bone mass is low adulthood
The onset of early menopause
Hysterectomy is premature
Insufficient intake
Alcoholism
Smoking
Physical activity of excess
2. Secondary osteoporosis
Secondary osteoporosis experienced by less than 5% of patients with osteoporosis, which
is caused by another medical condition or by medications. Osteoporosisbisa disease
caused by chronic renal failure and hormonal disorders (particularly thyroid, and
parathyroid, adrenal) and drugs (eg corticosteroids, barbiturates, anti-seizure and
excessive thyroid hormone). Excessive alcohol consumption and smoking can aggravate
the condition of osteoporosis.
Patients are said to have primary osteoporosis when a secondary cause of
osteoporosis cannot be identified, including juvenile and idiopathic osteoporosis.
Idiopathic osteoporosis can be further subdivided into postmenopausal (type I) and ageassociated or senile (type II) osteoporosis, as described in Table 2, below.
Table 2. Types of Primary Osteoporosis
Type of Primary Osteoporosis
Characteristics
Juvenile osteoporosis
Usually occurs in children or young adults

of both sexes

Normal gonadal function

Age of onset: usually 8-14 years

Hallmark characteristic: abrupt bone pain

and/or a fracture following trauma

Occurs in women aged 50-65 years

Characterized by a phase of accelerated

bone loss, primarily from trabecular bone

Fractures of the distal forearm and vertebral

bodies common

Occurs in women and men older than 70

years

Represents bone loss associated with aging

Fractures occur in cortical and trabecular

bone

Wrist, vertebral, and hip fractures often seen

in patients with type II osteoporosis

Idiopathic osteoporosis

Postmenopausal osteoporosis (type I

osteoporosis)

Age-associated or senile
osteoporosis (type II osteoporosis)

Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes

osteoporosis (see Table 3, below). Up to one third of postmenopausal women, as well as many
men and premenopausal women, have a coexisting cause of bone loss,[21, 22] of which renal
hypercalciuria is one of the most important secondary causes of osteoporosis and treatable with
thiazide diuretics.[23]
Cause Examples

Genetic/congenital

Renal hypercalciuria one of the most important secondary causes of osteoporosis; can
be treated with thiazide diuretics

Cystic fibrosis

Ehlers-Danlos syndrome

Glycogen storage disease

Gaucher disease

Marfan syndrome

Menkes steely hair syndrome

Riley-Day syndrome

Osteogenesis imperfecta

Hemochromatosis

Homocystinuria

Hypophosphatasia

Idiopathic hypercalciuria

Porphyria

Hypogonadal states

Hypogonadal states

Androgen insensitivity

Anorexia nervosa/bulimia nervosa

Female athlete triad

Hyperprolactinemia

Panhypopituitarism

Premature menopause

Turner syndrome

Klinefelter syndrome

Endocrine disorders[24]

Cushing syndrome

Diabetes mellitus

Acromegaly

Adrenal insufficiency

Estrogen deficiency

Hyperparathyroidism

Hyperthyroidism

Hypogonadism

Pregnancy

Prolactinoma

Deficiency states

Calcium deficiency

Magnesium deficiency

Protein deficiency

Vitamin D deficiency[24, 25]

Bariatric surgery

Celiac disease

Gastrectomy

Malabsorption

Malnutrition

Parenteral nutrition

Primary biliary cirrhosis

Inflammatory diseases

Inflammatory bowel disease

Ankylosing spondylitis

Rheumatoid arthritis

Systemic lupus erythematosus

Hematologic and neoplastic disorders

Hemochromatosis

Hemophilia

Leukemia

Lymphoma

Multiple myeloma

Sickle cell anemia

Systemic mastocytosis

Thalassemia

Metastatic disease

Medications

Anticonvulsants: phenytoin, barbiturates, carbamazepine (these agents are associated

with treatment-induced vitamin D deficiency)

Antipsychotic drugs

Antiretroviral drugs

Aromatase inhibitors: exemestane, anastrozole

Chemotherapeutic/transplant drugs: cyclosporine, tacrolimus, platinum compounds,

cyclophosphamide, ifosfamide, high-dose methotrexate[26]

Furosemide

Glucocorticoids and corticotropin[27] : prednisone (5 mg/day for 3 mo)[28]

Heparin (long term)

Hormonal/endocrine therapies: gonadotropin-releasing hormone (GnRH) agonists,

luteinizing hormone-releasing hormone (LHRH) analogues, depomedroxyprogesterone,
excessive thyroxine

Lithium

Selective serotonin reuptake inhibitors (SSRIs)

Miscellaneous

Alcoholism

Amyloidosis

Chronic metabolic acidosis

Congestive heart failure

Depression

Emphysema

Chronic or end-stage renal disease

Chronic liver disease

HIV/AIDS

Idiopathic scoliosis

Immobility

Multiple sclerosis

Ochronosis

Organ transplantation

Pregnancy/lactation

Sarcoidosis

Weightlessness

Risk Factor for Osteoporosis

Risk factors for osteoporosis, such as advanced age and reduced bone mineral density
(BMD), have been established by virtue of their direct and strong relationship to the incidence of
fractures; however, many other factors have been considered risk factors based on their
relationship to BMD as a surrogate indicator of osteoporosis.
Risk factors for osteoporosis include the following[29, 30, 31] :

Advanced age (50 years)

Female sex

White or Asian ethnicity

Genetic factors, such as a family history of osteoporosis

Thin build or small stature (eg, body weight less than 127 lb)

Amenorrhea

Late menarche

Early menopause

Postmenopausal state

Physical inactivity or immobilization[32]

Use of drugs: anticonvulsants, systemic steroids, thyroid supplements, heparin,

chemotherapeutic agents, insulin

Alcohol and tobacco use

Androgen[33] or estrogen deficiency

Calcium deficiency

Dowager hump

Osteoporosis Radiologic
Radiological examination to assess bone mass density is not sensitive.Deteksi osteoporosis on
plain films require at least a 30% reduction massatulang. Picture of a typical radiology is
dandaerah trabecular thinning of the cortex are more lusen. This will appear on the bones of
vertebraeyang gives an overview picture foramen vertebrae.