Senile osteomalacia


Senile osteomalacia

Description, Causes and Risk Factors:

ICD-10: M83.1.

Senile osteomalacia is a multifactorial skeletal disease, characterized by a reduction in bone mass and deterioration of the micro-architectural structure of bone tissue, with a resulting increase of bone fragility and of fracture risk.

The primary evolutionary function of the bones is to bear the muscle contraction - and gravity-induced mechanical forces exerted on them without breaking, and ultimately, to enable the efficient locomotion of the body. To successfully carry out this locomotive function, the bone tissue is equipped with a mechano-sensory system that facilitates the skeletal adaptation to loading. In essence, bones first sense the loading-induced deformation and then elicit a response that eventually results in an appropriate modification of the bone structure, if required, to cope with the altered loading milieu. It has been recently proposed that the pathogenesis of senile osteomalacia (i.e., the gradual loss of mineral from bones with aging) would be attributable to a failure of this control system: either the mechano-sensitivity of bones is reduced or the capacity of bones to respond to loading is weakened. An alternative pathomechanistic theory suggests that bone loss in senescence represents simply an appropriate response to reduced loading in a less active host.

Regarding the skeletal mechano-responsiveness per se, both systemic factors (hormones such as estrogen and growth hormone) and local factors (growth factors such as insulin-like growth factor 1 and 2) have been shown to have a direct modulatory effect. Also, individual responses to mechanical stimuli have been shown to depend on genetics and gender, whereas the influence of age on bone mechano-responsiveness has remained controversial. The accumulation of adipocytes to the bone marrow during aging has been speculated to accelerate endocortical resorption, whereas it has been shown that periosteal expansion continues well into old age, particularly in men, implying that the mechanosensory system may be properly functioning. Experimental studies have shown that the responsiveness of the aged skeleton is increased, reduced, or unaffected.

Risk factors for senile osteomalacia are multiple, stretching from chromosomal abnormalities (e.g. osteogenesis imperfecta, homocystinuria, Down's syndrome etc.) to a genetic predisposition, to chronic diseases such as liver cirrhosis, hyperthyroidism, vitamin D deficiency, tumors that infiltrate the bone marrow and many more. The most frequent cause, however, is the age-related osteoporosis due to hormonal imbalance in women around the time of their menopause with subsequent lowering of their estrogen levels. This drop in the estrogen level can also be the result of a hysterectomy with bilateral oophorectomy, i.e. the removal of both ovaries. Another very important cause, at least temporary, osteoporosis can be found in long-term immobility of the body or of individual bones. The former may be due to long lasting bed-rest because of a chronic disease process, and the latter may be the result of bone fractures with extended bed-rest requirements. Also, a sedentary life-style such as most office jobs in a predominantly sitting position, as well as smoking and excessive consumption of alcohol, can accelerate the development of senile osteopenia.

Symptoms:

In Senile osteomalacia, general back pain, hip pain or associated muscle pain may arise, as well as problems with carrying or lifting heavy objects. Senile osteomalaciais also associated with an increased risk of bone fractures and it is often only at the time of a fracture that the degree of the disease is get diagnosed.

Diagnosis:

Bone mass, or bone density, can be determined by special computer-associated x-ray machines (densitometry) at the wrist, the hip bone or the lower vertebrae of the spinal column. This non-invasive examination can be performed within just a few minutes by specially trained and equipped physicians in their private practice, as well as in any major hospital. First measurements for women are recommended in their mid-thirties, after their bone peak mass has been achieved, and at the beginning of their menopause in order to establish a 'base-line' picture of their bone density, followed by regular examinations every 2 years or according to the suggestions of the physician who can best determine the individual needs.

senile osteomalacia

Treatment:

Senile osteomalacia cannot yet be successfully reversed. It can only be stopped, or rather, slowed down, if preventive treatment is introduced before bone loss has occurred. Especially in women, estrogen replacement therapy at the time of menopause, is recommended. The addition of a progesterone derivative prevents the otherwise increased change of developing endometrial cancer. The somewhat increased risk of developing breast cancer on a long-term estrogen therapy is only significant if there is a family history of breast cancer. Otherwise, the benefits that accompany estrogen therapy in regard to delayed development of osteoporosis as well as the significant decrease in cardiac failures outweigh the risks. In severe cases, ingestion of fluorides produces new bone tissue which is, however, of lesser quality and therefore with less ability to withstand the daily stress that is put upon the skeleton. Regular, light exercise like daily walks, and vitamin D supplements (1,000 to 1,500 mg/day) are recommended.

NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.

DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.

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