Osteoporosis definition

Once the bone mineral density report is available, T-scores and Z-scores are useful tools in interpreting the data. The T-score is the number of standard deviations from the mean bone mineral density in healthy young white women. Osteoporosis is defined as a T-score at least -2.5 standard deviations below the mean (Table 53-3). Osteopenia, or low bone mass that eventually may lead to osteoporosis, is defined as a T-score between -2.5 and -1.0 standard deviations below the mean. The International Society for Clinical Densitometry recommends use of the WHO definition and T-scores for diagnosis of osteoporosis in postmenopausal women and men... 

TABLE 53-3. World Health Organization Definition of Osteoporosis... 

The definition of osteoporosis is (NIH 2000) A systemic skeletal disease characterized by low bone mass and micro architectural deterioration of bone tissue, with a consequent increase in bone fragility and susceptibility to fracture . 

Adequate calcium nutrition during childhood and adolescence is thought to bean important deterrent to osteoporosis in later life. A one-year study of 149 girls (8 years old) revealed the effects of consuming a typical diet (900 mg Ca/day) or a diet supplemented with an additional 850 mg Ca/day Bonjour el al, 1997). The Ca supplement was supplied by specially prepared biscuits, juices, and candy bars (rather thar pills) to assure compliance. To view some of the data, the density at the femoral diaphysis increased by 5% (unsupplemented) and by 6% (plus calcium) during the 1-ycar period. The density at the lumbar spine increased by 4% (unsupplemented) and by 4% (plus calcium). The data dernonstrated a dear and definite increase in bone density at some sites, but not at others. This study, as well as others Johnston et al., 1992), tend to show that caicium supplements to children can benefit bones of the appendicular skeleton, but not the axial skeleton. The appendicular skeleton includes the pelvis, arm bones, and leg bones. The axial skeleton includes the skull, vertebra, ribs, and sternum. 

An estimated 75 million people are affected by osteoporosis to some degree in the United States, Europe, and Japan. Osteoporosis is a systematic skeletal disease characterized by bone mass and microarchitectural deterioration with a consequent increase in bone fragility and susceptibility to fracture. Operationally, osteoporosis can be defined as a certain level of bone mineral density. The definition of osteoporosis is somewhat arbitrary and is based on epidemiological data relating fracture incidence to bone mass. Uncertainty also is introduced due to variability in bone densitometry measurements. Other clinical measures to assess the skeleton include collagen cross-links (measure of bone resorption) and levels of bone-specific alkaline phosphatase and osteocalcin (bone formation). A list of biochemical markers of bone remodeling is provided in Table 37-3. Measurement of total serum alkaline phosphatase level and urinary hydroxyproline or calcium levels is of limited value. 

Involutional (primary) osteoporosis is the manifestation of a metabolic bone disease in which the amount of normally mineralized bone matrix in affected patients has been reduced to a level below that of the normal population of the same age and sex. The disease is certainly of multifactorial origin, since genetic (Seeman etal. 1989), mechanical (e.g.. Frost 1988), nutritional (e.g., Hegsted 1986), and hormonal factors (e.g., Melton and Riggs 1988) can cause the severe impairment of the bone remodeling process (Eriksen etal. 1994) which underlies the observed reduction in bone mass and microarchitectural deterioration of bone tissue that lead to an increased risk of fractures at typical sites of the skeleton (for a definition, see Anonymous 1993)... 

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