Types of Osteoporosis

Postmenopausal Osteoporosis (Type I)

As women enter the period of life encompassing termination of the reproductive function, there is a gradual decline in ovarian function and loss of estrogen and progesterone production. The overt sign of this is menopause, the cessation of menstrual periods. As estrogen production falls, loss of bone tissue begins. The onset of menopause is associated with increased activation of remodeling sites and an increase in bone resorption. Formation increases to a lesser degree. The increase in osteoclastic activity results in a loss of trabecular bone. Two types of fracture typically occur with Type I osteoporosis: vertebral and hip.

Age-Associated Osteoporosis (Type II)

Type II osteoporosis occurs in both men and women over 65 years of age. Its primary cause is bone loss due to increased bone turnover over an extended period time (during the 35 years since peak bone mass was reached at age 30 to 35). There is also an age-related decline in renal production of 1,25 dihydroxy-vitamin D with subsequent secondary hyperparathyroidism. It is the hyperparathyroidism that is largely responsible for the excess cortical bone loss. Hip fracture can be associated with Type II osteoporosis. The clinical features and diagnosis are similar to that of Type I, with the occasional incidence of upper arm, shin, and pelvic fractures, as well as dorsal kyphosis ("dowager's hump").

Secondary Osteoporosis

Secondary osteoporosis is caused by an identifiable agent or disease. Among the medical conditions associated with secondary osteoporosis and decreased bone mass in men and women presenting with vertebral or hip fractures are:

• Bone metastases - a bone tumor which is invasive and resistant to treatment
• Hyperthyroidism - abnormally increase and uncontrolled secretion of the thyroid gland
• Early oophorectomy - removal of the ovaries which produce estrogen
• Hypogonadism (in men) - in adequate gonadal function (which produce testosterone, progesterone and small amounts of estrogen)
• Subtotal gastrectomy - partial removal of the stomach
• Hemiplegia - stroke
• Systemic mastocytosis - mast cell infiltration of the system

• Glucocorticoids - steroids used for the reduction of inflammation, i.e. rheumatoid arthritis
• Thyroxine - active iodine used for synthetic thyroid gland secretions
• GnRH analogs - estrogen-suppressing hormone used for treating endometriosis and fibroid tumors
• Anticonvulsants (hypnotics and barbituates) - medications for preventing or arresting convulsions
• Loop diuretics (furosemide) - treatment for edema associated with congestive heart failure, cirrhosis of the liver and renal disease
• Heparin (long-term) - anticoagulant used to treat clogged blood vessels and coronary illnesses

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