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history of low trauma fracture at age 45 year, postmenopausal women age 50
–65 with risk factors for osteoporosis besides menopause, women age 65 years and older regardless of additional risk factors,
postmenopausal women who present with fractures, women considering therapy for osteoporosis if BMD testing would facilitate such decision
and finally women who have been on HRT for prolonged periods. b.
Menopausal Women‟s Risk Factors
Risk factors in menopausal women can be categorized as modifiable and non- modifiable factors. Non-modifiable risk factors are
as follow: age 65 years and older, female, Caucasian and Asian women, early menopause before age 45, women whose ovaries were
removed before menopause, small body build, family history of fractures, and experience of bone fragility fracture, while modifiable
risk factors are as follows: inadequate calcium intake, sedentary lifestyle, regular smoking, regular drinking of alcohol, regular and
excessive drinking of coffee, Body Mass Index BMI lower than 19kg, excess exercise, propensity for falling due to impaired vision and
estrogen deficiency in pre-menopause due to taking gonadotropin releasing hormone GnRH analogue.
7. Osteoporosis Symptoms
A decrease in bone mass in osteoporosis does not cause pain or other symptoms. Osteoporosis disease often happens to be asymptomatic
until there is a broken bone or a fracture, thus it is called a silent disease. perpustakaan.uns.ac.id
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Osteoporotic fractures cause pain and disability. In most cases this will remain throughout life, but in other cases it will gradually disappear or
improve Hurricane, 2005. Osteoporosis symptoms can be a pain in the bones, reduced height and body hunchback.
c. Pain in Bones
The bone pain in osteoporosis can be acute or chronic. Acute pain comes from a bone or periosteum due to a recent fracture, while
chronic pain comes from the soft tissue due to a ligament and muscle deformity.
d. Reduced Height
Height shrinkage occurs due to compression fractures in the vertebrae and it is usually accompanied either by symptoms or
asymptomatic, which lasts for several days with a severe pain to several months, respectively. A reduced height occurs if there is fracture in
several places of the rear vertebrae for several times and therefore the height will be shorter than the long span arms. In normal circumstances,
the height and the long span arms both have the same size. Long stretches of both arms are measured from the tip of the right middle
finger across the chest to the tip of the left middle finger. e.
Body Hunchback Body hunchback aka kyphosis is the spinal deformities, which
can occur as the result of compression fractures. perpustakaan.uns.ac.id
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8. Osteoporosis Diagnosis
There are mainly two criteria to diagnose osteoporosis either by measurement of BMD or by biochemical markers of bone turnover.
BMD can be measured by Dual Energy X-ray Absorptiometry DXA. WHO diagnostic criteria are used to diagnose osteoporosis in
women by comparing the measured BMD with maximum BMD in young women and considering lower value or one equal to 2.5 times of standard
deviation for diagnosis of osteoporosis. Risk of bone fracture is increased 1.4-2.6 times for one time of decreasing of standard deviation Grade A,
Level Ia. As biochemical index of bone formation and resorption is changed
by several factors, it is not suggested to use biochemical markers of bone turnover for diagnosis of osteoporosis and in addition, it may be unusual in
several diseases. However, it can be used together with BMD to assess risk of bone fracture. The index is useful for treatment monitoring after three
months and a year and to assess response to treatment with rapid detection. Biochemical index of bone resorption includes urinary deoxypyridinoline
DPD, urinary N-telopeptide NTx and serum C-telopeptide CTx while biochemical index of bone formation includes bone specific alkaline
phosphatase BSAP, osteocalcin and N-terminal propeptide of type 1 procollagen P1NP.
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9. Osteoporosis Investigations
