Differentiating Osteoporosis from other diseases

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Eiman Ghaffarpasand, M.D. [2], Cafer Zorkun, M.D., Ph.D. [3], Raviteja Guddeti, M.B.B.S.[4]

Overview

Osteoporosis must be differentiated from other diseases that cause a decrease in the bone mineral density (BMD), such as idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria, and hypermetabolic resorptive osteoporosis.

Differentiating osteoporosis from other diseases

Osteoporosis must be differentiated from other diseases that cause a decrease in the bone mineral density (BMD), such as idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria, and hypermetabolic resorptive osteoporosis. The major similarities and differences among the diseases are discussed in the following table:

Differential Diagnosis Similar Features Differentiating Features Osteoporosis On physical examination, demonstrates acute musculoskeletal pain, if fracture happened On imaging studies, demonstrates severe decrease in BMD - Idiopathic transient osteoporosis of hip On physical examination, demonstrates acute hip pain On imaging studies, demonstrates sub-chondral cortical loss and diffuse osteopenia of the femoral neck On history, demonstrates mostly involvement of pregnant women and young men On history, demonstrates to be self-limiting in 6-8 months Osteomalacia On physical examination, demonstrates diffuse bone pain, fatigue, and fractures are the common symptoms On imaging studies, demonstrates low bone mineral density (BMD) On imaging studies, demonstrate the brief bone mass loss in bones Scurvy On physical examination, demonstrates bone pain and frequent fractures due to brittle bone On imaging studies, demonstrates low bone mineral density (BMD) On physical examination, demonstrates other mucosal disruption symptoms, such as bleeding gums On imaging studies, demonstrates normal bone mineral density (BMD) Osteogenesis imperfecta On physical examination, demonstrates short stature, scoliosis, and propensity for fractures On physical examination, demonstrates tooth defects, hearing defects, and blue sclera On imaging studies, demonstrates near normal bone mineral density (BMD) Multiple myeloma On physical examination, demonstrates diffuse bone pain and tenderness On imaging studies, demonstrates osteolytic lesions in the bones On laboratory studies, demonstrates monoclonal IgM overload in electrophoresis, and also Bence-Jones protein in urine Homocystinuria On physical examination, demonstrates diffuse bone pain and musculoskeletal symptoms On physical examination, demonstrates visual impairment On laboratory studies, demonstrates high amounts of homocysteine in urine

Idiopathic transient osteoporosis of hip

Primarily, it is thought to be seen most often in women during the third trimester of pregnancy; but it described also in middle-aged men. Acute hip pain is the main characteristic of the disease; totally, self-limited after 6-8 months. Sometimes it may be explained as early or benign avascular necrosis (AVN). Subchondral cortical loss and diffuse osteopenia of the femoral head and neck are the pathognomonic features. Treatment includes joint protection, limited weight bearing, and NSAIDs.

Osteomalacia

Inability to mineralize the newly formed bone matrix, which is caused by the deficiency of vitamin D in adults. It is kind of low-turnover bone disease, in which osteoblasts are always scant. Diffuse bone pain, fatigue, and fractures are the common symptoms. It also can progress to osteoporosis.

Scurvy

Regarding the major role of vitamin C in the biosynthesis of collagen, its deficiency may lead to dysfunction of every collagen containing organs; such as bones. New bone formation is disturbed and the old bone becomes brittle due to lack and poor quality of collagen. Treatment is vitamin C replacement.

Osteogenesis imperfecta

Osteogenesis imperfecta is mainly induced by defect in synthesis of collagen type I along with improper osteoblasts functioning. Short stature, scoliosis, tooth defects, hearing defects, blue sclera, and propensity for fractures are the main clinical features of the disease.

Multiple myeloma

Multiple myeloma is a malignant proliferation of the plasma cells, mostly in bone marrow. It accounts for 40% of all bone tumors. Diffuse bone pain and tenderness are common. Radiologically, osteolytic lesions could be found on the bones. The prognosis is poor. Chemotherapy is the mainstay of treatment.

Homocystinuria

Homocystinuria is an autosomal recessive inherited disorder that affects the metabolism of the amino acid methionine. Failure to thrive, visual problems and musculoskeletal problems are the major presentations.