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: Cafer Zorkun, M.D., Ph.D. [2],Raviteja Guddeti, M.B.B.S.[3]

Overview

Osteoporosis must be differentiated from other diseases include: idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria, and hypermetabolic resorptive osteoporosis; which can all present with some similar features, too.

Differentiating osteoporosis from other diseases

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). Sub-chondoral 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 new formed bone matrix, which is caused by 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: defect mostly in collagen type I synthesis and also improper functioning of osteoblasts. Short stature, scoliosis, tooth defects, hearing defects, blue sclera, and propensity for fractures are the main clinical features. 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. When study the disease radiologically, osteolytic lesions could be found on the bones. The prognosis is poor. Chemotherapy is the mainstay of treatment. 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.

Idiopathic transient osteoporosis of hip; note to the decreased bone density in left femur.

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