Osteoporosis differential diagnosis
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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 distinguished from idiopathic transient osteoporosis of hip, osteomalacia, scurvy, osteogenesis imperfecta, multiple myeloma, homocystinuria and hypermetabolic resorptive osteoporosis, which can all also present with similar features.
Distinguishing Disease from other Diseases
- Idiopathic transient osteoporosis of hip - seen most often in women during the third trimester of pregnancy and in middle aged men. Complaints include groin pain and mild limited range of movements at the hip. X-ray shows diffuse osteopenia of the femoral head and neck. Treatment includes joint protection, limited weight bearing and NSAIDs. Spontaneous recovery occurs after 2-9 months of conservative treatment. In pregnant women, symptoms resolve in the first few months post-partum.
- Osteomalacia - caused by deficiency of vitamin D in adults. There is defective mineralization of newly formed bone. Diffuse bone pain, fatigue and fractures are the common symptoms. It can progress to osteoporosis.
- Scurvy - the biosynthesis of collagen is defective due to vitamiin C deficiency. New bone formation is prevented and the old bone becomes brittle due to lack and poor quality of collagen. Treatment is vitamin C replacement.
- Osteogenesis imperfecta - caused by a defect in collagen and the improper functioning of osteoblasts. Short stature, scoliosis, tooth defects, hearing defects and propensity for fractures are the main clinical features.
- Multiple myeloma - this is a malignant tumor of the plasma cells. It accounts for 40% of all bone tumors. Diffuse bone pain and tenderness are common. It also forms osteolytic lesions on the bones. The prognosis is poor. Chemotherapy is the main stay 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. There is not a cure.