Osteoporosis is usually a silent disease and often remains undiagnosed until a fracture following minimal trauma (1). It may present with:
- in vertebral fractures -
- may be asymptomatic in as many as two thirds of patients (2) (but these subclinical fractures are important in predicting risk of future fractures) (1)
- vertebral collapse leads to gradual loss of height with increasing thoracic kyphosis
- back pain (1)
- back pain usually occurs in the thoracic or lumbar region, due to wedging or compression of one or more vertebral bodies
- it is usually an early sign
- about 25% of caucasian women over the age of 60 years will develop the so called dowagers hump with progressive rounding of the shoulders.
- non vertebral or peripheral fractures
- usually present with more obvious fracture symptoms following a fall
- sometimes stress fractures may present as acute regional musculoskeletal pain (1)
One or more overt low trauma fractures, typically of the distal radius, vertebral body or femoral neck, affect 40% of women over 65 years of age. Femoral neck fractures are more likely in older patients and is the "classic sign" of senile osteoporosis. About 20% of women will have experienced a fractured hip by the age of 90 years. Senile osteoporosis may also result in fractures of the ribs or the pubic rami. Often, the fractures result from apparently trivial injury.
Notes:
- an evaluation of physical signs for diagnosising osteoporosis or spinal fractures revealed (1):
- the most useful physical examination signs for detecting osteoporosis were weight < 51kg, self-reported humped back, and < 20 teeth
- the most useful physical examination signs for detecting spinal fractures were wall-occiput distance > 0cm and rib-pelvis distance <= 2 finger breadths
- the authors concluded that no single manoeuvre is sufficient to rule out osteoporosis or spinal fractures without further testing
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