BONE DISEASES
Osteoporosis and Osteomalacia Beginning at
about age 50, it is not unusual for people to note a slight diminution of height
every few years. It is well known, too, that bones tend to become more brittle
and to be more prone to fracture as we pass from the middle years to the later
years. Both the slight height reduction and tendency to bone brittleness result
from a process called osteoporosis (literally, softening of the bones) which
occurs with aging.
Bones that are osteoporotic contain the same individual
minerals and proteins but they are less dense than younger bones.
Hence, they are more likely to be compressed (resulting in
height loss) or broken. While x-rays do not invariably reveal the presence of
osteoporosis, it is not uncommon for the condition to be first identified on a
routine x-ray film. One rather common x-ray finding in osteoporosis is
compression and fracture of a vertebra which may cause mild back pain but does
not endanger the spinal cord. Osteoporosis is not limited to the later years.
Other causes which a physician must consider include:
1. Steroid medications which may produce osteoporosis
changes even in very young patients when administered for prolonged periods.
2. Lack of stress. Bones begin to weaken when they are not
subjected to normal stresses such as those exerted by muscles and by the pull
of gravity. Astronauts, as the result of exposure to gravity- free environment,
have shown early changes of osteoporosis. More commonly, such changes may stem
from immobilization because of illness or the casting of a fractured bone.
Osteoporosis also may be- come apparent after a stroke when muscles in a limb
fall into disuse.
3. A diet low in calcium and protein.
These are the basic building blocks of bone, and a dietdeficient in them will eventually lead to weakening of bones.
Cancer, when it spreads to bone, weakens the intrinsic structure.
Menopause apparently hastens the development of
osteoporosis, and many women past the menopause exhibit bone changes (see page
618). What can be done to prevent osteoporosis and to treat it should it occur?
Prolonged immobilization should be avoided. If it cannot be, exercises to
maintain muscle tone and stress on bone are of value. Almost every hospital
today has a physical therapist to administer such exercises as a precaution.
Bone diseases poor blood supply, natural body defenses
against infection, which are circulated by the blood, have a more difficult
time reaching a trouble area. Bone infection may result from in- jury to a
bone, such as a compound fracture, or the entrance of a foreign body, or from
spread of infection from elsewhere in the body. If acute bone infection is not
treated effectively, the infection may become chronic.
With chronic osteomyelitis, the bone is weakened and made more subject to fracture, pus may
be discharged chronically through the skin, the body's reserves are drained
by the constant need to fight the infection, and there may be considerable pain
and discomfort.
For these reasons, any attack of severe bone pain and
fever-usually it occurs in a child or young adult- needs quick evaluation and
therapy. An effort will be made to identify the causative organisms and select
an anti- biotic suitable for combating them. In addition, surgery to drain the
infected area may be required. Surgery is often an indispensable adjunct to
antibiotic treatment in cases of chronic bone infection.
Dead and dying tissuewhich serves as the nest, for continuing infection must be removed.
Occasionally it is difficult to remove all the infected or dead tissue located
in and around the bone, and repeated surgery may be required. In some
instances, chronic osteomyelitis may be present for years, with alternating
periods of quiescence and activity, and intensive therapy is needed to affect a
cure.
