Bone Metabolic Disorders
Bone Metabolic Disorders is a relatively new discipline, which mainly concerns Orthopedic Surgeons, Rheumatologists, Endocrinologists and Physiatrists, without excluding any other medical specialty, as is the case with radiologists and biopathologists who choose to be actively involved in this field. The differing points of view for each medical specialty is an intriguing subject and the best approach is usually the interdisciplinary one. However, as Professor G. Lyritis puts it “Orthopedics is the only specialty that addresses the patient and his needs before, during and after the fracture”. Regardless, every single approach is equally important in the treatment of Bone Metabolic Disorders.
Osteoporosis is the most common of the Bone Metabolic Disorders but, it is definitely not the only one. Of course, if osteoporosis is the only metabolic disorder known to the attending physician, then automatically all metabolic disorders are inaccurately “baptized” osteoporosis and treated accordingly. Therefore, attention and vigilance are required, both in the proper identification of the metabolic disorder and in the effective treatment of even the most frequent of them.
Osteoporosis is also called the silent epidemic, sometimes even the silent killer. The reason is that it has no warning symptoms at all and the first manifestation is usually a low energy fracture. The most common osteoporotic fractures and at the same time a red flag for diagnosing the underlying metabolic disorder are: A. wrist, B. vertebral, C. hip and D. shoulder (still often overlooked). Of these, A, B, D are usually treated conservatively, resulting in inadequate recording and under-reporting, while C, as well as the most displaced of D, require hospital admission for surgical treatment, resulting in improved statistics.
However, vertebral fractures disproportionately affect the whole organism, significantly increase mortality, although they may be asymptomatic and the patient may not be aware of their existence, if x-rays of the spine have never been done. On the other hand, hip fractures are recorded almost entirely, as they require hospitalization and surgical repair. Consequently, they are the most reliable index of morbidity and mortality from osteoporosis.
Contrary to what most patients and many doctors of other specialties believe, osteoporosis may eventually cause the patient’ s demise and it fully deserves the nickname “silent killer”. Secondary osteoporosis should always be kept in mind, as of course osteoporosis in men. Currently, an exceptional tool for accurately calculating fracture risk is readily available over the internet. FRAX incorporates decades of scientific research and is now considered mandatory for reaching a treatment decision.