This patient has osteoporosis, which is an age-related decrease in bone mass in which bony trabeculae become thinner.
Osteoporosis is a common disorder of bone metabolism that can predispose to fracture. Osteoporosis is an age-related decrease in bone mass secondary to uncoupling of osteoclast-osteoblast activity. In osteoporosis, the existing bone is adequately mineralized. This is in contrast to osteomalacia, in which osteoid is inadequately mineralized. Findings in osteoporosis include thinned cortices and loss of trabecular bone.
Sweet et al. discuss the diagnosis of osteoporosis. Osteoporosis may be a clinical or radiographic diagnosis. In particular, low-impact fractures (fractures that occur with a fall from standing height), particularly in an elderly woman, are highly suggestive. The DEXA scan is a radiological test that may be used for screening or diagnostic purposes.
Christodoulou et al. discuss osteomalacia. Osteomalacia occurs due to a disorder in the mineralization phase of bone remodeling. Accordingly, this leads to improper mineralization of osteoid, which results in soft, weak bones. Vitamin D deficiency is frequently responsible for osteomalacia. In children, this can present as rickets.
Figure A depicts a radiograph of an osteoporotic spine with two compression fractures labeled "1" and "3." Illustration A is a cartoon depicting the microscopic bone architecture of normal versus osteoporotic bone. Illustration B shows the gross bony abnormality of the proximal femur that may be seen in rickets.
Answer 1: Subperiosteal bone resorption is associated with hyperparathyroidism.
Answers 2,3: Vitamin D deficiency and excessive unmineralized osteoid are findings in osteomalacia.
Answer 5: Hypocalcemia is not seen in osteoporosis, which classically has normal serum calcium and vitamin D levels. Hypocalcemia may be seen in osteomalacia.
Sweet MG1, Sweet JM, Jeremiah MP, Galazka SS. Diagnosis and treatment of osteoporosis. Am Fam Physician. 2009 Feb 1;79(3):193-200.
PMID:19202966 (Link to Abstract)
Christodoulou S1, Goula T, Ververidis A, Drosos G. Vitamin D and bone disease. Biomed Res Int. 2013;2013:396541. doi: 10.1155/2013/396541. Epub 2012 Dec 27.
PMID:23509720 (Link to Abstract)