Osteoporosis occurs in elderly persons and as a secondary feature of certain diseases. The pathologic process is one of deficient bone matrix, rather than mineral, and has been defined by Bartter as: "a metabolic bone disease in which the total body mass of bone is less than that of a normally active subject of comparable size as a result of failure of new bone formation." 1 It should be added that features of increased bone destruction may exist as well in some types of osteoporosis. The lack of a fundamental understanding of the precise mechanisms of bone formation, maintenance, and destruction precludes adequate classification of the various osteoporotic conditions; however, the following scheme is a clinically useful approach (modified from Bartter1 and Albright2):
Decreased osteoblastic activity: Disuse Estrogen lack (postmenopausal) Osteogenesis imperfecta Hypophosphatasia
Reduced available nitrogenous components: Starvation (including malabsorption syndromes) Deficiency of nitrogen retaining hormones
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