Osteoporosis

Introduction

Osteoporosis, often referred to as the silent epidemic, is a disease condition characterized by a decrease in bone mass per unit volume, resulting from the loss of bone proteins. This disorder is manifested by a disruption of the bone remodeling process, marked by an increase in bone resorption which does not correspond to a parallel increase in bone formation.

Known as the “silent thief,” osteoporosis operates insidiously, often without obvious symptoms. This insidious disease can progress silently over several years, eroding bone density and increasing the risk of fractures. Unfortunately, the silent nature of osteoporosis makes it difficult to detect, and it often goes unrecognized until a fracture occurs, usually in the hip, ribs, or spine.

Bone fragility resulting from osteoporosis is of particular concern due to its serious health consequences. Hip fractures, for example, are associated with significant morbidity and mortality, particularly among older adults. These fractures can lead to loss of independence, medical complications, and reduced quality of life.

Osteoporosis primarily affects postmenopausal women due to the hormonal changes associated with this time of life. However, it can also affect men and other population groups, particularly those with risk factors such as calcium deficiency, vitamin D deficiency, smoking, physical inactivity, and prolonged use of certain drugs.

Diagnosis of osteoporosis is often based on bone density tests, which can assess bone mineral density and identify people at increased risk of fractures. However, it is crucial to raise awareness about the prevention and management of this disease well before it progresses to an advanced stage. Preventative measures include eating a diet rich in calcium and vitamin D, exercising regularly to strengthen bones and improve balance, and avoiding harmful behaviors such as smoking and excessive consumption of drugs. ‘alcohol.

Treatment of osteoporosis often aims to slow bone loss, strengthen existing bone mass, and reduce the risk of fractures. It may involve the use of specific medications, nutritional supplements, and regular medical monitoring.

Thus, osteoporosis represents a major public health challenge, affecting the quality of life of individuals and leading to serious complications. As a “silent thief,” she reiterates the importance of prevention and awareness to identify and treat this disease before it causes irreversible damage. Continued research in the field of bone health is crucial to developing more effective approaches to the prevention and treatment of osteoporosis, in order to improve the bone health of the global population.

The shrinkage of bone cells (osteoclasts) is greater than the activity of the cells that form bone (osteoblasts)

The stiffness of a bone is directly proportional to its calcium concentration. Osteoblasts are the cells responsible for the formation of osteons, thus constituting bone tissue, while osteoclasts are responsible for its resorption. In children, frequent remodeling of bone structure is essential to promote growth. Bone is a dynamic tissue, undergoing a constant process of bone remodeling that involves both bone resorption and bone production throughout life.

On the other hand, in adults, it may happen that the activity of osteoclasts predominates over that of osteoblasts. In these cases, the bone mass loses its strength, thus becoming prone to fractures.

Osteoclasts are responsible for bone resorption, involving the breakdown and removal of bone tissue, while osteoblasts are responsible for the formation of new bone. In the context of osteoporosis, an imbalance between these two processes typically manifests as increased osteoclast activity, leading to a net loss of bone tissue over time. This imbalance can result from various factors such as aging, hormonal changes (including decreases in sex hormones like estrogen in postmenopausal women), calcium or vitamin D deficiency, and other genetic or environmental factors. .

Treatment of osteoporosis often aims to restore the balance between bone formation and resorption. This may involve lifestyle adjustments, such as eating a diet rich in calcium and vitamin D, doing muscle-strengthening exercises regularly, and managing risk factors. In some cases, medications may be prescribed to stimulate bone formation or inhibit bone resorption. It is crucial to consult a healthcare professional to obtain an accurate diagnosis and develop a suitable treatment plan for osteoporosis.

Osteoclast

Bone cells responsible for the resorption of bone tissue and therefore participating in its continuous renewal.

Osteoblast

Bone cells responsible for the deposition of bone tissue

Characteristics of Osteoporosis

1. Reduction in the Number of Trabeculae: Trabeculae, the fine lattice structures that give strength and flexibility to bones, decrease in number, compromising the strength of the framework.
2. Reduced Trabecular Thickness: Reducing trabecular thickness weakens the ability of bones to carry loads, thereby increasing vulnerability to fractures.
3. Reduced Trabeculae Connectivity: Connectivity between trabeculae is impaired, compromising structural cohesion and the ability of the bone to maintain its integrity.

Vertebral Fractures: Vertebral fractures are the most common complications of osteoporosis, often associated with decreased height and increased curvature of the spine, leading to impaired posture and mobility.

Hip Fracture: Hip fracture, although less common, represents one of the most serious complications of osteoporosis, with a significant mortality rate. Increased bone fragility increases the risk of falls, and a hip fracture can have severe impacts on quality of life and mobility.

Bone Composition: Bone, a living and dynamic tissue, is mainly made up of collagen, a protein providing a flexible structure, and calcium phosphate, a mineral which provides strength and solidity to the framework. This unique combination of flexibility and robustness allows bones to withstand the stresses and impacts of everyday life.

Bone Regeneration Cycle: More than 99% of the body’s calcium is housed in bones and teeth, demonstrating the importance of this mineral in bone strength. Throughout life, a constant process of bone regeneration takes place. During childhood and adolescence, bone formation exceeds resorption, leading to an increase in bone size and density. However, by the late 20s, resorption begins to outpace formation, leading to a progressive loss of bone mass.

Consequences of Imbalance: When bone resorption prevails over formation, bone mass decreases, thus increasing the risk of osteoporosis. Therefore, prevention and management of this condition should begin at a young age to maximize bone mass and minimize later risks.

In conclusion, osteoporosis alters bone structure in complex ways, highlighting the importance of early vigilance to prevent serious complications associated with this condition. Understanding the dynamics of bone formation, bone composition and the consequences of the imbalance between resorption and formation offers clear perspectives to guide prevention and treatment strategies, aimed at maintaining bone health throughout life.

Osteoporosis in women

For women, bone loss is most rapid during the first years after adolescence, and it continues until menopause because their ovaries no longer produce estrogen, which helps maintain bone mass. Osteoporosis is more likely to develop if you have not achieved optimal peak bone mass during your bone-building years.

Risk factors

Unchangeable risks

• Sex . Your chances of developing osteoporosis are greater if you are a woman. Women have less bone tissue and lose bone more quickly than men due to changes that occur with menopause.
• Age. The older you are, the higher your risk of osteoporosis. Your bones get thinner and weaker as you age.
• Body size . Small, thin-boned women are at greater risk.
• Ethnicity. White and Asian women are most at risk. African American and Hispanic women have a lower, but significant, risk.
• Family history . The risk of fracture may be due, in part, to heredity. People whose parents have a history of fractures also appear to have reduced bone mass and may be at risk for fractures.

Changeable risks

• Sex hormones . Abnormal absence of menstrual periods (amenorrhea), low estrogen levels (menopause), and low testosterone levels in men can cause osteoporosis.
• Anorexia nervosa. Characterized by an irrational fear of weight gain, this eating disorder increases your risk of osteoporosis.
• Calcium and vitamin D intake . A lifelong diet low in calcium and vitamin D makes you more prone to bone loss.
• Use of medications. Long-term use of certain medications, such as glucocorticoids and some anticonvulsants, can lead to loss of bone density and fractures.
• Way of life. An inactive lifestyle or prolonged bed rest tends to weaken bones.
• Smoking. Smoking is bad for your bones as well as your heart and lungs.
• Alcohol consumption. Excessive alcohol consumption increases the risk of bone loss and fractures.

Classification of osteoporosis

Osteoporosis is defined as primary (Type I or II) or secondary (Type III).

Osteoporosis type I

• Often called postmenopausal osteoporosis, is six times more common in women than in men.
• Estrogen deficiency in women and testosterone deficiency in men lead to trabecular bone loss.
• Patients with type I osteoporosis typically present with vertebral compression fractures or distal radius fractures.

Osteoporosis type II

• Previously called senile osteoporosis, occurs twice as frequently in women as in men and occurs more frequently in people over the age of 70.
• Impaired calcium metabolism and intrinsic problems with bone formation lead to decreased new bone formation.
• Hip and pelvic fractures are common

Type III osteoporosis

• Secondary osteoporosis due to medications (glucocorticoids) or other conditions causing decreased bone mass

Cause of secondary osteoporosis: secondary to hereditary or acquired

1. Secondary osteoporosis of hereditary origin: Some cases of secondary osteoporosis have a genetic component. Hereditary factors can influence bone density and susceptibility to bone loss. If family members have been affected by osteoporosis, there may be a genetic predisposition to developing this condition.
2. Acquired secondary osteoporosis: Acquired causes of secondary osteoporosis are often related to external factors or specific medical conditions, such as:

• Sex hormone deficiency (decreased estrogen in postmenopausal women):
  • Decreased sex hormones, particularly estrogen in postmenopausal women, are a common cause of osteoporosis. Estrogen plays a key role in maintaining bone density by regulating the balance between bone formation and resorption.
• Nutritional deficiency:
  • A lack of calcium, vitamin D or other essential nutrients can contribute to bone fragility. These nutrients are essential for bone mineralization and strength.
• Endocrine disorders (disorders of the thyroid gland, parathyroid glands, or adrenal glands):
  • Certain endocrine disorders can affect bone density by disrupting the hormonal balance necessary for bone health.
• Drugs :
  • Certain medications, such as long-term corticosteroids, can cause bone loss by disrupting the normal process of bone regulation.
• Chronic inflammatory diseases:
  • Chronic inflammatory diseases, such as rheumatoid arthritis, may contribute to osteoporosis due to systemic inflammation that affects bone health.
• Gastrointestinal diseases:
  • Gastrointestinal disorders, such as celiac disease or inflammatory bowel disease, can interfere with the absorption of nutrients necessary for bone health.
• Chronic alcoholism:
  • Excessive and prolonged alcohol consumption can interfere with bone formation and mineralization, contributing to bone density loss.
• Smoking:
  • Smoking has been linked to decreased bone mineral density due to chemicals found in tobacco smoke, which can negatively affect bone health.
• Low body weight or eating disorders:
  • Low body weight, especially in the presence of eating disorders such as anorexia or bulimia, can lead to nutritional deficiency, increasing the risk of osteoporosis.
• Hyperthyroidism:
  • Excessive activity of the thyroid gland, producing excess thyroid hormones, can accelerate bone resorption, contributing to osteoporosis.
• Chronic kidney diseases:
  • People with chronic kidney disease may have altered levels of minerals in the blood, such as calcium and phosphorus, affecting bone health.
• Systemic lupus erythematosus (SLE):
  • This autoimmune disease can cause damage to joints and organs, including bones.
• Chronic lung diseases:
  • Certain chronic lung conditions, such as chronic obstructive pulmonary disease (COPD), can increase the risk of osteoporosis.
• Chronic hepatitis C:
  • Studies suggest that chronic hepatitis C virus infection may be associated with decreased bone density.
• Prolonged drug treatments:
  • Certain medications such as anticonvulsants, heparins, and aromatase inhibitors used to treat breast cancer may contribute to bone loss.
• Inflammatory bowel diseases:
  • Diseases like Crohn’s disease or ulcerative colitis can affect the absorption of nutrients needed for bone health.
• Malabsorption syndrome:
  • Conditions such as irritable bowel syndrome (IBS), celiac disease, and other malabsorption disorders can hinder the proper absorption of nutrients essential for bone health.
• Excess physical activity:
  • Extreme levels of physical activity, especially in female athletes, can disrupt menstrual cycles and cause estrogen deficiency, increasing the risk of osteoporosis.
• Early or surgical menopause:
  • Women experiencing menopause before the normal age, either naturally or following surgery, may experience accelerated bone loss due to the rapid decline in sex hormones.
• Excess corticosteroids:
  • Prolonged use of medications such as corticosteroids (e.g., prednisone) to treat various inflammatory conditions may lead to decreased bone density.
• Endocrine diseases:
  • Disorders such as Cushing’s syndrome (excess cortisol), hyperparathyroidism (excess parathyroid hormone), and acromegaly (excess growth hormone) can contribute to osteoporosis.
• Growth hormone deficiency:
  • A lack of growth hormone in adults can negatively influence bone density.
• Antiretroviral drugs:
  • Some medications used to treat HIV/AIDS may be associated with bone loss.
• Organ transplantation:
  • People who have had an organ transplant, due to the immunosuppressive medications needed to prevent rejection, may be at increased risk of osteoporosis.
• Bariatric interventions:
  • Certain types of weight loss surgery, such as gastric bypass surgery, can cause problems absorbing essential nutrients.
• Hematological diseases:
  • Certain blood diseases, such as thalassemia and sickle cell disease, can contribute to osteoporosis.

Prevention

To achieve optimal peak bone mass and continue to build new bone tissue as you age, you need to consider several factors.

Calcium

• Insufficient calcium intake over a lifetime can contribute to the development of osteoporosis.
• Many published studies show that low calcium intake appears to be associated with low bone mass, rapid bone loss, and high fracture rates.
• National nutrition surveys show that many people consume less than half the recommended amount of calcium to build and maintain healthy bones.
• Food sources of calcium include low-fat dairy products, such as milk, yogurt, cheese and ice cream; dark green leafy vegetables, such as broccoli, collard greens, bok choy and spinach; sardines and salmon on the bone; Tofu; almonds; and foods fortified with calcium, such as orange juice, cereals and bread.
• Depending on how much calcium you get from food each day, you may need to take a calcium supplement.

Recommended calcium intake

• The body’s demand for calcium is greatest during childhood and adolescence, when the skeleton is developing rapidly, as well as during pregnancy and breastfeeding.
• Postmenopausal women and older men also need to consume more calcium.
• Additionally, as you age, your body becomes less efficient at absorbing calcium and other nutrients. Older adults are also more likely to have chronic health conditions and use medications that can impair calcium absorption.

Group at life stage	mg/day
Infants 0 to 6 months	200
Infants 6 to 12 months	260
1 to 3 years	700
4 to 8 years	1000
9 to 13 years old	1300
14 to 18 years old	1300
19 to 30 years old	1000
31 to 50 years old	1000
Men aged 51 to 70	1000
Women aged 51 to 70	1200
70 years	1200
14 to 18 years old, pregnant/nursing	1300
19 to 50 years old, pregnant/nursing	1000

Source: Food and Nutrition Board, Institute of Medicine, National Academy of Sciences, 2010.

Factors helping increase calcium deposition in bone

1. Adequate Calcium Intake: A diet rich in calcium is essential for the deposition of calcium in bones. Dairy products, green leafy vegetables, dried fruits and other food sources rich in calcium help support bone mineralization.
2. Adequate Vitamin D Intake: Vitamin D is essential for the efficient absorption of calcium from the intestine. Proper exposure to sunlight and a diet that includes sources of vitamin D, such as oily fish, eggs, and fortified products, promotes calcium deposition in bones.
3. Physical exercise: Exercise, particularly body-weight bearing activities such as walking, running, and weight training, stimulates bone mineralization by increasing bone mineral density. Exercise also helps strengthen bones and maintain their health.
4. Hormones: Certain hormones, such as estradiol (a form of estrogen), promote the deposition of calcium in bones. These hormones play an important role in regulating bone metabolism.
5. Hormonal Balance: Overall hormonal balance, including normal levels of parathyroid hormone and calcitonin, is crucial for proper bone metabolism and calcium deposition.
6. Nutrients such as vitamin K and magnesium: Vitamin K and magnesium are also involved in bone metabolism. Vitamin K participates in the regulation of proteins that modulate calcium deposition in bones, while magnesium is an essential cofactor in several enzymatic reactions linked to bone formation.
7. Healthy body weight: Maintaining a healthy body weight helps reduce the load on bones and promote optimal metabolic balance for calcium deposition

Symptoms of osteoporosis

1. Frequent fractures: Osteoporosis makes bones fragile, increasing the risk of fractures. Fractures can occur more easily, even in the absence of major trauma.
2. Bone pain: Some individuals may experience pain in their bones, particularly in the back or hips. However, osteoporosis is often asymptomatic until a fracture occurs.
3. Loss of height: Repeated vertebral fractures can lead to decreased height and a hunched posture, which may be observed as a loss of height over time.
4. Kyphosis (curvature of the spine): Vertebral fractures can contribute to an abnormal curvature of the spine, called kyphosis. This can result in a hunched appearance.
5. Loss of muscle mass: Decreased bone density may also be associated with loss of muscle mass, which can contribute to decreased strength and mobility.
6. Weakening of the teeth: Osteoporosis can also affect the jaw, leading to weakening of the bones that support the teeth.

Treat osteoporosis

• A comprehensive osteoporosis treatment program emphasizes good nutrition, exercise and safety concerns to prevent falls that can lead to fractures.

Nutrition: The foods we eat contain a variety of vitamins, minerals and other important nutrients that help keep our bodies healthy. All these nutrients are needed in balanced proportion. In particular, calcium and vitamin D are necessary for strong bones and for your heart, muscles and nerves to function properly. (See the “Prevention” section for recommended amounts of calcium.)

Exercise: Exercise is an important part of an osteoporosis prevention and treatment program. Exercise not only improves your bone health, but it increases muscle strength, coordination and balance, and leads to better overall health. Although exercise is good for someone with osteoporosis, it should not put sudden or excessive strain on your bones. As added insurance against fractures, your doctor may recommend specific exercises to strengthen and support your back.

Therapeutic medications: Several medications are available for the prevention and/or treatment of osteoporosis, including: bisphosphonates, calcitonin, estrogen (hormone therapy); estrogen agonists/antagonists (also called selective estrogen receptor modulators or SERMs); parathyroid hormone (PTH) analogue; parathyroid hormone-related protein (PTHrp) analogue; RANK Ligand Inhibitor (RANKL); and tissue-selective estrogen complex (TSEC).

Fall prevention

Fall prevention is a particular concern for men and women with osteoporosis. Falls can increase the likelihood of breaking a bone in the hip, wrist, spine, or other part of the skeleton. In addition to the environmental factors listed below, falls can also be caused by impaired vision or balance, chronic illnesses that affect mental or physical functioning, and certain medications, such as sedatives and antidepressants. It is important for people with osteoporosis to be aware of any physical changes that affect their balance or gait and to discuss these changes with their health care provider. Here are some tips to help you eliminate the environmental factors that lead to falls.

Outside

• Use a cane or walker for added stability.
• Wear shoes with rubber soles for traction.
• Walk on grass when the sidewalks are slippery.
• In winter, carry salt or cat litter to sprinkle on slippery sidewalks.

Inside

• Keep rooms free of clutter, especially on floors.
• Keep floor surfaces smooth, but not slippery.
• Wear supportive low-heeled shoes even at home.
• Avoid walking in socks, stockings or slippers.
• Make sure the mats have a non-slip backing glued to the floor.
• Make sure stairwells are well lit and stairs have handrails on both sides.
• Install grab bars on bathroom walls near the tub, shower, and toilet.
• Use a rubber bath mat in the shower or bathtub.
• Keep a flashlight with fresh batteries next to your bed.
• If you’re using a stair stool for hard-to-reach areas, use a sturdy one with a handrail and wide steps.
• Add ceiling lights to rooms lit by lamps.
• Consider purchasing a cordless phone so you don’t have to rush to answer the phone when it rings, or so you can call for help if you fall.
• Use caution on highly polished floors which become slippery and dangerous when wet.
• If possible, use plastic or carpet sliders.

Vertebral osteoporosis

Vertebral osteoporosis is a specific manifestation of osteoporosis that affects the vertebrae of the spine. Here are some characteristics of spinal osteoporosis:

1. Compression Fractures: Vertebral osteoporosis often manifests as compression fractures, which are fractures of the vertebrae that occur due to loss of bone density. These fractures can cause a reduction in vertebral height.
2. Spinal Deformity: Repeated compression fractures can contribute to spinal deformities, including kyphosis (forward curvature). This can make the spine look hunched.
3. Spinal pain: Compression fractures related to spinal osteoporosis can cause pain in the spine. The pain may be localized to the fracture site and may be acute or chronic.
4. Decreased body height: Vertebral fractures due to osteoporosis can lead to a decrease in body height over time. This is often seen in older people with advanced osteoporosis.
5. Gibbosity (dorsal hump) formation: Severe kyphosis can lead to the formation of a dorsal hump, also called Dowager’s gibbosity. This can affect the aesthetics of the posture.
6. Risks of subsequent fractures: People with spinal osteoporosis have an increased risk of sustaining additional vertebral fractures or developing fractures in other parts of the skeleton.

Vertebral fracture

• Vertebral fractures are the most common osteoporotic fractures. The posterior part of the body is the region that best resists a vertical compressive force. In a compression fracture of the vertebral body, the anterior and medial portion will be crushed more than the posterior portion. Following a compression fracture, the vertebra will then be wedge-shaped (the anterior height of the vertebral body will be smaller than the posterior)
• The presence of vertebral fractures can greatly be a clue to future fracture and should be reported even when they are identified as incidental findings on radiographs.
• A vertebral fracture is often felt as a simple back pain which often becomes asymptomatic after 6-8 weeks.
• Up to 50% of vertebral fractures may be present in asymptomatic patients.
• A height loss of more than 5 cm is an indication to perform bone mineral density tests and spinal x-rays.

Radiographic signs of osteoporosis

1. Decreased bone density: On x-rays, bones with osteoporosis may appear less dense and more transparent than normal bones.
2. Spinal collapse: Osteoporosis can lead to compression fractures of the vertebrae, resulting in a reduction in spinal height and sometimes curvature of the spine.
3. Stress fractures: X-rays can reveal stress fractures, often seen in long bones like the femur.
4. Cortical erosions: Osteoporosis can cause a reduction in the cortical thickness of bones, which can be detected on x-rays.
5. Decreased trabecular density: Reduced trabecular density, which represents the internal network of the bone structure, may be visible on x-rays.
6. Bone deformities: Bones affected by osteoporosis may show deformities, particularly in the long bones, ribs and vertebrae.
7. Lengthened joint spaces: Osteoporosis can cause an increase in the space between joints, especially in the knees and hips.
8. Lower limb fractures: Lower limb fractures, particularly of the femoral neck, are common in people with osteoporosis and may be visible on x-rays.
9. Pelvic Alterations: Osteoporosis can affect bone density in the pelvis, leading to radiographic changes.
10. Abnormal displacements of the vertebrae: X-rays may show abnormal displacements of the vertebrae due to vertebral fractures caused by osteoporosis.

Radiographic characteristic of vertebral osteoporosis

Wedge-shaped vertebra (decreasing anterior aspect of the vertebral body)

Wedge-shaped vertebrae are often associated with compression fractures, which can be caused by osteoporosis. When a person has osteoporosis, bone density decreases, making bones more fragile and prone to fracture more easily. Vertebral compression fractures can cause characteristic deformities of the vertebrae, making them wedge-shaped on x-rays.

Radiographic signs of a wedge-shaped vertebra related to osteoporosis include:

1. Vertebral collapse: The vertebra appears to reduce in height, giving a wedge-like appearance.
2. Widening of the intervertebral space: Due to compaction, the space between neighboring vertebrae may appear larger on x-rays.
3. Spinal deformity: Repeated compression fractures can cause curvature of the spine, often kyphosis (forward curvature).
4. Pain: Vertebral compression fractures can cause pain in the affected area.

Picture frame-shaped vertebra (decreased cortical bone at the periphery)

The description of a “picture frame” vertebra in the context of osteoporosis generally evokes a characteristic radiographic image associated with this condition. Osteoporosis causes a decrease in bone density, particularly in the cortical bone that forms the periphery of the bones. This decrease in density can be manifested by specific radiographic changes. This is how it can be described:

1. Decreased cortical bone: Cortical bone, which is the dense outer layer of bones, may show a decrease in density on x-rays.
2. Picture Frame Appearance: Due to loss of density, the vertebra may have a distinctive picture frame appearance on x-rays. This can result in a decrease in bone density at the periphery of the vertebra, giving the impression of a thinner outline, like the edges of a picture frame.
3. Spinal Compression: Osteoporosis can lead to spinal compression fractures, which can contribute to the reduced height of the vertebra. Combined with a decrease in density, this can accentuate the frame-like appearance.
4. Spinal Deformities: Over time, repeated compression fractures can contribute to spinal deformities, such as kyphosis (forward curvature).

Flat foot vertebra (severe compression fracture)

The description of a “flatfoot” shaped vertebra in the context of a severe compression fracture evokes a specific radiographic picture associated with osteoporosis. This is how it can be described:

1. Severe compression fracture: Osteoporosis, characterized by decreased bone density, makes the vertebrae more susceptible to compression fractures. A severe compression fracture can cause a significant decrease in the height of the vertebra.
2. Flatfoot Appearance: Severe compression fracture can give the vertebra a characteristic “flatfoot” appearance on x-rays. This often results in a significant decrease in the height of the vertebra, with an upper surface that may appear enlarged and flat.
3. Spinal Deformity: Repeated compression fractures, associated with osteoporosis, can contribute to spinal deformities, often in the form of kyphosis (forward curvature).
4. Alterations in vertebral alignment: Severe compression fracture can also cause changes in the alignment of surrounding vertebrae, contributing to overall alterations of the spine.

Corner vertebra

Compression of the vertebrae will cause a marked decrease in height (less trabecula anteriorly) which gives the appearance of a wedge vertebra.

Striation of the vertebrae

Decrease in horizontal trabeculae and increase in vertical trabeculae gives an appearance of striation to the vertebral body.

Picture frame appearance

Due to resorption processes, the vertebral bodies show an overall increase in radiolucency and a thin, well-demarcated cortical margin.

Vertebra shaped like a flat foot

Is the term given when a vertebral body has lost almost all of its height anteriorly and posteriorly, representing a very advanced compression fracture.

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