Osteoporosis Differential Diagnosis Table

Osteoporosis is a disease that weakens bones to the point where they break very easily without warning or symptom. For this reason, this disease osteoporosis is also called the silent disease because you don’t notice a single change in the bones until they break.

The main cause of this disease is the lack of calcium in our body, which develops diseases such as osteoporosis. Daily unhealthy food intake leads to low levels of calcium in our body, which ultimately leads to diseases like osteoporosis, rickets, etc.

Osteoporosis is usually a silent disease and does not show any symptoms. But there are a few minor symptoms (some people have experienced them in their lifetime) namely high loss, receding gums, lower back pain etc.

Treating osteoporosis includes treating fractures and preventing future fractures by increasing bone density and calcium levels in the body. An experienced doctor will examine the fracture and treat it with either surgery or medication. While changing daily lifestyle affects bone density.

Osteoporosis Differential Diagnosis Table:

Symptomsky	Osteoporosis	Rheumatoid Arthritis	Arthritis	Hyperthyroidism	Vitamin D Deficiency	Multiple Myeloma	Paget's Disease	Osteomalacia	Hyperparathyroidism
Fractures	Yes	Common	Rare	Common	Rare	Yes	Yes	Yes	Yes
Loss of height	Yes	No	No	Rare	Yes	Rare	Rare	Yes	Yes
Back pain	Yes	Common	Yes	No	Yes	Yes	Yes	Yes	Yes
Stooped posture	Yes	No	No	No	Yes	Yes	Yes	Yes	Yes
Joint pain and swelling	No	Yes	Yes	No	Yes	Yes	Yes	No	No
Thyroid dysfunction	No	No	No	Yes	No	No	No	No	Yes
Muscle weakness	Yes	Yes	No	Yes	Yes	Yes	Rare	Yes	Yes
Bone pain and tenderness	Yes	Yes	No	No	Yes	Yes	Yes	Yes	Yes
Bone deformities	Yes	Yes	Common	No	No	Rare	Yes	Yes	Common
Softening of bones	Yes	No	No	No	Yes	No	Yes	Yes	Common
Hypercalcemia	No	No	No	Common	Yes	Yes	Rare	No	Yes
Nodules or protuberance in joints	No	Yes	Yes	No	No	No	No	No	No
Loss of hair	Common	Yes	Yes	Common	Yes	Rare	No	No	Rare
Diagnostics	Bone density test, X-rays (DXA)	Rheumatoid factor (RF) test, Anti-cyclic citrullinated peptide (anti-CCP) test, Joint ultrasound or MRI. Clinical exam	C-reactive protein (CRP) test, Erythrocyte sedimentation rate (ESR) test, Anti-cyclic citrullinated peptide (anti-CCP) test.	Thyroid function tests (TFTs): Elevated levels of free thyroxine (T4) and triiodothyronine (T3), Low thyroid-stimulating hormone (TSH) levels.	Serum 25-hydroxyvitamin D test, Parathyroid hormone (PTH) test.	Serum protein electrophoresis (SPEP), Serum immunofixation electrophoresis (IFE), Complete blood count (CBC). Myelogram, MRI	Alkaline phosphatase (ALP) test, X-rays or bone scans.	Serum 25-hydroxyvitamin D test, Serum alkaline phosphatase (ALP) test. Calcium blood test	Serum calcium test: Elevated levels, Parathyroid hormone (PTH) test: Elevated levels.

Osteoporosis is a common bone disease that is characterized by a reduction in bone and quality density, which leads to a decrease in bone strength. This condition increases the risk of fragility fractures. Fragility fractures occur spontaneously or after traumas. The most common fragility fractures are hip, radio, and vertebrae fractures.
There are numerous risk factors associated with this condition, such as low bone mass, being female, advanced age, smoking history, Caucasian ethnicity, history of recent fractures, sedentary lifestyle, excessive consumption of caffeine or alcohol, insufficient consumption of calcium or vitamin D.
Most patients are asymptomatic until they have fractures. It is very important to make a good anamnesis and physical examination. During the physical examination, signs of fractures should be looked for, such as a decrease in the height of intervertebral discs, previous fractures, pain on palpation. Posture, balance, and muscle strength have to be evaluated since we can rule out other entities such as genetic or rheumatological diseases.

How to Distinguish Osteoporosis from Other Diseases

Distinguish Rheumatoid Arthritis from Osteoporosis – Diagnosis

Rheumatoid arthritis is an idiopathic systemic disease that manifests itself by affecting synovial joints.

• Rheumatoid arthritis is a disease that affects the joints, unlike osteoporosis, which affects the bones.
• Rheumatoid arthritis onset is characterized by symmetric polyarthritis in the metacarpophalangeal joints, unlike osteoporosis, which often has no symptoms.
• Rheumatoid arthritis stiffness in the affected joints is predominantly during the morning, unlike osteoporosis, which, if it has symptoms, occurs suddenly.
• Rheumatoid arthritis, unlike Osteoporosis, manifests itself symmetrically in the joints and produces nodules that appear on the surface of friction or pressure.

Distinguish Arthritis from Osteoporosis – Diagnosis

Arthritis is a systemic autoimmune inflammatory disease of unknown etiology characterized by inflammation of the synovial membrane of the joints.

• Arthritis, unlike Osteoporosis, has an autoimmune component.
• Arthritis is an inflammation of the synovial membrane, while Osteoporosis is a decrease in bone density.
• Arthritis is a non-degenerative disease, which means it is not caused by aging, while Osteoporosis is.
• Arthritis Symptoms are: swelling, joint pain, fatigue, redness, protuberance in joints, muscle weakness, decreased range of motion, and intermittent pain, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height.

Distinguish Hyperthyroidism from Osteoporosis – Diagnosis

Hyperthyroidism is the excessive secretion of thyroid hormone from the thyroid gland.

• Hyperthyroidism clinical presentation is: weight loss, heat intolerance, weakness, oligomenorrhea, anxiety, tremors, palpitations. During physical examination, the signs that can be found are: fixed gaze, hair loss, atrial fibrillation, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height.
• Hyperthyroidism is a non-degenerative disease, which means it is not caused by aging, while Osteoporosis is a degenerative disease.

Distinguish Vitamin D Deficiency from Osteoporosis – Diagnosis

Decreased levels of serum vitamin D in the bloodstream are called vitamin D deficiency.

• Vitamin D deficiency can lead to osteoporosis, unlike osteoporosis itself, which is a degenerative disease mostly caused by aging.
• Vitamin D deficiency is asymptomatic unless the patient is already dealing with its most serious presentations, which are: rickets (in children) and osteomalacia in adults. It may occur: recurrent infections, fatigue, muscle aches, hair loss, and bone pain, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height.

Distinguish Multiple Myeloma from Osteoporosis – Diagnosis

Multiple Myeloma is a neoplastic disease of plasmatic cells.

• In the laboratory, cells that are used to be able to identify multiple myeloma, the following findings are found: anemia, thrombocytopenia, and leukopenia, unlike Osteoporosis, which will only be identified as a decrease in bone density.
• In multiple myeloma, unlike Osteoporosis, there are high levels of calcium in the bloodstream.
• The most common symptom in multiple myeloma is bone pain (especially in the spine or ribs). The second most common symptom is anemia, so the patient will present: fatigue, tiredness, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height, as the symptoms of this condition are similar to Osteoporosis and other diseases, diagnosis is based on myelogram.

Distinguish Paget´s Disease from Osteoporosis – Diagnosis

Paget´s disease is a chronic bone disorder that causes alterations and deformation in the body skeleton.

• Paget’s disease is more common in men, while Osteoporosis is more common in women.
• Paget’s disease may present neurological symptoms like deafness, urinary and fecal incontinence, and hydrocephaly, unlike Osteoporosis, which is very rare to find these symptoms. However, it presents: kyphosis, lower back pain, stooped posture, fractures, and loss of height.
• In Paget´s disease, the production of new bone matrix is of poor quality, unlike Osteoporosis, where the bone matrix production decreases.

Distinguish Osteomalacia from Osteoporosis – Diagnosis

Osteomalacia is a disease that occurs due to a deficit in the mineralization of the bone matrix.

• Osteomalacia can occur in pediatric patients as rickets, unlike Osteoporosis, which normally occurs in people over 65 years of age.
• Osteomalacia affects soft bone due to an incomplete mineralization which is part of the bone’s formation, while Osteoporosis, there is a decrease in bone density.
• Osteomalacia’s most common symptoms are: pseudofractures, muscle weakness, numbness on hands and feet, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height.

Distinguish Hyperparathyroidism from Osteoporosis – Diagnosis

Hyperparathyroidism is the excessive production of parathyroid hormone.

• Hyperparathyroidism symptoms are non-specific; the diagnosis will be based on lab tests. It will produce systemic symptoms due to the hormone affected and its function. These symptoms are: muscle weakness, bone pain, hypertension, polyuria, polydipsia, depression, abdominal pain, while Osteoporosis symptoms are: kyphosis, lower back pain, stooped posture, fractures, and loss of height.

Common Red Flags with Osteoporosis

Bone mineral content is directly proportional to bone mass, which reaches its peak between 25-30 years. Bone mineral content will also depend on aging and the reduction of estrogen deficit in women. It is important to educate and recommend stopping smoking and reducing or quitting alcohol consumption.
It is important to promote osteoporosis prevention by modifying eating habits and promoting supplement use: recommend the calcium and vitamin D intake; they are essential to reach maximum bone mass and maintain it during the postmenopausal stage. Promote weight workouts: it decreases bone loss during aging and helps with balance and muscle strength.
There are chronic diseases that cause secondary osteoporosis; they can be divided into: Endocrine diseases: Acromegaly, hyperthyroidism, diabetes, Cushing’s syndrome. Genetic diseases: Porphyria, Osteogenesis imperfecta, homocystinuria. Gastrointestinal diseases: Celiac disease, cirrhosis. Hematologic diseases: multiple myeloma, leukemia. Infectious diseases: HIV-AIDS. Metabolic diseases: Alcoholism, malnutrition, vitamin D deficiency. Neurological diseases: Muscular dystrophy, bone marrow injuries. Kidney diseases: Renal tubular acidosis, kidney failure. Rheumatic diseases: rheumatoid arthritis, systemic lupus. Secondary to drugs: Protease or aromatase inhibitors, thyroxine.

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