Osteoporosis is commonly seen in postmenopausal Caucasian women. However, it is found in women of all racial groups including black women. The disease does not spare males in the late stages of life; they too may be affected by senile osteoporosis. Osteoporosis may be caused by endocrinopathies, nutritional deficiencies, drugs (long-term steroid therapy), or immobilization. Smoking is a well-recognized risk factor for osteoporosis.

Osteoporosis may be akin to a "silent thief." As it evolves, the patient has no symptoms and is not aware of the developing disease. Routine blood work-up including sedimentation rate, complete blood count, creatinine, calcium, phosphorus, uric acid, liver function tests, thyroid stimulating hormone, parathyroid hormone, alkaline phospha-tase, and serum vitamin D levels remain normal throughout. Frequently the disease is diagnosed late when the patient sustains a spontaneous vertebral fracture or breaks a long bone following minimal trauma. Fractures tend to occur in the vertebral bodies, proximal hip, distal radius, and proximal humerus. Vertebral fractures are a major source of morbidity and affect the quality of life of many patients. There are approximately 700,000 new vertebral fractures each year in the United States. These fractures may be incidentally discovered in films obtained for other reasons and are frequently missed by inexperienced physicians.

Clinical Presentation

Severe axial pain may develop following a trivial trauma, or spontaneously after nontraumatic events such as coughing or sneezing. The pain increases with movements and disappears with complete rest. The pain may prevent the patient from ambulating. Tenderness to percussion over the fractured vertebra is apparent. In many instances the pain is addressed with the proper medications but no work-up is offered, and the patient is left undiagnosed. This "benign neglect" results in

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