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Osteoporosis

April 16, 2012

Osteoporosis

D.Neville

Introduction

Osteoporosis, a systemic skeletal disease, is characterized by low bone mass and deterioration of bone tissue that can affect almost the entire skeleton. Unfortunately, this disease does not usually become clinically present until a fracture occurs. Osteoporosis is the most common metabolic bone disease in the United States and needs to be detected early if possible. I will explain in more detail the pathogenesis, etiology, diagnosis, treatment, incidence and mortality, and research and charity groups available for more information and support.
 

Pathogenesis

Normal bone is composed of collagen, calcium, and protein, all of which provide strength to the bones. Osteoporosis is a condition characterized by a decrease in bone density of bone. This decreases bone strength and results in fragile bones, leading to fractures. It does this by turning bone into porous bone that is compressible like a sponge. Calcium and phosphate ate two minerals that are essential for normal bone formation. As you grow, the body uses these minerals to produce bones. If there is not enough calcium, or if the body does not absorb enough calcium from the diet, bone production and bone tissue may suffer. As we age, calcium and phosphate may be reabsorbed back into the body from the bones, which makes them weak. This makes the bones break more easily to relatively minor injuries whereas normal bones would not break. The loss of bone usually occurs gradually over years, depending on the stage, osteoporosis can be maintained or slowed or stop bone loss. Usually, osteoporosis doesn’t cause symptoms until a bone fracture. Therefore, patients may not be aware of their condition until a serious, painful bone fracture. Symptoms the develop in late stages of the disease include bone pain or tenderness, fractures with little or no trauma, loss of height, low back pain (due to fractures in the spine), neck pain, and stooped posture. Some risk factors include advanced age, female sex, genetic factors, thin build, late menarche, early menopause, physical inactivity, alcohol and tobacco use, and calcium deficiency.


 
 

 

 

 

 

 

 

Etiology

Primary osteoporosis occurs in patients in whom a secondary cause cannot be identified. This includes juvenile, type I, (postmenopausal), and type II (age-associated or senile). The leading cause of osteoporosis is a drop in estrogen levels in women at the time on menopause, type I. For men, their testosterone levels drop, type II. Women over the age of 50 and men over the age of 70 are more at risk. Secondary osteoporosis occurs when an underlying disease, deficiency, or drug causes osteoporosis. These can include being confined to a bed, chronic rheumatoid arthritis, chronic kidney disease, eating disorders, corticosteroid medications or antiseizure drugs, hyperparathyroidism, and vitamin D deficiency. A family history of osteoporosis also provides a greater risk of developing osteoporosis.

Diagnosis

A bone mineral density test can be done to measure how much bone you have. This test measures bone density in the spine, wrist, and hip. Those are the most common sites of fractures. This can provide information or predict your risk for bone fractures in the future, detect low bone density before a fracture, and determine your rate of bone loss or monitor the effects of treatment. A special type of spine CT can be done to show loss of bone mineral density in rare cases. In severe cases, a spine or hip x-ray may show fractures, however, simple x-rays of bones are not very accurate in predicting whether someone is likely to have osteoporosis. Other blood and urine tests are done if the cause is due to a medical condition, rather than the bone loss seen with older age.

Treatment

The goals of osteoporosis treatment are to control the pain, slow or stop bone loss, prevent bone fractures, and minimize the risk of falls leading to fractures. Lifestyle changes may need to be made to help with this disease. Some examples would be diet and exercise. High calcium foods such a cheese, ice cream, low-fat milk, salmon, tofu, and yogurt are a few choices. Exercising regularly can reduce the likelihood of bone fractures like walking, dancing, free weights, stationary bicycle, and yoga to help with balance. Medications are used when osteoporosis has been diagnosed by a bone density study or osteopenia (thin bones) has been diagnosed. Bisphosphonates are used to prevent and treat osteoporosis in postmenopausal women. They are only taken once a week or once a month. Calcitonin is used to slow the rate of bone loss and relieves bone pain. This is a nasal spray or comes as an injection but is less effective than bisphosphonates. Hormone replacement therapy can also be used, but rarely used anymore; it does treat patients who already been diagnosed with the condition. Parathyroid hormone is used more often for postmenopausal women who have severe osteoporosis; this medicine is given through daily shots underneath the skin. One more medication used to prevent and treat this disease is raloxifene. This is similar to the breast cancer drug tamoxifen. It can reduce the risk of spinal fractures but does not appear to prevent other fractures. All treatment options will be discussed with your doctor and based on individual cases.

 

Incidence and Morality

Osteoporosis is an increasing worldwide problem, as both the world population grows and age increases. Lifetime risk for osteoporotic fractures in women is 30-50% worldwide, and 15-30% in men. One in three women over the age of fifty will suffer from a fracture due to osteoporosis. With that number, this increases to one in two over the age of sixty. One in five men over the age of fifty will suffer from osteoporosis and increases to one in three over the age of sixty.
Approximately 1.6 million hip fractures occur each year global, and the incidence is set to increase to 6.3 million by the year 2050. The annual incidence rate of osteoporotic fractures in women is greater than the combined incidence rates of heart attack, stroke, and breast cancer.
The mortality of this disease does not usually lead to death, although, about 10% of osteoporosis cases do. In most cases, osteoporosis can cause other problems or lead someone to bed rest.

Research, Charities and Support Groups

Most of the research taking place right now is determining the cause of osteoporosis and its specific affects, and treatment. Researchers are finding a specific gene and possible programmed cell death could lead to osteoporosis. As far as treatment, researchers are looking at different studies. A low-dose estrogen study has been done as showed good preventative results. Molecules called peptidomimetics block the bone resorption process have been studies, and also calcium supplements may show some helpful progression. For more information click on the link below.
http://osteoporosis.emedtv.com
Because this disease is popular and common in the elderly, there are also many support groups and charities out there that provide helpful information and support for people who suffer with this disease. There are many charities worldwide who donate and provide scholarly articles and information for people to better understand and cope with the disease. Below are a couple charities that I thought were beneficial to this disease.
http://www.nos.org.uk
http://www.nof.org
As for support groups, look into local areas or hospitals that may hold a support group near you. It is nice to know and be around other people that share the same disease to discuss and relate to one another. If there are not any local groups by you there are many online support groups available to anyone. You are able to blog or just read about others who share about osteoporosis. Online support groups can provide more anonymous information, or very public, it is up to you how you want to share your information. Below are some links to maybe get you started or look into and get your foot in the door.
 http://www.everydayhealth.com/osteoporosis/osteoporosis-support-groups.aspx
http://www.mdjunction.com/osteoporosis
http://www.maleosteoporosis.org

Sources

Essentials of Human Disease by Leonard V. Crowley

www.ncbi.nlm.nih.gov

www.medicinenet.com/osteoporosis

http://emedicine.medscape.com

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