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Osteoporosis

Osteoporosis is a disease in which bones become fragile and weak, leading to an increased risk of fractures (broken bones). People with osteoporosis can experience a fracture even after a slight bump, or a fall from standing height, in the course of daily activities.

Osteoporosis comes from ‘osteo’ meaning bone and the Greek word ‘por’ (passage) i.e. porous bone. Normal bone is composed of a mixture of calcium and other minerals such as magnesium and phosphate. It is also made up of collagen (protein), which forms the structural framework of bone. Osteoporosis occurs when there is a loss of mineral from bone mainly in the form of calcium as well as architectural loss of normal bone structure. The loss of mineral content of the bone is referred to as a loss of bone mineral density in the bone.

The 3 types of bone cells are osteoblasts, osteoclasts, and osteocytes. The osteocytes function as “mechanostats”, sensing the degree of micro-damage and triggering remodeling in areas of stress and strain, thus allowing continual renewal, repair, and replacement of bone. This process of remodeling maintains bone strength.

Osteoporosis has no signs or symptoms until a fracture occurs – this is why it is often called a ‘silent disease’. Fractures due to osteoporosis occur most commonly at sites such as the wrist, upper arm, pelvis, hip and spine, and can result in severe pain, significant disability and even death.

About 54 million Americans have osteoporosis and low bone mass, placing them at increased risk for osteoporosis. Studies suggest that approximately one in two women and up to one in four men age 50 and older will break a bone due to osteoporosis.

Causes

Genetic Factors – Bone health can be strongly inherited so consider your family history of osteoporosis. It is important to note if anyone in your family (particularly parents or siblings) has ever been diagnosed with osteoporosis, broken a bone from a minor fall or rapidly lost height. These can indicate low bone density.

Medical History – Certain conditions and medications can impact on your bone health. Corticosteroids – commonly used for asthma, rheumatoid arthritis and other inflammatory conditions Low hormone levels – in women: early menopause; in men: low testosterone Thyroid conditions – over active thyroid or parathyroid Conditions leading to malabsorption eg: coeliac disease, inflammatory bowel disease Some chronic diseases eg: rheumatoid arthritis, chronic liver or kidney disease Some medicines for breast cancer, prostate cancer, epilepsy and some antidepressants.

Calcium and Vitamin D Level – Low calcium intake – adults require 1,000 mg per day (preferably through diet) which increases to 1,300 mg per day for women over 50 and men over 70 Low vitamin D levels – a lack of sun exposure can mean you are not getting enough vitamin D which your body needs to absorb calcium.

Gender

Women are more at risk of developing osteoporosis than men because the hormone changes that occur in the menopause directly affect bone density.

The female hormone oestrogen is essential for healthy bones. After the menopause (when monthly periods stop), oestrogen levels fall. This can lead to a rapid decrease in bone density.

In most cases, the cause of osteoporosis in men is unknown. However, there’s a link to the male hormone testosterone, which helps keep the bones healthy.

Risk factors – Many hormones in the body can affect the process of bone turnover. If you have a condition of the hormone-producing glands, you may have a higher risk of developing osteoporosis.

  • Hormone-related conditions that can trigger osteoporosis include:
  • hyperthyroidism (overactive thyroid gland)
  • disorders of the adrenal glands, such as Cushing’s syndrome
  • reduced amounts of sex hormones (oestrogen and testosterone)
  • disorders of the pituitary gland
  • hyperparathyroidism (overactivity of the parathyroid glands)

Lifestyle choices – Some bad habits can increase your risk of osteoporosis. Examples include –

  • Sedentary lifestyle – People who spend a lot of time sitting have a higher risk of osteoporosis than do those who are more active. Any weight-bearing exercise and activities that promote balance and good posture are beneficial for your bones, but walking, running, jumping, dancing and weightlifting seem particularly helpful.
  • Excessive alcohol consumption. Regular consumption of more than two alcoholic drinks a day increases your risk of osteoporosis.
  • Tobacco use – The exact role tobacco plays in osteoporosis isn’t clearly understood, but it has been shown that tobacco use contributes to weak bones.

Symptoms

There are often no warning signs or symptoms until a minor fall or a sudden impact causes a bone fracture. Healthy bones should be able to withstand a fall from standing height, so a bone that breaks in these circumstances is known as a fragility fracture.

The most common injuries in people with osteoporosis are:

  • wrist fractures
  • hip fractures
  • fractures of the spinal bones (vertebrae)

Sometimes a cough or sneeze can cause a rib fracture or the partial collapse of one of the bones of the spine. In older people, a fractured bone can be serious and result in long-term disability. For example, a hip fracture may lead to long-term mobility problems. Although a fracture is the first sign of osteoporosis, some older people develop the characteristic stooping (bent forward). It happens when the bones in the spine have fractured, making it difficult to support the weight of the body.

Treatment

Medications – Treatment recommendations are based on an estimate of your risk of breaking a bone in the next 10 years using information such as the bone density test. If the risk is not high, treatment might not include medication and might focus instead on lifestyle, safety and modifying risk factors for bone loss.

For both men and women at increased risk of fracture, the most widely prescribed osteoporosis medications are bisphosphonates. Examples include –

  • Alendronate (Fosamax)
  • Risedronate (Actonel, Atelvia)
  • Ibandronate (Boniva)
  • Zoledronic acid (Reclast)

Side effects include nausea, abdominal pain, difficulty swallowing, and the risk of an inflamed esophagus or esophageal ulcers. These are less likely to occur if the medicine is taken properly. Intravenous forms of bisphosphonates don’t cause stomach upset. Bisphosphonates have the potential to affect the jawbone. Osteonecrosis of the jaw is a rare condition that can occur after a tooth extraction in which a section of jawbone dies and deteriorates. You should have a recent dental examination before starting bisphosphonates.

Hormone-related therapy – Estrogen, especially when started soon after menopause, can help maintain bone density. However, estrogen therapy can increase a woman’s risk of blood clots, endometrial cancer, breast cancer and possibly heart disease. Therefore, estrogen is typically used for bone health only if menopausal symptoms also require treatment.

 

Alternative Treatment

Supplements

  • Calcium is the most abundant mineral in the human body. It is well recognized for its importance in the development of bones and teeth and has many other functions as well. The ability of calcium supplements to “maintain good bone health and reduce the high risk of osteoporosis later in life” is one of the few health label claims allowed by the U.S. Food and Drug Administration.
  • Magnesium is the second most common mineral in the body, after calcium. Magnesium is important for many metabolic processes, including building bone, forming adenosine triphosphate, and absorbing calcium. Dietary sources of magnesium include nuts, whole grains, dark green vegetables, fish, meat, and legumes. Magnesium is often deficient in the standard American diet, due to low consumption of foods containing this nutrient, as well as soil depletion from commercial farming practices such as overcropping.
  • Vitamin D is essential for the formation and maintenance of bone tissue, due to its involvement in several complex mechanisms, including the regulation of calcium and phosphorous absorption. If vitamin D levels are low, parathyroid hormone (PTH) increases and triggers osteoclasts to release calcium into the blood via bone readsorption. If this process continues over time, it weakens bone and leads to osteoporosis. In addition, vitamin D stimulates intestinal epithelial cells to synthesize calcium-binding proteins that support the absorption of calcium in the blood.
  • Boron is ubiquitous throughout the human body, with the highest concentrations found in the bones and dental enamel. Although there is currently no RDA for it, boron appears to be indispensable for healthy bone function, possibly because of its effects on reducing the excretion and absorption of calcium, magnesium, and phosphorus.
  • The mineral strontium is a powerful agent in the treatment and prevention of osteoporosis. Strontium is a naturally occurring mineral present in water and food. Trace amounts of strontium are found in the human skeleton, where it is adsorbed at the matrix crystal surface of bones.
  • Research supports the positive effects of soy isoflavones on reducing the risk of developing osteoporosis. Diets high in soy may decrease bone reabsorption in postmenopausal women. Although ipriflavone, a semi-synthetic flavone comparable to genistein and daidzein found in soy foods, was ineffective in restoring bone density in rats, it modulated IGF-I (insulin growth factor I), which is linked to bone mineral density, and increased bone remodeling through several mechanisms.
  • Vitamin K is a fat-soluble vitamin known for its effect in blood clotting, which it accomplishes by regulating the coagulation cascade via its ability to bind calcium ions (Ca2+), among other mechanisms. Three known vitamin K–dependent proteins have been isolated in bone: MGP (matrix Gla protein), protein S, and osteocalcin. One of vitamin K’s roles in helping to maintain healthy bone mass is linked to its importance in the formation of osteocalcin by osteoblasts. The synthesis of osteocalcin requires both vitamin D and vitamin K.
  • Omega-3 fatty acids is proven way to improve cardiovascular health, Omega-3 fatty acids have also shown some benefit to those with rheumatoid arthritis, reducing morning stiffness and joint swelling
  • Traditional Chinese Medicine (TCM) and acupuncture: TCM has been proven over thousands of years to help treat many different physical ailments. Based on herbs (usually brewed into tea or soup), TCM can improve how your body uses calcium, which in turn helps bone health.

 

References

http://www.osteoporosis.org.au/about-osteoporosis

http://www.medicinenet.com/osteoporosis/page2.htm

http://www.mayoclinic.org/diseases-conditions/osteoporosis/basics/risk-factors/con-20019924

http://www.choosingwisely.org/patient-resources/bone-density-tests/

http://nof.org/learn

http://womenshealth.gov/publications/our-publications/fact-sheet/osteoporosis.pdf

http://menopauseandu.ca/documents/OsteoporosisinMenopause2014.pdf

http://share.iofbonehealth.org/WOD/2013/patient-brochure/WOD13-patient_brochure.pdf