Health Program

 Osteoporosis

Definition


Osteoporosis is accelerated bone loss. Normally, there is loss of bone mass with aging, perhaps 0.7% per year in adults. However, bone loss is greater in women past menopause than in men of the same age. The process of bone remodeling from resorption to matrix synthesis to mineralization normally takes about 8 months--a slow but constant process. Bone in older persons just isn't as efficient as bone in younger persons at maintaining itself--there is decreased activity of bone cells and decreased production of growth factors and bone matrix.


Osteoporosis can be classified as primary or secondary. Primary osteoporosis is simply the form seen in older persons and women past menopause in which bone loss is accelerated over that predicted for age and sex. Secondary osteoporosis results from a variety of identifiable conditions that may include:


  • Metabolic bone disease, such as hyperparathyroidism

  • Malnutrition

  • Drug therapy, as with corticosteroids

  • Prolonged immobilization

  • Weightlessness with space travel


Risk Factors


Modifiable risk factors that may potentiate osteoporosis include:


  1. Smoking

  2. Alcohol abuse

  3. Excessive caffeine consumption

  4. Excessive dietary protein consumption

  5. Lack of dietary calcium

  6. Lack of sunlight exposure (to generate endogenous vitamin D)


Risk Groups


  1. Women

  2. People who have previously broken their hip or waist

  3. People who have family history of Osteoporosis

  4. Women that had menopause before the age of 45

  5. People who have had anorexia nervosa


Treatment


Treatment will usually include three things: education, exercise, and medication. The education part of the treatment is to educate the people about the appropriate vitamin D intake and about over all nutrition. Exercise will help the patient maintain bone density and reduce the risk of falls. The medications help one or two things. Medications will reduce fractures by strengthening the bones and/or prevent future bone loss. Medications prescribed to slow or stop bone resorption are: Bishosphonates, Calcitonin, Estrogen Receptor Modulators, and Estrogen/ hormone therapy. Medication to increase bone formation are: Teriparatide, and parathyroid hormone.


Statistics


  1. Osteoporosis is second only to cardiovascular disease as leading health care problem according to the WHO (world health organizations)

  2. Osteoporosis-related disabilities confine patients to more immobile days in bed than any of the following: chronic obstructive pulmonary disease, stroke, myocardial infraction, and breast cancer.

  3. Life-time risk for women dying from hip fracture complications equal risk of dying from breast cancer.

  4. More women die each year as a result of an osteoporosis fracture than from breast cancer and ovarian cancer combined

  5. 28 million people are affected in the U.S.

  6. Women are affected four times as men

  7. One out of every 2 women will have osteoporosis-related fracture in their life time.


Prevention Strategies


The best long-term approach to osteoporosis is prevention. If children and young adults, particularly women, have a good diet (with enough calcium and vitamin D) and get plenty of exercise, then they will build up and maintain bone mass. This will provide a good reserve against bone loss later in life. Exercise places stress on bones that builds up bone mass, particularly skeletal loading from muscle contraction with weight training exercises. However, any exercise of any type is better than none at all, and exercise also provides benefits for prevention of cardiovascular diseases that are more common in the elderly. Athletes tend to have greater bone mass than non-athletes. Exercise in later life will help to retard the rate of bone loss.