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Osteoporosis

Approximately 8 million people in the United States are affected by osteoporosis (Ray, Chan, Thamer, et al., 1997). Of these, 80% are older women (Ray, Chan, Thamer, et al., 1997). In addition to this problem, another 17 million people in this country have low bone mass, which puts them at an increased risk for developing osteoporosis as they get older (Ray, Chan, Thamer, et al., 1997). Every year, 1.5 million broken bones, 500,000 of them spinal fractures and 300,000 of them broken hips, are caused by the disease (Ray, Chan, Thamer, et al., 1997). It has been predicted that 50% of women and 20% of men who are over the age of 65 will have a fracture or broken bone related to osteoporosis at some time throughout their lives (Ray, Chan, Thamer, et al., 1997). The population of the world is increasing, and the life expectancy for people in many countries is also increasing, which means that osteoporosis and the number of people afflicted with it is going to continue to rise and become even more problematic in the future (Ray, Chan, Thamer, et al., 1997).

The next half century will likely see dramatic increases in the number of people that have this disease, and the largest increases are expected to be in Latin America and Asia (Ray, Chan, Thamer, et al., 1997). Unless there are preventative measures that are taken now, some predict that there will be a global epidemic where osteoporosis is concerned in the future. Currently, managing osteoporosis in the United States costs approximately $14 billion each year (Ray, Chan, Thamer, et al., 1997). Because the disease is so costly and so prevalent, detecting the disease, treating it, and if possible preventing it have become top priorities for many in the field of health care. Still, many people do not really know that much about osteoporosis, and many that are at risk do not realize that they are, or what a significant impact this can have on their lives.

Women that are past menopause have a risk that is higher than average for the development of osteoporosis (Ray, Chan, Thamer, et al., 1997). The risk is larger in women that are Asian or Caucasian than it is for those that fall into other racial categories. Others that are at increased risk include people that have taken certain specific medications and those that experienced early hormone deficiency or chronic malnutrition (Ray, Chan, Thamer, et al., 1997). Avoiding weight-bearing exercise and smoking also increase the risk of developing osteoporosis (Ray, Chan, Thamer, et al., 1997). Every year, 250,000 hip fractures, 700,000 vertebral fractures, and 250,000 distal forearm fractures occur because of osteoporosis (Ray, Chan, Thamer, et al., 1997). In addition to these fractures, 300,000 fractures occur in other bones from the disease (Ray, Chan, Thamer, et al., 1997). Each year, the number of hip fractures worldwide has been on the increase, and by the year 2050 the number is expected to be 6.26 million (Ray, Chan, Thamer, et al., 1997).

When the clinical significance of osteoporosis is looked at, it is based on the rate of fractures rather than the underlying process of the disease. This underlying process causes bones to become more porous than the normally are and when they are more porous they are also more susceptible to being fractured if the person falls or is struck (Ray, Chan, Thamer, et al., 1997). Elderly women are particularly at risk for two reasons. First, they simply live longer on average than men do, so they have a longer period of being elderly and having the chance to fracture a bone. Second, they have accelerated bone loss after menopause because the estrogen that they produce is reduced. This leads to bone loss at a more rapid rate than the bone loss that is seen in men (Ray, Chan, Thamer, et al., 1997). The most significant fractures for both women and men appear to be hip fractures.

Of those that fracture a hip, 50% will need assistance to walk for the remainder of their lives, and 25% will have to have long-term care (Riggs & Melton, 1995). The risk of death also increases by 10% to 20% within six months of sustaining a hip fracture, although research into the issue does not specifically indicate why this is the case (Riggs & Melton, 1995). It may, however, be related to several factors, including the depression that often comes with a reduced quality of life. Since osteoporosis develops silently, there is no way to know if one has or is at risk for the disease without being tested for it. The disease itself can be around for a long number of years before the person that has it is aware of it, and most people are not aware that they have it until they sustain some kind of fracture.

Generally, old bone is broken down constantly and reabsorbed into the body by osteoclasts (Riggs & Melton, 1995). New bone is then formed by osteoblasts (Riggs & Melton, 1995). This is the normal bone-remodeling cycle that takes place throughout the human body all the time. When there is a disruption in this cycle, such as what comes with osteoporosis, the bone mass is broken down faster than it is replaced, and therefore there is a higher chance of fractures and other problems (Riggs & Melton, 1995). By age 38, the peak bone mass has usually been reached, and there has been recent research that indicates that women in their thirties can still gain approximately 12.5% of their total bone mass if they take steps to do so (Riggs & Melton, 1995). Once this peak bone mass has been reached, bone mass begins to decline (Riggs & Melton, 1995). Generally, this is on a continuum up until the age of 85 or 90 years old (Riggs & Melton, 1995).

For men, total lifelong bone mass loss is between 20% and 30% (Riggs & Melton, 1995). For women, since they go through menopause which accelerates their bone mass and since they live longer, total lifelong bone mass loss can be as high as 45% to 50% (Riggs & Melton, 1995). There are recent treatments to help rebuild some of this bone loss, in the form of medication, but these treatments are not the subject of this research and will not be discussed here. There are other reasons besides aging that can cause a loss of bone mass. Sometimes, there are abnormalities in the repair process that bones go through, or problems with the microstructure of the bones themselves (Riggs & Melton, 1995). Also, gonadal deficiency can cause less active osteoblasts, and therefore the bone does not get rebuilt as fast as it is broken down by the body (Riggs & Melton, 1995).

The risk factors for osteoporosis are many and varied in addition to those that have already been listed. Bone mineral density is one factor, as well as family history, small bone structure, being inactive, early or late menarche, and an excessive amount of exercise that results in amerorrhea (Neer, 1995). There are also nutritional factors that must be considered, such as an inability to tolerate milk, not enough calcium intake, too much alcohol, and eating a large amount of red meat (Neer, 1995). Consuming antacids that have aluminum in them, anticonvulsants, glucocorticoids, or lithium, being on chemotherapy, or having endocrine abnormalities contribute to the problem as well (Neer, 1995). However, despite the importance of a patient's medical history, there is no substitute for simply performing a bone mineral density test when judging to see who is at risk for osteoporosis. Some with risk factors will never develop the disease and some that seem to have no risk factors will develop it.

Assessing the true cost of osteoporosis is difficult, despite the estimates…[continue]

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