Osteoporosis Definition of Osteoporosis Osteoporosis Term Paper

Excerpt from Term Paper :

More than half of all men who undergo a hip fracture go from the hospital to a nursing home, and 79% of those who endure for one year still live in nursing homes or transitional care facilities.

Osteoporosis is a major threat to more than 2 million men in the United States. In spite of these facts, as per a 1996 Gallup Poll, many men still view osteoporosis as a women's disease. Only very few men know that this disease is a major threat to their mobility and freedom. For a majority of the people, bone mass increases during the third decade of life. Men naturally have gathered more bone mass by this age in comparison to women. After this point, the amount of bone in the skeleton naturally starts declining slowly as removal of old bone surpasses the creation of new bone. Men in the 50s do not undergo the quick loss of bone mass that women do in the years after menopause. But by the age of 65 or 70, men and women lose bone mass at the same speed levels, and absorbing calcium, which is a vital nutrient for bone health throughout the entire life, decreases in both men and women. Extreme bone loss makes the bone become weak and is more prone to break. Fractures due to osteoporosis usually takes place in the hip, spine, and wrist, and will disable permanently and mainly hip fractures are dangerous. Because such fractures occur mostly at older ages in men in comparison to women, men who have hip fractures have more chances than women to die from the various complications which arise. Some of the likely causes for Osteoporosis in men are due to extreme levels of intake of alcohol; smoking; chronic pulmonary disease which is obstructive and due to asthma.

Etiology of Osteoporosis:

new theory is given for the first time to clarify the etiology of osteoporosis. Prostaglandins like E2 and F2 alpha at certain concentrations have been found to cause bone formation. A close relation is present between levels of prostaglandins -- E2 and F2 alpha shown in the neonatal mouse causing bone formation, with estimated prostaglandins --E2 and F2 alpha concentrations found in man. Some hormones like "vasopressin, oxytocin, luteinizing hormone, follicle-stimulating hormone, cortisol, estradiol, and testosterone" can obliquely affect prostaglandin formation resulting in reduced bone formation. The link between these hormones and prostaglandins -- E2 and F2 alpha describes the physiological mechanism whereby estradiol can be useful for the treatment of osteoporosis. This link also explains the etiology of lumbar spondylitis/spondylodynia, causes for complaints of enhanced pain in wet cold weather among arthritics and a number of other events.

Osteoporosis takes place when the body cannot form new bone or when too much of old bone is reabsorbed by the body. Though there are a number of reasons, hormone deficiency is the main reason. Women, particularly over the age of 50, are the most common victims of this disease due to the loss of ovarian function and subsequent reduction in estrogen production that takes place at the time of menopause.

Pathogenesis of Osteoporosis:

The pathogenesis of osteoporosis is based on various factors. Two kinds of osteoporosis can be found in aging women: "postmenopausal osteoporosis and age-related osteoporosis." Postmenopausal osteoporosis is found in women who are postmenopausal but less than 70 years. These women are found to have Type I or postmenopausal osteoporosis. Type I osteoporosis is found by enhanced bone resorption because of osteoclastic activity and is usually considered to be connected to estrogen deficiency. Vertebral crush fractures and fractures of the distal radius are the major difficulties. Osteoporosis which is related to age is called senile or type II osteoporosis and it takes place when there is extreme bone loss and is found after the age of 70 years in both men and women. Type II osteoporosis occurs due to normal aging and is linked with a steady, 1-2% loss of cortical and trabecular bone mass annually. Age-related bone loss starts at age 35-40 years when the balance moves to support resorption and the skeleton starts losing bone mass. Hip and vertebral fractures are very common in this type of osteoporosis.

In the Western world, osteoporosis is the major health problem affecting around 100 million people. It is found mainly in postmenopausal women and shows an inequity between the twin processes of bone resorption and bone formation, so that bone is gradually lost after mid-life. The present day pharmacological approaches to osteoporosis are to guarantee sufficient calcium and vitamin D intake and reduce bone resorption by drugs that reduce osteoclast activity like hormone replacement therapy, bisphosphonates and calcitonin. But, patients with osteoporosis have lost more than 50% of bone at vital sites in the skeleton, and have disturbance of trabecular bone microarchitecture.

They require therapeutic methods to renovate or restructure the bone that has been lost by improving osteoblast differentiation and further bone formation. It has been found that medicines that prevent the enzyme HMG-Co -- A reductase, the rate limiting step in cholesterol biosynthesis, also enhances osteoblast differentiation both in vitro and in vivo. Three million people take these drugs daily to reduce their serum cholesterol and to decrease the risk of heart attack. But, this new data points out that in addition to this effect, they increase the expression of the bone growth regulatory factor, BMP-2, and further boost new bone formation by increasing osteoblast differentiation.

A and Z Scores:

T-SCORE is the amount of standard variations by which "the bone mineral density measurement is above or below the YOUNG-NORMAL MEAN bone mineral density." AZ SCORE is the amount of standard variations by which "the measurement is above or below the AGE-MATCHED MEAN bone mineral density."

The T- and Z-scores were formed due to the changes in BMD measurement technology among various producers. Thus, the BMD results are mentioned as standard variations from a comparison to the referent mean. T-scores are normally used to describe osteoporosis or osteopenia. A BMD which is more than 2.5 standard deviations and which is below the mean for a young healthy adult white woman discovers 30% of all postmenopausal women as having osteoporosis and half of these women would have had a fracture already. The hip T-score is the site which is being used in clinical decisions. Z-score is not usually used but may be useful in finding persons who should undertake a work-up for secondary reasons for osteoporosis. AZ-score varies over time with regard to the T-score. The following shows how one could interconvert T- and Z-scores. Converting T-score to Z-score at the hip shows that at "Age 50: T = Z - 0.37; at age 60: T = Z - 1.01; at age 70: T = Z - 1.56; Age 80: T = Z - 2.11; Age 90: T = Z - 2.52."

Treatments and Trends in Osteoporosis:

Though there is no remedy for osteoporosis, there are measures that can be taken to avoid or to slow down its growth. Sufficient calcium, vitamin D, suitable exercise and, in certain instances, drugs are essential for promoting and maintaining bone health. Presently the U.S. Food and Drug Association --FDA has approved bisphosphonates like alendronate, ibandronate and risedronate; calcitonin, estrogens, parathyroid hormone and raloxifene for the preventing and treating osteoporosis. The bisphosphonates like alendronate, ibandronate and risedronate; calcitonin, estrogens and raloxifene have an effect on the bone remodeling cycle and are grouped as anti-resorptive medications. Bone remodeling has two different stages: bone resorption and that of bone formation. During resorption, special cells found on the bone's surface soften bone tissue and form small cavities.

During the stages of formation, other cells load the cavities with new bone tissue. Usually, bone resorption and bone formation are connected so that they are found in close order and remain to be balanced. A disparity in the bone remodeling cycle creates bone loss that finally results in osteoporosis and danger of fracture. Anti-resorptive medications reduce or stop the bone-resorbing portion of the bone-remodeling cycle but do not reduce the bone-forming portion of the cycle. Therefore, new formation continues at increased levels in comparison to bone resorption, and bone density may enhance over time. Teriparatide, which is a form of parathyroid hormone, is a newly accepted osteoporosis medication and it is the first osteoporosis medication to boost the rate of bone formation in the bone remodeling cycle.

The best protection against developing osteoporosis is forming strong bones before the age of 30, and a healthy way of life is essential for keeping the bones strong. There are many steps to prevent osteoporosis. Prevention of this disease is very important. Though there are many treatment methods, but presently there is no permanent cure. The steps to prevent osteoporosis are: the daily suggested amounts of calcium and vitamin D is to be taken; regular exercise; must avoid smoking and excessive alcohol; must consult healthcare provider about bone…

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