Osteoporosis Definition of Osteoporosis: Osteoporosis

Osteoporosis

Definition of Osteoporosis:

Osteoporosis is a developing condition in which bone density is lost, or there is inadequate bone formation, thereby deteriorating the bones and making them more vulnerable to fractures. Osteoporosis is also known as the silent disease and is a familiar bone disease, which makes the bone lean and having holes. Osteoporosis takes place when the body does not form new bone and it affects both men and women. During a person's lifetime, the body requires minerals phosphate and calcium to form bones. If the nutritional consumption of these minerals is not enough or if the body does not take up sufficient minerals from the diet, the bone production and bone tissue will be affected leading to fragile and weak bones. Osteoporosis is called the silent disease because this occurs over a period of time. Many people are not aware that they have osteoporosis until they fracture a bone and by this time it is in its advanced stage.

Osteoporosis is a condition in which bones become weak and are prone to break. These broken bones occur mainly in the hip, spine and wrist. Any bone can be affected, but the main troubles are fractures of hip and spine. A hip fracture almost always needs hospitalization and major surgery. It can damage an individual's capacity to walk without help and may create lengthened or permanent disability or even death. Spinal or vertebral fractures also have severe consequences, including loss of height, acute back pain, and deformity.

Incidence of Osteoporosis:

The word occurrence of Osteoporosis means the yearly diagnosis rate, or the amount of new cases of Osteoporosis detected annually. The occurrence of hip fracture at age 50 is 17% to 22.7% in women. In the case of men it is 6% to 11%. On the whole the occurrence of any suggestive fracture in persons of the age of 60 and above with an average life expectation is 56% for women. And this would be 29% for men. In spite a lower levels of occurrence and incidence, the one year mortality after having hip fractures is 1.5 to 2 times higher in men in comparison to women. The latest facts point that the incidence of osteoporosis among patients having vertebral fractures is greatly miscalculated. This is due to the fact that even if a vertebral fracture is both found and detected, the existence of osteoporosis as a factor is rarely detected. A report showed that only 60% of the fractures were accounted for and osteoporosis was only dealt with for about a quarter of those patients.

Prevalence of Osteoporosis:

The word occurrence of Osteoporosis generally means the number of people who are coping with Osteoporosis over a period of time. Osteoporosis is the main health threat for 28 million Americans. At present, in the United States, 10 million people already have osteoporosis and 18 million more have low bone mass, keeping them at increased risk for this disease. On the whole, around eight million American women and 2 million men have osteoporosis. The following figures reveal the prevalence of Osteoporosis in the U.S.A. According to the figures for the year 2004 brought out by National Osteoporosis Foundation, there are 10 million cases of Osteoporosis in the U.S.A.; 34 million at possibility; 55% of people over the age of 50 have the risk of the disease in the country; women constitute 80% of cases; men account for 20% of the cases; During their lifetime, 50% of women over the age of 50 will have osteoporosis related fracture; During their lifetime 25% of men over the age of 50 years will have an osteoporosis related fracture in the country.

A study entitled "Osteoporosis in Postmenopausal Women: Diagnosis and Monitoring" noted that there are 10 million cases of osteoporosis supporting the figures of the National Osteoporosis Foundation. The study further noted that 18 million people have the chance of developing osteoporosis in the U.S.; 80% of cases relating to this disease occur in women in the country; there are 8 million cases of osteoporosis in women in the country and among men there are 2 million of cases; In the case of white women above the age of 50 the reported cases relate to 15%. According to WHO women above the age of 80 accounts for 70% of osteoporosis cases in the U.S.A.

Morbidity of Osteoporosis:

In aged people, one of the most common diseases is osteolysis. A study was done in a home for the aged in Guangzhou City in March of the year 1995 to get the morbidity data of osteolysis and to provide data for the planning of health programs for the aged population. 326 cases of the ages of 57 to 95 were reported with 113 of males and 213 of females. A feedback form was given to get the data of related factors of osteolysis. Body weight and body length were calculated and the out-off point of bone density for the detection of osteolysis was 0.488 g/cm2 for females and 0.535 g/cm2 in the case of males. The results validated that the morbidity for osteoporosis was 34.6%. The morbidity of female was considerably much higher than that of males. The body weight and body height of osteolysis group were considerably less than that of normal group. The bone density of smokers and alcohol drinkers was appreciably lesser than that of others. The bone density of the people who kept themselves fit was considerable higher in comparison to those who did not. It was also to be noted that the exercises will help in preventing osteoporosis.

Costs of Osteoporosis to society:

major health menace for 28 million Americans is osteoporosis, of which 80% are women. Osteoporosis is the major cause for more than 1.5 million fractures yearly, inclusive of 300,000 hip fractures, and around 700,000 vertebral fractures, 250,000 wrist fractures, and at other sites of more than 300,000 fractures. Projected national direct costs for osteoporosis and related fractures are $14 billion a year. The projected national direct costs for osteoporotic and associated fractures were $17 billion in 2001, i.e. $47 million each day and the rate is increasing.

Secondary Osteoporosis:

Osteoporosis can be further classified into 3 types: involutional or primary osteoporosis in which no primary reason can be found; secondary osteoporosis in which the primary reasons for example, use of steroid use is known; and thirdly rare forms of the disease, like juvenile, pregnancy-related, and postpartum osteoporosis.

There is no supporting procedure on how to assess patients for secondary causes of osteoporosis. The history and physical checking may advise a clear cause, for example, hypogonadism, anorexia nervosa. One proposed laboratory work-up is given: "Calcium, phosphate, alkaline phosphatase, liver function studies; Creatinine, albumin; 24-urine calcium; 25-OH vitamin D; Thyroid-stimulating hormone; Complete blood count; Sedimention rate." These tests can be ordered selectively on the basis of history, physicality, and on the basis of the results of the above tests: "Lutenizing hormone, follicle-stimulating hormone, estradiol, testosterone; Parathyroid hormone; Serum and urine protein electrophoresis; 24-urinary-free cortisol; Ferritin."

Juvenile Osteoporosis:

Osteoporosis also occurs in childhood, even though it is more common in older people and particularly women in menopause. The average age in children is 8 to 14, but it can also occur during the period of growth spurts. In children the main reason for this disease is genetic disorder or a medical condition. In such cases it is known as secondary osteoporosis. But sometimes no reason can be found and it is categorized as a very peculiar form of osteoporosis known as idiopathic juvenile osteoporosis -- IJO.

The reasons, which may be credited for the different forms of osteoporosis in children, are: secondary osteoporosis disorders which is formed by a prevalent medical condition like "juvenile arthritis; diabetes mellitus; osteogenesis imperfecta; homocystinuria; hyperthyroidism; hyperparathyroidism; Cushing's syndrome; malabsorption syndromes; anorexia nervosa and kidney disease." Medications include "anti-convulsants; corticosteroids; immunosuppressive medications." Lifestyle includes increased inactivity or immobility; deficiency of dietary calcium and vitamin D; increased exercising causing amenorrhea. Children with idiopathic juvenile osteoporosis -- IJO may have lower back, hip and foot pain. The indications of juvenile osteoporosis may be like other bone ailments or medical problems. Detection of juvenile osteoporosis is usually not made till the child has a broken bone. The detection procedures for juvenile osteoporosis are: medical history of the family, skeletal x-rays - this test makes use of invisible electromagnetic energy beams to create images of internal tissues, bones, and organs onto the film, bone density test - this method finds the bone mineral content and skeletal variations like bone loss, blood tests in order to measure the levels of serum calcium and potassium.

Osteoporosis in Men:

Many people do not believe that men can have osteoporosis, as this disease is most commonly linked with women. Men can also get hip and other bone fractures, which is a common feature of osteoporosis. Usually men are detected to have osteoporosis only when they have fractured a bone. Hip fractures take place only at older ages in men, which could make it clear why men who break a hip are more prone to die of problems than women. 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 health; have a bone density test performed and take medication when required.