Osteoporosis in the U.S. Osteoporosis

Osteoporosis in the U.S.

Osteoporosis is the loss of bone mass because of a loss of calcium (American Family Physician 2004). In this condition, the inside of the bone becomes weak and makes the bone likelier to break. It occurs more in women than in men because women have less bone mass than men, have greater longevity and less intake of calcium and need the female hormone estrogen to keep their bones strong. The risk of developing osteoporosis grows as a person lives longer. Total bone mass reaches a peak on the late 20s or early 30s and the person begins to lose bone mass. The rate of bone loss in women increases after menopause when the level of estrogen decreases. Bone loss may also occur after the surgical removal of the ovaries. Symptoms include broken bones, low back pain, a hunched back or reduced height. These often show up only after a lot of bone calcium has already been lost. Risk factors include menopause before age 48, removal of the ovaries before menopause, insufficient dietary calcium and vitamin D, insufficient exercise, smoking, family history, alcohol abuse, thinness and small bone frame, white or Asian skin, hyperthyroidism, long-term use of oral steroids and prior bone fracture as an adult (American Family Physician).

Records say that osteoporosis affects more than 25 million Americans (Mangels 2005). In 2001 alone, the approximate national direct expenditure for osteoporosis and fractures related to the condition was $17 billion and still rising. A person, especially a woman, needs 1,000 mg of calcium daily before menopause and 1,500 mg after menopause if she is not taking estrogen (American Family Physician 2004). Good sources of calcium are nonfat and low-fat dairy products, dried beans, sardines, broccoli, juices and cereals, which are fortified with calcium. Vitamin D helps the body absorb calcium and a woman needs 400-800 IU of the vitamin daily. Treatment of osteoporosis includes proper diet, exercising, quitting smoking and medicines, such as hormones (American Family Physician).

A telephone survey found that most women were not taking adequate steps to prevent osteoporosis (AORN Journal 2004). According to the National Women's Health Resource Center, osteoporosis can cause bone weakness and women beyond 50 will experience osteoporosis-related fracture in their lifetime. The telephone survey revealed that 59% of the participants had not been checked out for bone mineral density; 65% of them were aware of the seriousness of the condition but only 1% of them expressed concern that they could die of it; and almost two-thirds of them did not believe they were at risk for developing the disease. Ninety percent of them were taking calcium supplements to protect against bone loss, but the Resource Center said that the supplements were insufficient for women in the postmenopausal years (AORN Journal).

Statistics showed that 1.5 fractures each year in the U.S. are traceable to osteoporosis and likely to increase as the population continues to age (Wellbery 2005). There are guidelines to identify older women who may be at high risk through the bone mineral density screening, but predicting osteoporosis, osteopenia and spinal fracture risk in younger patients was not conclusive. Researchers said that no single examination was enough to make a diagnosis of osteoporosis. Furthermore, it was unlikely that women at risk were being screened according to recommendations. A study conducted on clinical guidelines revealed that almost a third did not provide information on how they were to be established and more than a half did not define "consensus." The guidelines were inconsistent at what age women should be screened and what risk factors should be considered. Another intervention found that improved rating rates were likelier to lead to bone mass density tests if the patients received positive-focused counseling than negative-focused. In summary, screening guidelines for osteoporosis lacked uniform recommendations, the screening rates were generally low and few interventions made or studied to improve these screening rates (Wellbery).

Surgeon General Richard Carmona prescribed exercise to prevent or even reverse bone disorder osteoporosis (Shelton 2005). Although the skeleton weakens when the person reaches age 40 or 50 on account of a deficit of bone minerals, such as calcium, he or she can improve bone health by increasing calcium and Vitamin D intake and through exercise. Foods high in calcium include yogurt, milk, broccoli and almonds and those rich in Vitamin D include fortified dairy products. Otherwise, multivitamins will fill this requirement. On the other hand, exercise can be performed through weightlifting and weight-bearing aerobic exercises, like walking, climbing stairs, and running. These activities are important for building and rebuilding bone. Dr. Carmona said that, like muscle, bone gets stronger and tougher with exercise. Exercise wards osteoporosis off by overloading the bones with weight and by working many muscle groups. It increases bone density at any age, reduces the risk of fractures and enhance longevity (Shelton).

The scaffolding for bone is made from a protein called collagen (Mangels 2005). Calcium and phosphorus combine to produce hydroxyapatite, which is a mineral-rich substance, which crystallizes on the collagen scaffold and turns it into a strong and rigid material. But this material does not remain permanently in the bone. When another part of the body needs calcium, it is taken from the body to that other part needing calcium. But when more calcium is available, it is used by the body to rebuild the bone. In the early life stages, more bone is built by the body than broken down, but this process slows down by age 30 and results in a net loss of bone. Although this occurs with aging, the normal loss of bone will not be too severe if the person has had larger and stronger bones at the start of life. Women face a greater risk of osteoporosis than men because women naturally have less bone and lose them more quickly, especially after menopause. At ages 20 to 29, women have 76% of men's bone matter and this amount decreases to 60% when they reach 70s. At this time, women start losing bone mass and develop very fragile bone. Genetics also plays a role in determining the risk of osteoporosis. Gender and genetics cannot be changed but the risk can be managed markedly through diet and exercise, as previously mentioned. In addition to calcium, the diet should include the right amount of Vitamin D, protein, phosphorus, fluoride, Vitamin A and Vitamin K (Mangels).

Children with low-calcium diets may develop osteoporosis as adults and a greater risk of fracture (Mangels 2005). Some studies suggested that older adults with high calcium intake develop stronger bones and have lower fracture risk. Some studies on vegetarians with low bone density and low calcium intake said that calcium was well-absorbed from a vegetarian or vegan diet. Sources of well-absorbed calcium include calcium-fortified soymilk and juice, calcium-set tofu, soybeans and soynuts, bok choy, broccoli, collards, Chinese cabbage, kale, mustard greens and okra. But a high-calcium diet is insufficient without adequate Vitamin D to absorb calcium (Mangels, Hudson 2006). This vitamin is necessary throughout life to build the bones of childhood and adolescence as well as throughout adulthood. The skin produces natural Vitamin D by exposure to the sun but factors, like the season, the time of day, age and use of sunscreen and pollution, can stand on the way. Hence, most people should include it in their diet. Vitamin D occurs only in very small amounts in plant sources, so that vegetarians should rely on other foods fortified with the vitamin, such as non-dairy milks, juices and breakfast cereals (Mangels). Some popular publications have made erroneous claims that the animal protein content of vegan diets would minimize calcium losses. Other studies contended that a higher protein intake would be needed to promote calcium absorption, reduce the risk of fracture, and increase bone density. These conflicting claims require additional research but, at the moment, the consensus is that the diet must include 0.8 grams of calcium and protein per kilogram of weight to assure the best level of bone health. Phosphorus is a major part of the bone found in many foods and in abundance in vegan diets. Fluoride enhances the accumulation of calcium and phosphate in the bone and comes primarily from fluoridated water. Vitamin A aids bone growth but its overuse can increase the risk of fracture when there are excessive amounts of retinol, a form of Vitamin A found in many animal foods. Vitamin K is needed to produce a protein, which strengthens the bone. It comes from green vegetables and other plant foods (Mangels). And exercise can help stimulate bone size and strength. Running, dancing, weight training and roller-blading are examples. Even 30 minutes of exercise twice a week can achieve the effect and reduce the risk of developing osteoporosis later in life (Mangles).

Treatment of osteoporosis includes anti-resorptive agents and agents, which stimulate the growth and formation of bones (Hudson 2006). Anti-resorptive agents decrease the imbalance between bone resorption and bone formation by reducing excessive osteoclast activity. These agents affect the trabecular bone by stabilizing its structure and thus reduce the risk of fracture. They are most effective in the spine, which is the most common site of osteoporotic fracture. The role of adequate calcium intake has always been mentioned as most essential in the growth and development of all normal tissues, including bone. A low-calcium diet restricts the intake of dairy products, has low amounts of fruits and vegetables, and includes a high intake of low-calcium beverages. Other dietary factors can also affect bone health and accrue to the development of low bone density. Among these are a high-sugar diet, refined grains and flours, caffeine, alcohol and excessive intake of calcium, phosphorous and sodium. Soy has been attracting interest for its likelihood in producing positive effect on bone health. Soybeans contain phytoestrogens called isoflavones and diadzein. Soy is the only dietary source of daidzein. Soy appears to increase the length of the menstrual cycle by one to five days and thus assert a positive effect on bone density due to higher estrogen levels. Animal studies supported this assumption and hold promise for human bone health. A study conducted on menopausal women at the University of Illinois found an increase in the mineral levels and density in their lumbar spines after taking 55-90 mg of isoflavones for six months. The study showed that soybean protein diet was effective in preventing bone loss in the fourth lumbar vertebra and the right hip. Other studies indicated that soybean protein may have greater effect on the trabecular bone in the spine than on cortical bone in the hips (Hudson)

Other nutrients involved in bone formation include folic acid, Vitamin B6, C and K (Hudson 2006). Bone loss in postmenopausal has been partly traced to increased levels of homocysteine and experiments showed that folic acid is involved in the breakdown of homocysteine. Vitamin B6, on the other hand, reverses the elevated levels of homocysteine and may influence the production of progesterone. Vitamin C aids in the formation and cross-linking of some bone structural proteins. Furthermore, studies showed that deficiency in this Vitamin can cause osteoporosis. Scurvy, which is caused by Vitamin C deficiency, is linked with bone abnormalities. And Vitamin K is involved in the formation, remodeling and repair of bone. Vitamin K produces osteocalcin, which brings calcium to bone tissue (Hudson).

Women over 65 should be screened for osteoporosis on account of the high incidence of the disorder and the continuously aging population, fracture risk levels because of low bone density, and the promise of therapy in combination with diet improvement (Phillips 2003). An observational study conducted on women more than 50 years old showed that osteoporosis was linked with the fracture rate at four times that of normal bone mineral density. Another study identified the best predictors for hip fracture as female gender, age, low weight and current non-use of estrogen. Women 65 and older had increased risk yet none of the screening scaled exhibited adequate discriminatory performance. Multiple technologies predicting fractures, like the dual-energy x-ray absorptiometry and ultrasonography, have not shown effectiveness in screening women aged 65 (Phillips).

Yet 15% or 5 million American women aged 50 and over and of all races have osteoporosis and 40% or 14% have osteopenia (French et al. 2002). Tests showed that it increases with age from 4% of white women aged 50 to 59 and 48% ot those aged 80 to 89. At least 1 vertebral fracture can occur in 5% of white women aged 50-59 and 25% at age 80. White women aged 50 and above face a lifetime risk of hip fracture at 14% for women and 5% for men. Hip and symptomatic vertebral fractures happen mainly to women over 75, with wrist fractures increasing in frequency in the late 50s. Bone strength deteriorates with age. Prevention should start in childhood and be maintained throughout life in order to maximize bone mass. Efforts should be exerted to reduce falls, improve the diet, exercise regularly and avoid adverse habits. Most fractures occur as a result of falls at 90%, especially among women over 70. At this age, they suffer from poor cognitive function, slow gait and poor movement, poor vision, intake of drugs affecting alertness and balance and a history of falls. Adverse health habits, which should be stopped or avoided, include smoking, alcohol and too much coffee (French et al.).

Current available therapies for osteoporosis include calcium and Vitamin D, estrogen, biophosphonates, estrogen receptors modulators and salmon calcionin (French et al. 2002). Tests showed that increased or improve intake of calcium with or without Vitamin D positively affected fracture incidence. Doctors prescribe 1,200 to 1,500 mg a day and 800 IU of Vitamin D a day taken with meals. Statistics revealed that hormone replacement therapy, which combined an estrogen and a progestin, reduced hip and vertebral fractures. Estrogen exhibited positive effect on bone mass density whether in early or late post-menopause. Bisphosphates, alendronate and risedronate, have been approved by the U.S. For both prevention and treatment of postmenopausal osteoporosis. Results of tests showed that both rapidly reduce the risk of symptomatic fractures in women who have had fracture and osteoporosis. A bisphosphonate is now the drug of choice for severe osteoporosis. Oral bisphosphonates are, however, not well-absorbed and patients are advised to take the medicine with a full glass of water and remain upright sitting or standing for at least 30 minutes after taking it and should not recline until food is consumed. On the other hand, raloxifene is the only selective estrogen receptor modulator approved in the U.S. For the prevention and treatment of osteoporosis. Evidence showed that it significantly decreases new vertebral fractures in women who have a history of fractures and osteoporosis, similar to the effect of bisphosphonates. Raloxifene also reduces the risk of breast cancer with low estradiol levels and myocardial infarction in women at high risk. And salmon calcitonin showed beneficial analgesic effect for osteoporotic fracture. At large doses, it decreases new vertebral fractures among women with previous osteoporotic vertebral fractures. Nasal calcitonin solution may also prevent or resolve irritation and dryness (French et al.).