Twenty years ago osteoporosis was a word used mainly by researchers andphysicians. Over the past few years, there has been an explosion of informationabout this condition that can cause severe pain and crippling. No cure is knownyet, but ways to lessen your potential for osteoporosis have been identified.
Today, one in three Americans are 50 or older. The baby boom generation willbegin to enter their retirement shortly after the turn of the century that israpidly approaching. Thanks in part to medical advances and the emphasis onexercise and healthy diets, vast numbers of these baby boomers can expect toreach their eighties, nineties, and beyond. Yet, if present day trends unhealthyeating and lack of exercise continues, osteoporosis threatens to be one of thebiggest public health dangers of modern times.
Osteoporosis, literally meaning”porous bone”, is a disease of the skeleton in which the amount of calciumpresent slowly decreases to the point where the bones become extremely brittleand subject to fractures. The skeleton serves two functions. It providesstructural support for organs and muscles and also serves as a depository forthe bodys calcium and other minerals, manly phosphorous and magnesium. Thebone holds 99% of the bodys calcium. The other 1-% of remaining calcium isfreed to circulate in the blood and is essential for crucial functions in thebody such as blood clotting, muscle, contractions and nerve functions.
Boneshave two main sections. The outer section of the bone is the cortical bone. Itis composed of a hard shell that serves to protect the other section of thebone, called the trabecular bone. This part of the bone is an inner lacy,structural matrix of calcium that helps support the bone structure.
Bone tissueis constantly being broken down and reformed to help the body cope with everydaystress and for maintaining a properly functioning body. The breakdown of thebones is called resorption and is performed by cells known as osteoclasts thatdid holes into the bone allowing calcium to be released into the body. Then,cells produced by the bone called osteoblasts help rebuild the bone. Theosteoblasts first fill in these holes left by the osteoclasts with collagen andthen by laying down crystals of calcium and phosphorous. A complex mix ofhormones and chemical factors controls this osteoclast-osteoblast balance. Thetrabecular and cortical parts of the bone both give off calcium to the body whenit is needed, but as aging progresses the amount slowly declines.
The rebuildingof bones makes them denser until about the age of 35 and peak period of bonemass building is somewhere between the ages of 25 to 35. After the age of 35,the body becomes slower and slower in replenishing bone as time goes on. Osteoporosis develops when bone resorption occurs too quickly or if formationoccurs too slowly. Because weakened bones, an increased susceptibility tofractures of the hip characterize osteoporosis, spine, and wrist are prevalent. Doctors have identified two types of osteoporosis that correlate with specifictypes of fractures. Type I osteoporosis, often referred to, as post enopausalosteoporosis, is most associated with wrist and spine fractures.
Type IIosteoporosis, also called senile osteoporosis, is generally attributed toreduced calcium by old age and causes mainly hip fractures. There are more than300,000 hip fractures, 300,000 wrist fractures, and over 700,000 spinalfractures in the US each year (Peck and Avioli 19). Osteoporosis causes morethan 1. 5 million fractures each year and the cost to the healthcare system forthese fractures is over 13.
8 billion dollars per year, greater than the cost forcongestive heart failure and asthma. Of the individuals who fractured a hip,one-half will be permanently disabled, 20% will require long-term nursing care,and 20% of hip fracture victims die within a year, usually from complicationscaused by surgery. Hip fractures are responsible for about 65,000 deaths peryear in the United States. Hence, osteoporosis represents a major public healthproblem. There is no single cause of osteoporosis, and it seems that there aremany factors that contribute to the disease. Some people are more prone todevelop osteoporosis than others are.
Factors that increase the likelihood ofdeveloping osteoporosis can be separated into controllable and uncontrollablefactors. Uncontrollable factors include age, sex, body frame, and race. Thelonger a person lives, the greater their chance is in developing osteoporosis. Osteoporosis is associated with age because bone mass begins to decline after itpeaks at about the age of 35. The more years that passes the more loss of boneincreases.
Roughly estimating, people lose 10% of bone mass per year (24). Aspeople grow older they also become less physically active, and this assist inbone loss. Also, other changes occur with age that can affect out ability toabsorb calcium. The skin and kidney do not make Vitamin D with the sameefficiency as they do in youth. This affects the ability to absorb calcium fromthe diet or from supplements.
A decline in stomach acid after the age of 60 mayalso affect the ability of the body to absorb calcium. Another risk factor forosteoporosis is sex. Women are four times as likely to develop osteoporosis thanmen are. One reason is that woman generally have thinner, lighter bones then mendo. Also, the rapid loss of estrogen women experience after menopause can becontributed to osteoporosis. Estrogen protects the body against bone loss.
Womenwith regular menstrual periods are exposed to healthy levels of estrogen frompuberty to menopause. Around the time of menopause though, the levels ofestrogen sharply declines. Early menopause or surgically induced menopause, suchas a hysterectomy, can increase a womans likelihood of developingosteoporosis because the protective effect of estrogen is lost. Anothercontribution of sex to osteoporosis is t women live longer then men do, whichgives them more time to develop weaker bones. Race is also a risk factor ofosteoporosis.
Caucasians and Asians have a higher risk of osteoporosis thanAfrican-Americans and Hispanics do. African-Americans in the US ave heavier andlarger bones than Caucasians, although the reason for this is unknown. (33). Controllable risk factors for osteoporosis includes lack of calcium, lack ofphysical activity, cigarette smoking, and alcohol and caffeine intake. Lack ofcalcium is one of the great cause of osteoporisisCalcium is needed to buildstrong bones during childhood and early adult hood, and to prevent lossesthereafter.
Studies have linked an inadequate amount of calcium intakes appearto be associated with low bone mass, rapid bone loss, and high fracture rates (Germano99). Today, many people consume less than half of the amount of calciumrecommended to build and maintain healthy bones. Calcium needs change duringones lifetime. The bodys demand for calcium is greater during childhood andadolescence when the skeleton is growing rapidly.
Pregnant and lactating womanalso need increased calcium, as do postmenoptusal woman and older men and women. Good sources of calcium include low fat dairy products such as milk, cheese, andyogurt, dark green leafy vegetables like broccoli, collard greens, and spinachand other foods fortified with calcium like orange juice, cereals and bread. Lack of physical activity is another controllable factor. Bone is a livingtissue that responds like muscles to exercise.
Individuals who are inactive,immobilized, or bedridden for a long time are at higher risk. Weight bearingexercises such as walking, running, tennis, and other exercises that causemuscle to work against the force of gravity play an important role in preventingbone loss. Therefore, resumption of physical activity is an important factor inbuilding bone and preventing bone loss. Other risk factors are smoking, alcohol,and caffeine. A high intake of caffeine-containing foods, such as coffee, isthought to increase the amount of calcium eliminated in the urine (Bonnick 59).
For individuals who have osteoporosis, a comprehensive treatment programincludes a focus on nutrition, exercise, and safety issues to prevent falls thatmay result in fractures. In addition, medications may be prescribed to slow orstop bone loss, or increase bone density. Currently the U. S. Food and DrugAdministration for the treatment of postmenopausal osteoporosis approveestrogen, calcitonin, and alendronate.
Estrogen, reloxifene and alendronate areapproved for the prevention of the disease. While osteoporosis can be preventedand treated, there is, as of now, no cure. Prevention is the only way to avoidthis disease and its debilitating consequences. Yet millions of Americans arenot actively protecting themselves against osteoporosis.
Over the past decade,important information has slowly been uncovered about the causes of osteoporosisand the ways to prevent it. One of the most significant findings is thatosteoporosis in not an inevitable part of growing older. One of the great mythsassociated with this disease is that as people age, they are all susceptible tosuffering fractures or to becoming stooped over. This major misconception thatcauses individuals to overlook their risk and to avoid taking the necessarysteps to prevent and treat osteoporosis.
