Osteoporosis is a disease that weakens bones and reduces the ability of a person to perform physical activities and eventually cause physical disability. The common symptoms of osteoporosis are joint pains, stooping posture, and difficulties in standing. Fracture of hip, spine, and other bones is a major characteristic of osteoporosis due to fragility of bones.
Sunyecz (2008) states that in the United States, over 10 million people who are over 50 years old suffer from osteoporosis and 1.5 million cases of osteoporotic fractures occur every year.
Women are the dominant patients with osteoporosis because they experience significant changes in hormone levels during menopause. Hence, the case study of a 60-year-old female patient reflects the prevalence of osteoporosis among women. In this view, the essay seeks to enlighten the patient regarding the diagnosis, risk factors, and treatment of osteoporosis.
When one is diagnosed with osteoporosis, it means that the bone mineral density is below a certain level. To determine bone mineral density, radiography techniques are applicable. The World Health Organization recommends the use of dual-energy X-ray absorptiometry as a gold standard because it is a sensitive and an accurate method (Licata, 2006).
Dual-energy X-ray absorptiometry compares the bone mineral density of a person to that of a young person of 30 years. A young person of 30 years old is as a standard because he/she has optimum bone mineral density, and thus reliable in determining the extent of osteoporosis among individuals Thus, bone mineral density is a parameter that is applicable in the diagnosis osteoporosis.
Dual-energy X-ray absorptiometry measures bone mineral density in terms of T-score. Essentially, T-score is a scale that shows variations in bone mineral densities of individuals in terms of standard deviations against the standard reference mean. This means that the T-score values are standard deviations of bone mineral densities.
Low T-scores (standard deviations) are normal, while high T-scores are abnormal as they indicate the extent of osteoporosis. According to the World Health Organization, T-scores of zero to -0.99 show normal bone density, -1 to -2.49 shows osteopenia, above 2.5 indicates osteoporosis, and above 2.5 coupled with osteoporotic fractures is severe osteoporosis (Licata, 2006). Thus, the diagnosis of osteoporosis in the case study means that the patient has T-score of above 2.5 without any fractures.
One of the risk factors that predispose women to osteoporosis is age. Rizzoli, Bonjour, and Ferrari (2001) argue that age-related decline in bone density occurs because the rate bone resorption is slower than bone formation. Hence, at the age of 65 years, bone mineral density of the women in the case study is significantly lower than when she was at the age of 30 years.
Hormonal changes among women during menopause hasten bone loss. The rapid decline in estrogen levels after menopause is the major cause of osteoporosis among women (Rizzoli, Bonjour, & Ferrari, 2001). Hence, in this case study, the woman with the age of 60 years has low levels of estrogen, which predisposes her to osteoporosis.
The treatment of age-related osteoporosis requires supplementation of calcium and vitamin D. According to McLaughlin, Sleeper, McNatty, and Raehl (2006), supplementation of calcium and vitamin D enhances bone formation, and thus increase bone density. Hormone therapy is also essential in promoting absorption of calcium in the body.
Estrogen and calcitonin are two hormones that regulate the absorption and metabolism of calcium in the body (McLaughlin, Sleeper, McNatty, & Raehl, 2006). Both calcitonin and estrogen decrease activity of osteoclasts in bones, and consequently decrease bone resorption.
References
Licata, A. (2006). Diagnosing Primary Osteoporosis: It is More than a T-Score. Cleveland Clinic Journal of Medicine, 73(5), 473-476.
McLaughlin, E., Sleeper, R., McNatty, D., & Raehl, C. (2006). Management of Age-Related Osteoporosis and Prevention of Associated Fractures. Therapeutics and Clinical Risk Management, 2(3), 281-295.
Rizzoli, R., Bonjour, J., & Ferrari, S. (2001). Osteoporosis, Genetics, and Hormones Journal of Molecular Endocrinology, 26(1), 79-94.
Sunyecz, J. (2008). The Use of Calcium and Vitamin D in the Management of Osteoporosis. Therapeutics and Clinical Risk Management, 4(4), 827-836.
Being that the patient is 60 years old, she is past menopause. Menopause is a time when women lose their bone density very fast. This leaves them at risk of developing osteoporosis within 5 years of reaching menopause. The best advice after bone density tests is to encourage the patient to take up care for the prevention of extension of her bone loss.
When the bone density of a woman gets low, it is appropriate to start treatment to avoid any further risks that the situation may cause later in life (Moen and Keam, 2011). At the age of 60, treating the woman is a convenient move and that leaves her with little risk exposure for bone fractures. It is important to encourage the onset for treatment instead of waiting for her years to advance.
Such a patient needs encouragement and enlightening about the commonality of suffering hip fractures in old age. It is a good time for introducing the woman to the necessity of having adequate calcium in her diet (Banu, Varela and Fernandes, 2012).
Since her T-scores show osteoporosis, it is necessary to let her know that it simply means that the tests she went through showed her bone mass. T-scores give indications about the variations of one’s bone mass through averaging it against the bone mass of a healthy person. Testing bone density is relevant just like any other biologic test.
The average score determines the level of a healthy person’s bone density. The testing of osteoporosis shows in a T-score point of deviation from normal mean for bone density. That helps in doing a mathematical calculation for the determination of the degree of deviation of bone mass from the mean of normal bone density.
The results that a bone mass density test provides is the extent of deviation from the mean and that is referred to as the T-score. When the T-scores deviate from the mean, to a point below -2.5, it means that there is a loss of bone mass. In her case, the woman is already in post menopause and there is a need for treatment or else, there could be risk of developing secondary bone loss conditions as well as risking fractures.
Since one of the main risk factors of having, untreated osteoporosis is suffering hip fractures. She will need to use medications with calcium supplements to help her in the reduction of bone mass loss and for strengthening her bones. It is advisable to take them at night to allow for effective absorption and they are effective for those whose intestinal absorption of calcium is efficient.
Oestrogens are also effective for woman past menopause like the patient in this case. Their administration requires some care to avoid chances of developing other complications such as breast cancer. Some of the medications used in the treatment of osteoporosis are such as Conjugated equine oestrogen, oestradiol valerate (Progynova) and piperazine oestrone sulphate.
The available medications support patients differently with the main responsibility being the reduction of fractures (Laliberté, Perreault, Jouini, Shea and Lalonde, 2011).There are injections, which help in the minimization of pain. For example, Strontium ranelate is a compound currently used in the treatment of postmenopausal osteoporosis in places such as Australia.
It helps in the reduction of cases of vertebral fractures. After commencement of therapy, it is important for a patient to ensure that she is consistent with medication for the management of bone loss. This also requires timed density measurement, so that any cases of declines can be effectively intervened upon (Sanford and McCormack, 2011).
References
Banu, J., Varela, E. & Fernandes, G. (2012). Alternative therapies for the prevention and treatment of osteoporosis. Nutrition Reviews, 70(1), 22-40. doi:10.1111/j.17534887.2011.00451.x
Laliberté, M., Perreault, S., Jouini, G., Shea, B. & Lalonde, L. (2011). Effectiveness of interventions to improve the detection and treatment of osteoporosis in primary care settings: a systematic review and meta-analysis. Osteoporosis International: A Journal Established As Result Of Cooperation Between The European Foundation For Osteoporosis And The National Osteoporosis Foundation Of The USA, 22(11), 2743 2768. doi:10.1007/s00198-011-1557-6
Moen, M., D. & Keam, S., J. (2011). Denosumab: A Review of its Use in the Treatment of Postmenopausal Osteoporosis. Drugs & Aging, 28(1), 63-82. Web.
Sanford, M. & McCormack, P., L. (2011). Eldecalcitol: A Review of its Use in the Treatment of Osteoporosis… [corrected] [published erratum appears in DRUGS 2012; 71(18):2309]. Drugs, 71(13), 1755-1770. Web.
The consistent growth in geriatric populations worldwide requires care providers, such as doctors and nurses, to be aware of major health issues affecting older adults. Osteoporosis and the associated bone fragility are prevalent health problems that create risks for the well-being of older people. The present paper will explain the symptoms, causes, and treatments of osteoporosis and outline a possible future treatment for the condition.
Symptoms
Osteoporosis affects bone tissue by decreasing bone density. Wilson, Nelson, Newbold, Nelson, and LaFleur (2015) explain that, in osteoporosis, the differences in bone resorption and bone formation levels cause changes in bone mineral density, thus leading to the loss of bone mass. The symptoms that result from decreased bone density are back pain, an increased risk of bone fracture, and changes in height and posture.
Causes
The underlying cause of changes that are characteristic of osteoporosis is the decrease in sex hormones due to aging. For example, in women, who are at a higher risk of osteoporosis, the decreased level of estrogen after menopause causes bone loss by increasing bone resorption by 90% and bone formation by only 45% (Wilson et al., 2015). Similarly, in men, the decrease in sex hormone production impairs bone strength. Additionally, osteoporosis is linked to genetic factors, alcohol use, treatment with glucocorticoids, and some diseases (Compston et al., 2013). Assessing a person’s risk factors for osteoporosis can help care providers to suggest strategies for preventing the condition or reducing the pace of its development.
Current Treatments
The current treatment of osteoporosis involves lifestyle measures and pharmacological treatment. Lifestyle measures used in the management of osteoporosis are physical exercise, increased intake of calcium and vitamin D, and fall prevention (Compston et al., 2017). Recommended pharmacological treatment of osteoporosis and associated bone fragility includes prescribing one of the following: alendronate, risedronate, zoledronic acid, and denosumab (Compston et al., 2017). Hormone replacement therapy is also used in post-menopausal women to limit the development of osteoporosis (Cosman et al., 2014).
Although the listed treatments proved to be effective in reducing the risk of fractures, they have some precautions and side effects that create a need to develop a new approach to osteoporosis treatment.
Future Therapy
One of the possible future treatments for osteoporosis is Cathepsin K (CatK) inhibition. According to Duong, Leung, and Langdahl (2016), CatK is a cysteine protease, which is involved in the decay of collagen. Thus, CatK has a positive effect on the development of osteoporosis by impairing the production of the organic bone matrix. Inhibiting the activity of CatK can assist in improving bone mass while also enhancing bone composition and strength (Tabatabaei-Malazy, Salari, Khashayar, & Larijani, 2017). CatK inhibitors could prove to be effective in preventing and managing osteoporosis, which makes them an important option for future therapy of the condition.
Comparison of Treatments
In comparing the two treatments, it is critical to evaluate their efficiency and side effects. Current therapy with lifestyle modifications and recommended medications proved to be effective in reducing bone fracture risk and improving bone mineral density, thus reversing osteoporosis (Compston et al., 2013; Compston et al., 2017). In addition, lifestyle measures can be used for preventing osteoporosis in at-risk populations, including post-menopausal women. The side effects from recommended treatments include gastrointestinal symptoms, cramps, osteonecrosis of the jaw, and atypical femoral fractures (Compston et al., 2017).
CatK inhibitors also have some known side effects found in clinical trials. Duong et al. (2016) report declined bone formation within the first two years of treatment, increased risk of stroke, arterial fibrillation, and atypical fractures. The incidence of these side effects is rather low, and the medication still achieved beneficial results in clinical trials. CatK inhibitors caused a reduction in bone resorption while also limiting the decrease in bone formation, thus leading to increased bone mineral density (Duong et al., 2016; Tabatabaei-Malazy et al., 2017). The safety risks of CatK inhibitors have not been evaluated yet.
Until CatK inhibitors are approved, care providers should prescribe medical treatment with a recommended agent (e.g., alendronate, risedronate, zoledronic acid, etc.), supplemented by lifestyle interventions (Compston et al., 2017).
Conclusion
Overall, osteoporosis and associated bone fragility are important problems affecting older adults. The current approach to the management of osteoporosis includes lifestyle measures and medications. One potent future therapy option discovered during research is Cathepsin K (CatK) inhibition. However, until this treatment obtains formal approval, it is recommended to use a combination of medications and lifestyle modifications to manage osteoporosis and associated bone fragility.
References
Compston, J., Bowring, C., Cooper, A., Cooper, C., Davies, C., Francis, R.,… Selby, P. (2013). Diagnosis and management of osteoporosis in postmenopausal women and older men in the UK: National Osteoporosis Guideline Group (NOGG) update 2013. Maturitas, 75(4), 392-396.
Compston, J., Cooper, A., Cooper, C., Gittoes, N., Gregson, C., Harvey, N.,… Vine, N. (2017). UK clinical guideline for the prevention and treatment of osteoporosis. Archives of Osteoporosis, 12(1), 43-66.
Cosman, F., De Beur, S. J., LeBoff, M. S., Lewiecki, E. M., Tanner, B., Randall, S., & Lindsay, R. (2014). Clinician’s guide to prevention and treatment of osteoporosis. Osteoporosis International, 25(10), 2359-2381.
Duong, L. T., Leung, A. T., & Langdahl, B. (2016). Cathepsin K inhibition: A new mechanism for the treatment of osteoporosis. Calcified Tissue International, 98(4), 381-397.
Tabatabaei-Malazy, O., Salari, P., Khashayar, P., & Larijani, B. (2017). New horizons in treatment of osteoporosis. DARU Journal of Pharmaceutical Sciences, 25(1), 2-17.
Wilson, T., Nelson, S. D., Newbold, J., Nelson, R. E., & LaFleur, J. (2015). The clinical epidemiology of male osteoporosis: A review of the recent literature. Clinical Epidemiology, 7(1), 65-76.
In the advent of modern research facilities and advanced knowledge in the scientific field, many technological applications were developed as a means of improving people’s lives. Different advancements in scientific areas of discipline paved the way for beneficial inventions and innovations especially in the medical field. Radiology, for example, provided human beings the ability to explore his anatomy without surgery. There are many other examples of these advantageous technologies available to us in the modern times.
A very good example of technology’s benefits to human health is the development of a bone density test that only requires knowledge on radiation. It is important to check the density of the bone since it relates to a disease called osteoporosis. Osteoporosis is a disease of the bones characterized by the decrease in bone density due to lowering calcium levels and many other factors. It can be prevalent for a very long time, unnoticed by a patient suffering from it, unless a fracture transpires or unless detected by a bone density scan. This disease may be genetically caused or as an after-effect of medications such as steroids. It affects the way of life of the patient since it is directly linked to disability or death in the most serious cases (Hurd 2006).
The x-ray scan can immediately detect the occurrence of osteoporosis since the results on the x-ray film show significant differences from bones of a normal person in terms of diameter and other physical characteristics. Although x-ray can be used, a recent bone density scan was developed, called the dual energy x-ray absorptiometry scan (DEXA) that works similarly on the principle of radiation, but on a more precise level.
Bones
Anatomy
Bones, on the outside, are sturdy structures that protect and support the internal organs of the body and also affect the posture and overall shape of the body. It is composed of calcium and the inside of the bone is the literally the factory of blood cells. Ironically, the bone may seem to be lifeless but just like the skin and hair, it is continuously developing. This is evident in people who put extreme pressure to the bones such as weightlifters and athletes, who develop stronger bone structures. Women are more at risk in having osteoporosis since at the onset of menopause, there is a significant decrease in the levels of the hormone estrogen that prevents bone loss (“Osteoporosis”).
Bones develop constantly in length gradually from the inside. Ossification, or the process of bone growth, is characterized by the alteration of a weaker material of connective tissue by a sturdier bony tissue. Osteoblasts slowly develop first, forming an osteocyte. This continuous process soon creates a primary ossified center in the bone until it proceeds to the tip of the bones. As a result, there would be an increase in length followed by the development of a secondary ossified center in the epiphyses. Then, the weaker cartilaginous materials are substituted for by compact bony tissues. Development occurs early in the womb until adolescence when most of the time, the bones are considered to be mature. Growth in length ceases by this time as it is controlled by the growth hormone active during the puberty stage both in male and in females (“Bone and Development Growth”).
Breakdown of bones occurs naturally by the absorption of calcium in the bones. Vitamin D is a vitamin that enhances the absorption of calcium to the bones making it stronger. The National Osteoporosis Foundation and the National Institutes of Health both state the importance of Vitamin D in building stronger bones because of its very significant effect on calcium absorption (“Vitamin D’s Role”). Calcium does not only function in maintaining healthy bones but it is also needed by the body for transmitting electrical signals to and from the brain and also a component of lymph fluids. When the body is low in calcium, an immediate response is to take calcium stored in the bones. This leads to bone resorption and consequently, bone breakdown. As stated earlier, the menopausal stage in women and old age can also result to natural breakdown of the bones.
Osteoporosis Screening
In 2000, the statistics for older people suffering from osteoporosis rose at an alarming rate and the trend is increasing tremendously. Balbona (2000) reports that there are available screening tests for osteoporosis and interventions to prevent the onset of the disease. Experts believe that osteoporosis is a highly preventable disease that the medical industry has developed many suggestions for prevention. Patients’ levels of bone mineral densities (BMD) are constantly checked as this is a very good indicator of risk of osteoporosis occurrence. A value of BMD lower than “2.5 standard deviations from the mean BMD” is immediately termed as osteoporosis, whereas the BMD for normal bone density is within 1 standard deviation (Balbona 2000). “Osteoporosis diagnosis can be done by quantitative computed tomography (qCT), dual energy x-ray absorptiometry (DEXA) and single energy x-ray absorptiometry (SXA)” (Ott 2007). qCT makes use of comparison of measurements of the bone mineral density using t and z scores. Similarly, DEXA is quantitative in nature but is the most widely used to date as compared to SXA, which is an older method (Ott 2007).
Bone Densitometry
Technology
Kaufman (1999) states that bone density measurement started roughly during the 1940s making use of radiology, the most understood technology back then. The film that results from an x-ray scan did not do much good since at that time it was a very crude equipment. This led to the development of advanced bone densitometry devices that can clearly compare and isolate abnormalities of the bones compared to the normal. A Singh index was developed that takes advantage of the differences in the trabecular patterns of various bones. A grading system from 1-6 shows that fractures usually led to values of less than 3 when radiographed. Radiographic densitometry then commenced as another feat in the radiologic technology.
Dual Energy X-ray Absorptiometry (DEXA)
The DEXA makes use of low doses of radiation even lower than that used in chest x-rays. For instance, approximately 0.5-4.5 uSv is used by DEXA (DEXA RADIAITON SAFETY).The radioactive source of DEXA is an x-ray tube as compared to other scanning equipments that make use of gamma rays for instance. An x-ray generator is placed below while a detector or a device that can capture image is placed above. An invisible beam of x-rays having two different energy peaks are sent through the bone tissues. The two energy peaks are separately sent to the soft tissues and bones respectively. The values that can be obtained give the bone mineral density by subtracting the value of the energy peak of the soft tissue from the total. This is then sent to a computer for analysis and computation that later provides in display the results (“Bone Density Scan”).
Bone Mass Density
Densitometry works by the assumption that x-ray waves are absorbed by calcium ions, on the other hand, repelled by the bone tissues. The BMD is measured in grams/cm-3 of bone which makes up the volumetric density while a specific or given area of a bone is the areal density, measured in grams/cm-2 and usually done in the hip, wrist and the lower spine area. The mathematical equation to compute for the BMD is shown in Fig.1. DEXA can also be used to quantify the amount of fat and lean tissues of the whole body.
Figure 1. Formulas for the computation of the bone mineral density.
The densitometry machine takes a record of the computed results and compares it to a standard for osteoporosis since the main objective of the values is to correlate it to the risk of fracture. Values of the t-score and z-score are obtained as points of comparisons (Fig.2).
Figure. 2. Formulas for the computations of the t-score and the z-score.
The t-scores reflect the “number of standard deviations (SD) above or below the young adult mean” (Kaufman 1999). This is in reference to a database previously input in the computer. Thus, the risk of fractures increases two-fold for every standard deviation that falls below the normal values. On the other hand, the z-scores suggest the difference between the values expected for the patient’s age bracket, also depending on the data previously in the database. The type of osteoporosis is also identified by the z-scores. Z values less than -1.5 are signs of secondary osteoporosis. Knowing these values easily benefit the patients suffering from osteoporosis since medications and preventions can be addressed as early as possible to avoid the disease to get worse (Kaufman 1999).
Radiation Safety
The Dubuque Internal Medicine in Iowa has released guidelines for adults who would like to undergo bone densitometry. Pregnant women are not allowed to take the test because the radiation may deliver negative effects to the developing baby. Also, patients who have had another x-ray or nuclear scan within the span of a week are not allowed. The patient should wear something comfortable like cotton shirts without any metals on it. Jeans and girdles shall be removed before taking the scan. Forty-eight hours before the exam, the patient is also not advised to take calcium, as this may interfere with the results that can be obtained leading to erroneous data. When everything is ready, the patient is asked to lie down on a flat area where an imaging device is positioned on top and the x-ray generator is placed below, depending on which part of the body is to be scanned. Scanning can take approximately 10 minutes per area and is painless like the typical chest x-ray. Radiologists and physicians are capable of analyzing the results and it may take some time before the report is relayed to the patient (Dubuque Internal Medicine).
Advantages and Disadvantages of DEXA
Exposure to some doses of radiation can be beneficial in terms of what is done in bone densitometry, but in large doses, radiation can cause damage to molecules inside the body, by formation of pyrimidine dimers in DNA, damaging membranes, inhibiting biological catabolic and anabolic pathways, inducing cancer, and eventually cause death This is the reason why the time and distance of exposure needs to be monitored both for the patient and the operator of the DEXA machine. Time of exposure to radiation must be kept short as possible to prevent absorption. Distance should also be kept and the use of Pb aprons is also recommended as shield (Maher 1997).
The DEXA is very cheap compared to other procedures that can be done, and again requires no surgery. Also, anaesthesia is no longer needed. Importantly, this machine is available in most health care facilities. What is very beneficial in this procedure is that no radiation is left in the patient’s body and this procedure is usually free from negative side effects. Yet, there is always the risk of triggering the formation of cancer cells. Unfortunately, the DEXA can only predict the risk of fracture instead of preventing it (“Bone Density Scan”).
Before the development of the dual energy x-ray absorptiometry, the single photon absorptiometry was made available first in the 1960s. This makes use of an isotope instead of an x-ray. Only a single beam of energy photons are made to pass through the tissues and the bone for quantification of the bone mineral density. Since it uses an isotope, the source has the tendency to decay, thus, constant replacement of the source is needed unlike in DEXA where the source is x-ray (Kaufman 1999). While DEXA is primarily used in scanning the lower spine and hips, the SEXA or single energy x-ray absorptiometry is widely used in the scanning of the peripheral areas of the body which include the wrist and heels. Since it only uses a single energy source, it is less accurate than the DEXA but it is beneficial in the peripheral regions of the body which do not necessarily need the power DEXA can provide.
Federal Legislation and Bone Densitometry
Bone Mass Measurement Act
July 1, 1998 marked the ratification of the Bone Mass Measurement Act that calls for the bone mass testing of Medicare beneficiaries all over the United States of America. This is a very efficient and beneficial move by the American health care system since the statistics for osteoporosis during those times were alarming enough that this kind of nationwide and extensive action is very much opportune (“Bone Mass Measurement”)..
Medicare beneficiaries capable of availing this service must be:
“Any estrogen deficient woman who is determined by the physician or other nonphysician practitioner to be at clinical risk for osteoporosis based on her medical history or other findings. Even a woman on estrogen therapy can be considered to be estrogen deficient, especially if on an inadequate replacement dose or if noncompliant”. (Meckelnburg)
“An individual with vertebral abnormalities as demonstrated on X-ray to be indicative of osteoporosis, low bone mass, or vertebral fracture”. (Meckelnburg)
“An individual receiving or expected to receive glucocorticoid therapy equivalent to 7.5 mg prednisone or greater per day, for more than 3 months”. (Meckelnburg)
“An individual with primary hyperparathyroidism” (Meckelnburg)
“An individual being monitored to access the response to or efficacy of an FDA approved osteoporosis drug therapy” (Meckelnburg)
The Act did not only assist the beneficiaries on a one time basis, instead it was a continuous service goaled on long-term medication for them. Legislation also supported the Bone Mass Measurement Act by creating a string of policies. The Balanced Budget Act of 1997 details Medicare’s pledge to cover the procedures and techniques involved in bone mass measurement for the qualified beneficiaries. Title XVIII of the Social Security Act, on the other hand, protects the rights of Medicare as an organization and prevents abuse of the said benefits of the Bone Mass Measurement Act (“Medical Policy: Bone Mass Measurement”). These series of policies created for by the legislative body gives utmost importance to the cause of curing and preventing osteoporosis.
Conclusion
Osteoporosis is a highly preventable disease if diagnosed early by the use of the most widely used scanning technique. The dual energy x-ray absorptiometry (DEXA) makes use an x-ray source to quantify the bone mineral density which is directly linked to a person’s risk to have fractures. Data gathered from the person is recorded through a computer and the results are analyzed by a radiologist or a doctor. Through comparisons, the DEXA proved to be really cost-effective and beneficial than the other osteoporosis screening methods available.
The operation of an equipment which employs radiation needs to have safety guidelines to protect the patient and the operator of the apparatus. Guidelines for radiation safety, thus, were made available to prevent the negative effects of overexposure to radiation in terms of time and distance. With the statistics on the occurrence of osteoporosis, the United States of America created a health policy called the Bone Mass Measurement Act, passed in 1998, which provides Medicare beneficiaries the privilege to have themselves screened for the possible onset of osteoporosis.
Works Cited
Balbona, Eduardo.J. 2000. “Osteoporosis Screening.” Duval County Medical Society.
“Bone Density Scan”. 2006. radiological Society of North America, Inc.
“Bone Mass Measurement”. Centers for Medicare and Medicaid Services. U.S. Department of Health and Human Services. Web.
“Medical Policy: Bone Mass Measurement”. Palmetto GBA, LLC.
Dubuque Internal Medicine.
Meckelnberg. “New Medicare Guidelines for Bone Density Testing”.
Kaufman, John D. August 1999. “Osteoporosis: Bone Density Tests”. The American Academy of Orthopaedic Surgeons vol 47, no.3. Web.
Maher, Kieran. “Principles of Radiation Protection”.DEXA Radiation Safety.
“Osteoporosis”. 2007. National Osteoporosis Foundation. Web.
“Bone and Development Growth”. Seer’s Training Website. 2007.
“Vitamin D’s Role”. 2007. GlaxoSmithKline. Web.
Hurd, Robert. “Osteoporosis”. 2006. Medline Plus Medical Encyclopedia.National Institutes of Health and United States National Library of Medicine. Web.
Osteoporosis is commonly seen among women a decade o so after menopause. Osteoporosis results from the inadequate accumulation of bone mass during childhood and early adulthood followed by rapid resorption after menopause.
The primary treatment for this Osteoporosis inclusive consideration of underlying metabolic abnormalities and provision of supplemental calcium/Vitamin D in conjunction with bisphosphonates or calcitonin or both. It should be noted the hormone replacement therapy has been withdrawn since adverse effects were identified in long-term follow-up studies. Osteoporosis results from the loss of the normal density of bone the spine, hips, and wrists are common areas of bone fractures from Osteoporosis. The fracture can be either in the form of cracking or collapsing compression fracture of the vertebrae of the spine. Osteoporosis-related fractures also occur in almost any skeletal bone. [10]
Aims and objectives
One of the most significant health matters for middle-aged women is the threat of osteoporosis. It is a condition in which bones become thin, easily broken, and highly prone to crack. Numerous researches over the past 10 years have linked estrogen insufficiency to this gradual, yet debilitating disease. In fact, osteoporosis is more closely related to menopause than to a woman’s chronological age. [3]
Each year about 500,000 American women fracture a spine, the bones that make up the spine, and about 300,000 will fracture a huckle. Nationwide, treatment for osteoporotic fractures costs up to $10 billion per year, with hip fractures the most expensive. Vertebral fractures lead to curvature of the spine, loss of height, and pain. A severe hip fracture is painful and recovery may involve a long period of bed rest.
Nutrition is well recognized for its considerable, optimistic impact on academic presentation and students’ growth and expansion. Moreover, good nutrition and physical activity facilitate the expansion of good lifestyle habits that will add to students’ health and take advantage of achievement. Children and youth in Newfoundland and Labrador have the highest overweight and obesity rates in Canada. Harmful foods, physical immobility, and obesity are common risk factors of chronic diseases such as heart disease, stroke, diabetes, and cancer. Newfoundlanders and Labradorians undergo some of the uppermost rates of these diseases.
Children and youth are enhancing diabetes and the risk factors for heart disease and cancer at a much earlier age. Moreover to obesity and related diseases, other health concerns are related to unhealthy food habits replacing more nutritious foods. For example, soda pop is replacing milk in students’ diets and it is significant for children and teenagers to have a sufficient calcium intake to reduce the risk of fractures and osteoporosis later in life. It is important to provide nourishing foods in schools where the meals and snacks guzzled can make a major contribution to students’ and staffs’ total daily consumption of food and nutrients. [8]
Risk Factors for Developing Osteoporosis
The following factors that will increase the risk of developing Osteoporosis are
Female gender
Thin and small body frames
Family history of osteoporosis (for example if mother have osteoporotic hip fracture)
Personal history of fracture as an adult
Cigarette smoking
Excessive alcohol consumption
Lack of exercise
Diet low in calcium
Poor nutrition and poor general health
Malabsorption
Low estrogen levels (like the occurrence of menopause or with early surgical removal of both ovaries)
Chemotherapy can cause early menopause due to its toxic effects on the ovaries
Amenorrhea (loss of the menstrual period)
Vitamin D deficiency (since Vitamin D helps the body absorb calcium. When vitamin D is lacking, the body cannot absorb adequate amounts of calcium to prevent osteoporosis. Vitamin D deficiency can result from lack of intestinal absorption of the vitamin such as occurs in celiac sprue
Certain medications can cause osteoporosis. These include long-term use of heparin which is blood thinner. [4]
The following class of drugs also cause bone loss
Excessive thyroid hormones
Anticonvulsants
Antacids containing aluminum
Gonadotropin-releasing hormones used for treatment of endometriosis
Methotrexate for cancer treatment
Cyclosporine A, an immunosuppressive drug
Heparin
Cholestyramine (which was taken into control blood cholesterol levels)
Women lose bone material more rapidly than men especially after menopause when the level of estrogen falls. Oestrogen is a female hormone and helps to protect against bone loss. By the age of 70, some women have lost 30% of their bone material. In the UK about half of women and about 1 in 5 men over the age of 50 will fracture a bone and many of them as a result of osteoporosis. [1]
All men and women have some risk of developing osteoporosis as they become older when they are crossing the age of 60. women are more at risk than men. The following situations also increase the risk of developing bone loss and osteoporosis.
A woman who had menopause before the age of 45
Already had a bone fracture after a minor
Strong family history of osteoporosis
Have body mass index BMI of 19 or less.
A woman who stopped period for a year more before the time of menopause.
Smoking
Lack of calcium or vitamin D i.e. due to poor diet and little exposure to sunlight.
Lack of regular exercises [10]
Action plan
The NOF recommends one hour of weight-bearing activity–for instance, brisk walking (faster than a stroll, slower than when you’re late for a meeting)–four to six days a week. This prescription doesn’t rule out non-weight-bearing activities, like swimming or yoga. Small preliminary studies looking at bicycling, underwater workouts, and t’ai chi have shown modest improvements in bone density in postmenopausal women. Working out with weights is also recommended for building muscle strength, which, in addition to benefiting bone, Dr. DiNubile says, can help absorb shock from falls.
Osteoporosis develops as a result of sub-optimal bone growth in childhood and adolescence, and/or loss of bone mass later in life. Falls also play an important role in the development of osteoporotic fractures. Preventative measures should therefore address these issues. Lifestyle adjustments include ensuring good nutrition throughout life (in particular, adequate calcium and vitamin D intake), adequate levels of physical activity, avoiding smoking, and avoiding alcohol abuse.
Although there is good evidence for the importance of calcium and vitamin D in osteoporosis prevention, there is little promotion of this at the governmental level. In addition, not every European country has defined a recommended daily intake of these nutrients. Perhaps, as a result, inadequate intake is very common (particularly in the elderly). Weight-bearing exercise early in life is known to increase peak bone mass.
Importantly for elderly individuals, as well as improving bone mineral density, exercise also increases muscle strength, thus improving coordination and helping to prevent falls. Children and adolescents have been targeted in campaigns to improve nutrition and raise levels of physical activity. High-risk groups can also be targeted in campaigns to minimize osteoporosis-related lifestyle risk factors. Better promotional and educational programs are required in order to persuade more people to make the right lifestyle choices. [14]
Step 3: Guidelines for the prevention of osteoporosis-related fractures
Step 4: Fracture care, rehabilitation, and prevention of falls
Step 5: Economic data
Step 6: Evaluation of actions and planning the allocation of future healthcare resources: the European fracture database
The first issue in preventing osteoporosis is getting enough calcium, but there’s wrangling over how much is enough. The current U.S. Recommended Daily Allowance for women over twenty-five is 800 milligrams. Last June the National Institutes of Health Consensus Development Conference on Optimal Calcium Intake upped that to 1,000 milligrams for women over twenty-five and menopausal women on estrogen replacement therapy (1,500 milligrams for women not on ERT). [16]
Prevention and Treatment for Osteoporosis
Prevention of osteoporosis is an important treatment for the person. The following measures can be taken.
Calcium Supplements
Building strong and healthy bones requires an adequate dietary intake of calcium and exercise beginning in childhood and adolescence for both sexes. Taking calcium supplements alone is not sufficient in treating osteoporosis. After menopause for several years, rapid bone loss can occur even if calcium supplements are taken.
The following calcium intake can be used for all people.
800 mg/day for children ages 1 to 10
1000 mg/day for men, premenopausal women, and postmenopausal women also taking estrogen
1200 mg/day for teenagers and young adults ages 11 to 24
1500 mg/day for postmenopausal women not taking estrogen
1200 mg to 1500 mg/day for pregnant and nursing mothers
The total daily intake of calcium should not exceed 2000 mg
Daily calcium intake can be calculated by the following methods:
Excluding dairy products, the average diet contains 250 mg of calcium
There is approximately 300 mg of calcium in an 8-ounce glass of milk
There is approximately 45-0 mg of calcium in 8 ounces of plain yogurt
There is approximately 1300 mg of calcium in 1 cup of cottage cheese
There is approximately 200 mg of calcium in 1 ounce of cheddar cheese
There is approximately 90 mg of calcium in ½ cup of vanilla ice cream
There is proximately 300 mg of calcium in 8 ounces of calcium-fortified orange juice. [11]
Vitamin D
An adequate calcium intake and adequate body stores of vitamin D are important foundations for maintaining bone density and strength. Vitamin D is classified in the following ways.
Vitamin D helps the absorption of calcium from the intestines
A lack of Vitamin D causes calcium-depleted bone, which further weakens the bones and increases the risk of fractures.
Vitamin D along with adequate calcium has been shown in some studies to increase bone density and decrease fractures in older postmenopausal but not in premenopausal or per menopausal women. [9]
Nutrition
Vitamin D helps make the bones strong. Good sources of calcium are
Low-fat milk, yogurt, and cheese
Foods with added calcium such as orange juice, cereals, and breads
Vitamin D is needed for strong bones. Vitamin D makes the body with sun effective though out of way to the sun. The amount of calcium and vitamin D required each day to all persons depends upon their age. [9]
Age
Calcium
Vitamin D
0-6 months
210 mg
200 IU
7-12 months
270 mg
200 IU
1 to 3 years
500 mg
2-00 IU
4-8 years
800 mg
200 IU
9-18 years
1,300 mg
200 IU
19 to 50 years
1,000 mg
200 IU
51 to 70 years
1,200 mg
400 IU
Over 70 years
1,200 mg
600 IU
In the U.S. today, 10 million individuals already have osteoporosis and 34 million more have low bone mass, placing them at risk for this disease. More than 2 million American men suffer from osteoporosis, and millions more are at risk. Each year, 80,000 men suffer a hip fracture and one-third of these men die within a year. Osteoporosis is responsible for more than 1.5 million fractures annually, including 300,000 hip fractures, and approximately 700,000 vertebral fractures, 250,000 wrist fractures, and more than 300,000 fractures at other sites. Estimated national direct expenditures (hospitals and nursing homes) for osteoporosis and related fractures are $14 billion each year. [6]
Conclusion
Osteoporosis mainly affects women after the age of menopause. Even it may occur younger people About three million people in the United Kingdom have the condition and which is more common in women than men. Every year more than 230,000 fractures occur because of osteoporosis. One in two women and one in five men over the age of 50 will have a fracture. Osteoporosis assessment and management is an important factor in maintaining the health of bone structure when entering middle age. The medication can be applied with Calcium and vitamin D supplements, a variety of hormone treatments including HRT and SERMS and Bisphosphonates, etc.
Osteoporosis is not an aging disease or an estrogen or calcium deficiency but it is a degenerative disease of Western Culture. With regards to kids, a review of 19 studies indicated that kids do not benefit from calcium supplements and fortified foods, despite may not meeting recommended daily intakes of the mineral.
References
Barnett, Barbara. “Health as Women’s Work: A Pilot Study on How Women’s Magazines Frame Medical News and Femininity.” Women and Language 29, no. 2 (2006): 1.
Garcia, Robert, Erica S. Flores, and Sophia Mei-Ling Chang. “Healthy Children, Healthy Communities: Schools, Parks, Recreation, and Sustainable Regional Planning.” Fordham Urban Law Journal 31, no. 5 (2004): 1267.
Ghosh, Pradip K., ed. Health, Food, and Nutrition in Third World Development. Westport, CT: Greenwood Press, 1984.
Goldstein, Myrna Chandler, and Mark A. Goldstein. Controversies in Food and Nutrition. Westport, CT: Greenwood Press, 2002.
Johnston, Robert D., ed. The Politics of Healing: Histories of Alternative Medicine in Twentieth-Century North America. New York: Routledge, 2004.
Kirk, Ginger, Kusum Singh, and Hildy Getz. “Risk of Eating Disorders among Female College Athletes and Nonathletes.” Journal of College Counseling 4, no. 2 (2001): 122.
Krahn, Gloria L., Michelle Putnam, Charles E. Drum, and Laurie Powers. “Disabilities and Health: Toward a National Agenda for Research.” Journal of Disability Policy Studies 17, no. 1 (2006): 18.
Lewis, Kathleen A., Gail M. Schwartz, and Robert N. Ianacone. “Service Coordination between Correctional and Public School Systems for Handicapped Juvenile Offenders.” Exceptional Children 55, no. 1 (2000): 66.
Little, Jeffrey C., Danielle R. Perry, and Stella Lucia Volpe. “Effect of Nutrition Supplement Education on Nutrition Supplement Knowledge among High School Students from a Low-Income Community.” Journal of Community Health 27, no. 6 (2002): 433.
Munch, Shari, and Sarah Shapiro. “The Silent Thief: Osteoporosis and Women’s Health Care across the Life Span.” Health and Social Work 31, no. 1 (2006): 44.
Nayga, Jr. “Nutrition Knowledge, Gender and Food Label Use.” Journal of Consumer Affairs 34, no. 1 (2000): 97.
Nunn, Samuel, and Mark S. Rosentraub. “Dimensions of Interjurisdictional Cooperation.” Journal of the American Planning Association 63, no. 2 (2001): 205.
Orsega-Smith, Elizabeth, Andrew J. Mowen, Laura L. Payne, and Geoffrey Godbey. “The Interaction of Stress and Park Use on Psycho-Physiological Health in Older Adults.” Journal of Leisure Research 36, no. 2 (2004): 232.
Sims, Laura S. Food and Nutrition Policy in America Food and Nutrition Policy in America. Armonk, NY: M.E. Sharpe, 2000.
Smith, Richard M., and Pamela A. Smith. “An Assessment of the Composition and Nutrient Content of an Australian Aboriginal Hunter-Gatherer Diet.” Australian Aboriginal Studies 2003, no. 2 (2003): 39.
Wanjek, Christopher. Bad Medicine: Misconceptions and Misuses Revealed, from Distance Healing to Vitamin O. New York: Wiley, 2003.
The name of the article is called Osteoporosis. This article was updated by Zieve, David; Juhn, Greg; Eltz, David, R. (A.D.A.M. editorial team). This article was initially reviewed by Eckman, Ari, S. of John Hopkins School of Medicine on 23 November 2009. This article is available at the U.S. National Library of Medicine of National Institute of Health (NIH). This article describes Osteoporosis which is a condition associated with postmenopausal women; women above age 50. This category of women is susceptible to fractures of the vertebra, hip and wrist. Osteoporosis is essentially a product of calcium and phosphate homeostasis.
The guideline title is called Osteoporosis. The guideline was derived from the American college of Obstetricians and Gynecology (ACOG). Osteoporosis. Washington (DC): American college of obstetrician and Gynecologists (ACOG); 2004 Jan. 14 p. the aim of the guideline was to support practitioners in decision making concerning gynecology and obstetrics health care. Another objective of the guideline is to evaluate the right screening approaches and useful pharmacological interventions used in prevention and treatment of osteoporosis. The guideline focuses on adult women for the purpose of screening and guidance. The other persons targeted by this guideline are the postmenopausal women who are vulnerable to osteoporosis, for the purpose of treatment and prevention. According to the guideline osteoporosis is associated with hormone malfunction particularly that occurs in post menopause women. Thus, this condition can be alleviated using hormone therapies. However, hormone therapies are associated with numerous side effects including bone recession.
The name of the clinical trial is called Trial of Lithium Carbonate for Treatment of Osteoporosis-pseudoglioma Syndrome. The trial was carried out at the university of Maryland Amish Research clinic. The condition for which the clinical trial was performed was Osteoporosis Pseudoglioma for which the drug of intervention was lithium. The trial was verified by University of Maryland on April 2010 when the study was not yet ready for the recruitment of the subjects. This trial was funded by University of Maryland and was denoted identity number NCT01108068. The trial was targeted to treat a maximum of 10 cases of OPPG using lithium. The persons eligible for this study are persons between ages 4 to 64 who may be of any gender and who are victim of osteoporosis-pseudoglioma (OPPG). However, the trial accepts healthy volunteers who are first degree relative to a victim of the condition. Also the subjects should not have contraindication to lithium carbonate. Pregnant women and women who are unwilling to undergo pregnancy test are not accepted. Again, the individual should not have the Glomerular filtration rate lower that 80 cc/min. This study seeks to overcome the inadequacy experienced with using bisphosphonates drugs such as alendronate and pamidronate in treatment of osteoporosis-pseudoglioma. These drugs cannot prevent fracture of the hip. Lithium has been hypothesized to give more desirable outcome in treatment of OPPG as was evident from mouse model outcome.
Osteoporosis is an infection or rather a disease that affects the bones, thus weakening them to such an extent that they become very feeble and susceptible to breakages or fractures caused by minor injuries (Becker, 2007: 24).
According to a report released by the association of orthopedics in 2005, Osteoporosis is a condition that affects bones thus making them so porous and weak that they are likely to break as a result of very minor injuries (Ahmadpoor, Reisi, Makhdoomi, Ghafari, Sepehrvand & Rahimi, 2009:2025). For instance, a person suffering from osteoporosis is likely to suffer a bone fracture as a result of slight fall, picking up a heavy load, and even in very serious cases (of osteoporosis) fracturing a bone from normal actions such as sneezing. Orthopedics often refers to Osteoporosis as an advanced case of Osteopenia; the latter of which is a condition where an individual has a lower bone mass than normal.
If not treated well in advance, Osteopenia may develop to Osteoporosis. Medical tacticians therefore recommend that this condition be arrested at this stage since the condition can also respond to osteoporosis medication depending on the affected risk of Osteoporosis and bone breakages. Also, it has been proven that this situation be corrected through healthy living, exercising and eating a diet rich in calcium and vitamin D (Becker, 2007: 21)
The Risk Factor
According to a research carried out by the national institute of arthritis, musculoskeletal and skin diseases (August 2009), Osteoporosis affects the bone thus making them weak and highly vulnerable to breakages or rather fracture (Becker, 2007:26). The latter pointed out that osteoporosis can virtually affect any one. However, they brought to the attention (of the people) that the risk of contracting osteoporosis varies with individuals; natural factors, other personal characteristics as well as the general lifestyle of individual. First, women are at a higher risk of suffering from osteoporosis than their male counterparts all other factors kept constant. Although, women are the one who are mainly affected by osteoporosis, practical cases have revealed that men can also be affected. However, the risk of contracting the disease is much higher in women than in men. In fact, women are four times more likely to be affected by osteoporosis than men (Ahmadpoor et al., 2009:2022).
According to the facts presented in this report for instance, 50% of women over the age of fifty years and 25% of men of the same age are at a greater risk of breaking a bone as a result of osteoporosis. Becker (2007: 24) points out that the risk of developing osteoporosis increases as one gets old, becoming thin or small in body size, or having Osteopenia; a condition that refers to an individual having less than normal the body bones mass. In addition, the latter points out that the condition can be inherited or it can be genetically passed on. In such a case, an individual from a family with a predominant history of the condition is at a greater risk of developing the condition than others.
Furthermore, an individual’s race or gender can increase his or her risk of developing osteoporosis. For example, research shows that being an Asian or rather a white woman increases the risk factor of developing osteoporosis whereas the black and Hispanic counterparts are at a considerably lower risk of contracting osteoporosis (Ahmadpoor et al., 2009:2022). Other osteoporosis risk factors includes the sex hormones such as low levels of estrogen due to missing of menstruation period or menopause in older women, low levels of testosterone hormone in men, eating disorder or what is professionally referred to as anorexia nervosa, poor diet such as low physical intake of calcium and vitamin D and general lack of exercises (Becker, 2007: 24).
Lifestyle and Epidemiology of Osteoporosis
An individual’s lifestyle can also increase his or her risk of developing osteoporosis. Smoking or excessive consumption of alcohol are two unhealthy life habits which medical research have revealed to contribute greatly to the development of this condition. In addition, individuals who never take any exercise develop weak bones which may lead to osteoporosis. It is important to note therefore that, doing exercises such as weight lifting, jogging, taking a hike climbing stairs, cycling among other forms of exercises make ones bones stronger thus significantly reducing the risk of the latter suffering from osteoporosis.
Clinical Manifestation of Osteoporosis
In circumstances where this condition is not adequately treated or rather diagnosed well in advance and measures taken to contain it, it makes the bone weaker and weaker without the affected noticing or feeling any pain until the bone breaks. The bone breakages as a result of osteoporosis are generally referred to as fractures. Ideally, osteoporosis is typical to or it mainly affects the hip bones, the spine and the wrist all of which comes with dire consequences on the part of the affected (Becker, 2007:27). However, current researches (as well as past practical cases) have shown that even the other bodily bone have a chance of being affected by osteoporosis.
Medical practitioners especially the orthopedics pays more attention to osteoporosis effects on the hips and spine bone since the two bones have the greatest risk of getting affected. More importantly, the consequences of these effects are more intense in comparison with its effects on other bones. Take for instance a case of an individual who has fractured his or her hip bone as a result of this condition. Such an individual must require being hospitalized, intensive care and perhaps a major surgery to correct the fracture. In addition, it is likely to incapacitate the individual, impair his or her walking ability, and make him or her require assistance to walk.
Cases have been reported of such condition leaving the affected on the wheel chair. A spinal or vertebral fracture on the other hand can come with fatal consequences. While it can at times lead to loss of height, severe back pains and permanent deformity on the part of affected, it can also cause paralyses or death especially if the fracture injures the central nervous system (Ahmadpoor et al., 2009:2027).
The Treatment and Pathophysiology of Osteoporosis
Over the years, osteoporosis has been and still is very disheartening public health concern; which has caused medical practitioner’s sleepless nights in trying to come up with the best treatment and prevention of the condition. Over the last one decade however, relentless effort by researchers on osteoporosis have yielded massive advances towards attaining a solution to prevention, epidemiology, pathophysiology and treatment of the disease.
To date, more discoveries on the solutions to medical quagmire continue to be made at an unbelievable and unmatched rate of success. For instance, recent innovations on the issue have since seen Clinical assessments shift from the era when decisions were being made based on bone densitometry to the utilization of algorithms of complete bones breakages (Simmons, Zeitler & Steelman, 2007: 112).
As a result, the biochemical markers of bones turnover have been factored in and are now widely used. Despite the fact that Bisphosphonates remains the major model of therapy for osteoporosis patients, much improved perceptive of the most favorable amount of alterations containment, reduction of the time of the therapy, among others are of particular importance in the treatment of osteoporosis. In addition, diversified diagnostic and curative approaches including use of biological agents have become widespread in the treatment of this condition (Becker, 2007: 24).
The fact is that osteoporosis is a complex skeletal disease and which to a greater extent compromises the strength of bones thus increasing the risk of their fracture. According to Simmons, Zeitler & Steelman (2007:105), despite the fact that recent researches on bone biology and immunology have to a greater extent widened the professional’s knowledge in pathogenesis and osteoporosis, the suffering on the part of individuals already with the condition remains rigorous. Consequently, primary care physicians must understand the primary mechanisms of bone physiology and pathophysiology for effective prevention and treatment of osteoporosis.
Although advanced cases of osteoporosis should be treated medically, the condition can be prevented or treated using normal means of strengthening the bones such as eating a healthy diet rich in calcium and vitamin D, taking normal exercises such as weight lifting and leading a healthy lifestyle that is free from excessive smoking and alcohol consumption. Irrespective of the fact that osteoporosis is a rather silent condition or disorder i.e. an individual may fail to realize that he or she is suffering from the condition until the latter suffers a bone fracture. Bone specialists points out that the condition can still be diagnosed and identified in its early stages through regular bones strength check up and taking a mineral density test (Simmons, Zeitler & Steelman, 2007: 113, Becker, 2007: 24).
The easiest and most ideal prevention of osteoporosis, according to the National Institute of Arthritis and Musculoskeletal and Skin Diseases (2009), is for one to keep his or her bones strong through eating diet that is particularly rich in calcium and vitamin D. Moreover, regular exercising and leading a healthy lifestyle by refraining from excessive smoking and consumption of alcohol aids greatly in the prevention of this devastating condition (Simmons, Zeitler & Steelman, 2007: 98). However, those who have already developed the condition must learn to take good care of themselves through basic care such as preventing falls, taking light exercise, avoiding lifting heavy loads et cetera.
List of References
Becker, C. (2007). Pathophysiology and Clinical Manifestations of Osteoporosis Clinical Cornerstone, Volume 8, Issue 1, Pages 19-27.
Jill Simmons, Phil Zeitler and Joel, Steelman. (2007). Advances in the Diagnosis and Treatment of Osteoporosis Vol. 54, Issue 1, Pages 85-114.
P. Ahmadpoor, S. Reisi, K. Makhdoomi, A. Ghafari, N. Sepehrvand and E. Rahimi (2009). Osteoporosis and Related Risk Factors in Renal Transplant Recipients :Transplantation Proceedings Vol. 41, Issue 7, Pages 28.20-28.
Osteoporosis refers to a bone disease that predisposes bones to a high risk of fracture due to a reduction in bone mineral density (BMD) (Arden 34). It is caused by deterioration of bone microarchitecture and a change in quantities of proteins in bones. Factors that predispose people to the disease include age, low levels of sex hormones in the body, low body weight, gender, certain medications, and smoking (Arden 36). The disease does not show any symptoms. The disease is discovered after bone fractures. Treatment remedies include administration of vitamin D and calcium, regular physical exercise, and medication.
Bone formation
Two of the most important aspects of bone development include bone resorption and bone formation (Arden 37). Osteoporosis is caused by an imbalance in the two aspects. In normal and healthy bones, matrix remodeling does not change, and bone remodeling takes place at any given time (Cooper and Woolf 57). This process occurs in special regions known as bone multicellular units (BMUs). Changes in quantities of vitamin D, calcium, and proteins in the body affect the process of bone formation.
Stages of osteoporosis
Before the development of osteoporosis, bones undergo several stages. These include inadequate bone mass, a high rate of resorption, and inadequate formation of bone mass (Cooper and Woolf 63). The combination of these three stages leads to the formation of fragile bone tissues that are prone to osteoporosis. Bone mass reduces due to an increase in the ratio between air pockets and bone material (Cooper and Woolf 65). An increase in air pockets results in to decrease in bone mass. This results in a condition known as osteopenia. Hormones play an important role in controlling the process of resorption.
For example, the lack of estrogen in women due to menopause affects the process significantly. Lack of estrogen increases the rate of bone resorption and interferes with the deposition of new bone mass during the process of remodeling (Cooper and Woolf 67). Hormones also play important roles in the process of bone turnover. The deficiency of elements such as calcium and vitamin D alters the process of bone deposition thus acting as a risk factor for osteoporosis (Cooper and Woolf 68).
On the other hand, the presence of low calcium amounts in bones stimulates the parathyroid glands to secrete parathyroid hormone. This hormone speeds up the process of bone resorption to raise the quantities of calcium in the blood. In addition, the thyroid secretes a hormone known as calcitonin that plays an important role in bone deposition together with other hormones (Cooper and Woolf 71).
How lack of milk causes osteoporosis
Milk is a major source of calcium for the body. Therefore, a lack of milk decreases the levels of calcium in the body. During growth, the body breaks down old bones and produces new bones through a process known as remodeling. This process requires calcium to make new bones. Research has shown that calcium that is absorbed by the body from milk is important in raising bone mineral density (Orwoll and Bliziotes 47). However, research has also shown that high quantities of calcium have long-term effects on bones. In most cases, the levels of BMD are increased by increasing calcium intake. This can be achieved by drinking milk, which is rich in calcium.
Calcium serves two functions in preventing osteoporosis. First, it increases bone mineral density. Secondly, it increases the strength of bones thus reducing predisposition to fractures (Orwoll and Bliziotes 48). Calcium is necessary for promoting calcification of bone matrix that improves bone strength and thus reduces the occurrence of osteoporosis (Orwoll and Bliziotes 49). Low calcium level has severe effects on bones. Bones age slowly and are weak due to low bone mineral density. Therefore, increasing calcium intake increases bone mineral density and makes bones stronger. Research has shown that bones contain approximately 99% of the total quantity of calcium in the body.
This calcium helps to keep bones strong and maintain bone mass (Orwoll and Bliziotes 51). Calcium is most important during remodeling and bone degradation. It is recommendable to increase calcium intake during adolescent years and to lower calcium intake during later years. This is because excessive intake or accumulation of calcium in bones presents a risk factor for osteoporosis. After all, it reduces the action of osteoblasts (Orwoll and Bliziotes 53).
Conclusion
Osteoporosis refers to a bone disease characterized by a high risk of bone fractures due to a decrease in bone mineral density (BMD). The disease is difficult to detect because it is only evident when a bone fracture. Factors that predispose people to the disease include age, low levels of sex hormones in the body, low body weight, gender, certain medications, and smoking. Before the development of osteoporosis, bones undergo several stages.
These include inadequate bone mass, a high rate of resorption, and a low rate of remodeling. Calcium is an important component in the prevention of osteoporosis. It increases bone strength by increasing bone mineral density. It is usually obtained by an adequate intake of milk. Treatment remedies include administration of vitamin D and calcium, regular physical exercise, and medication.
Works Cited
Arden, Nigel. Osteoporosis. New York: Remedica, 2006. Print.
Cooper, Cyrus, and Woolf Anthony. Osteoporosis: Best Practice and Research Compendium. New York: Elsevier Science Health Science Division, 2006. Print.
Orwoll, Eric, and Bliziotes, Michael. Osteoporosis: Pathophysiology and Clinical Management. New York: Human Press, 2011. Print.
The aging process confers many limitations on any organism which is affected by it. Many structures within the body eventually become brittle and unstable, and skeletal structure is one of the major systems that is affected by aging the most. The weakening of bones in one’s organism is called osteoporosis, and it is a major global health issue. This essay discusses the possibility of slowing down or preventing osteoporosis.
As the human population on average became older, health complications that become regular late in life turned into a massive problem. The process of aging includes the degeneration of skeletal mass, which makes older people more susceptible to bone breaks and fractures (Chin & Ima-Nirwana, 2016). Several causes affect the bone structure in older people, such as hormone deficiency, inflammations, and oxidative stress (Chin & Ima-Nirwana, 2016). Osteoporosis is often encountered in people with unhealthy lifestyles who were not educated on the potential diseases from it.
Thus said, some of the factors that cause osteoporosis are preventable, and their effects are reversible through proper diet and exercise. To lessen the severity of this health problem, it is crucial to convey the impact that healthy food and a moderate amount of physical activity have on health. To achieve this effect, governments across the globe must modernize their community health programs (Nguyen, 2016). Nguyen (2016) suggests that “increasing calcium intake and weight-bearing exercises” are the primary methods for rising bone density (p. 19). Moreover, the study by Chin and Ima-Nirwana (2016) suggests that “live polyphenols have the potential to be developed as bone protective agents” (p. 9). Therefore, by promoting a healthy lifestyle and explaining the importance of exercises among communities that are the most prone to the development of osteoporosis, this disease can be prevented.
In conclusion, it is possible to reduce the rates of osteoporosis among the older population. However, people need to make significant changes to their behavior, which is troublesome to implement and make it become the norm. Nguyen (2016) recommends that “more research is needed to investigate further and advance the effectiveness” of community health programs (p. 30). Higher accessibility of calcium-rich products and physical education among older people could be the answer to that. In the meantime, merely raising awareness about the issue and promoting healthy behavior can prevent some cases of osteoporosis.
The safety of water is a necessary step in the establishment of a healthy population. Access to pure water is not a simple precaution, and it is one of the fundamental human rights. Modern civilization has developed numerous ways to decontaminate water efficiently. However, it is still challenging for people in some countries to obtain pure water, and sometimes these contaminants can appear in more developed countries as well. People need to understand what inorganic contaminants can be found in water, what health issues they can cause, and what are the primary methods for their treatment. This paper discusses the topic of inorganic contaminants, what problems they pose to society, and ways of their removal.
Several major contaminant minerals pose a severe health risk to humans. They include arsenic, nitrates from agricultural activities, metalloids, and various industrial byproducts (Fluence News Team, 2019). Their presence causes such health issues as damaged skin, weakened immune system, problems with the circulatory system, and higher risks of cancer (Fluence News Team, 2019). Jennings and Duncan (2017) state that “children are particularly vulnerable to the health effects of unsafe drinking water, which include not only the diarrheal disease but also diseases linked to inorganic pollutants” (p. 1029). While the importance of clean, safe drinking water is evident, it can be hard to achieve in some cases.
Modern civilization has sophisticated quality control and monitoring methods regarding the purity of water, yet it is prone to be compromised due to various factors. To keep water safe for everyone, people must be knowledgeable about the effects of its potential contaminants and must not tolerate any behavior that can compromise its purity. Jennings and Duncan (2017) argue that “societies are obligated to make resources available and to prohibit conduct that violates this right, even if lower priority must be given to other social interests” (p. 1032). The reduction of contaminants, including inorganic ones, is a global effort, and people should be mindful of this topic.
In conclusion, the safety of water can be guaranteed by constant surveillance of its state, strict laws and policies regarding its purity, and communal responsibility. It is unwise to put any socioeconomic factor over water decontamination, as this sacrifice will lead to weakened health of an entire population, which, in turn, will cause higher expenses on arising issues. Citizens must not hesitate and test their tap water at the slightest suspicion about its state, as some contaminants are barely recognizable by human senses. By working together with health experts, people can prevent a significant portion of health risks that arise from inorganic and other contaminants.
References
Fluence News Team. (2019). Water contaminants and their treatment. Fluence. Web.
Jennings, B., & Duncan, L. L. (2017). Water safety and lead regulation: Physicians’ community health responsibilities. AMA Journal of Ethics, 19(10), 1027-1035. Web.
Osteoporosis has long been a very serious problem within the medical diagnoses in the United States. Nowadays there are many high school, middle school, and children programs to fight osteoporosis at its beginning stage. Also, there are substantial adult programs. No wonder people who suffer from this disease need comfort and a thorough treatment, osteoporosis affects bones and makes them fragile and they become brittle. This usually happens when a person lacks calcium or vitamin D which frequently results from hormonal changes. Largely the patients diagnosed are elderly people. As such, it has been claimed that the amount of diagnosed patients will enlarge due to the aging of the population.
Assessment
Unfortunately, 44 million elderly people (50 years and more) living in the US in 2004 had osteoporosis or low bone mass. It has been counted that Americans spent about $16 billion dollars on treating fractures due to osteoporosis in 2002. Of course, these numbers are somewhat disastrous. However, it is supposed that if the citizens keep on saving on their own health and avoid expensive but correct medical treatment, the situation will get worse. This will result from poor bones check after the recovery or absence of cracks’ treatment at all. Provided that the situation is not getting any better, there will be 12 million people more suffering from osteoporosis by 2012. Moreover, there will be many more people having low bone mass (about 40 million) unless the population starts treating this problem in a more responsible manner. It is said that no one is too old or too young to take care about their own bones (Gaby, 1995).
Intervention/Evaluation
Significantly, the authorities of Florida take serious actions in order to make the citizens healthier and show them there are means government presents to lead a healthier life. There has been a partnership created with Area Health Education Centers (AHEC) and County Health Departments. Thus, programs for educating population are now being popularized. This means tremendous help for the citizens to find out more about their diagnosis or the ways to understand their relative has osteoporosis. The Osteoporosis Prevention and Education Program were launched to show people that healthy way of life means taking sports, proper eating habits, and absence of harmful habits. Some people simply need guidance on what to do after they have osteoporosis, while some of them need to be prevented from this sickness. That is why the programs created for the population are striving to have a healthier generation overall by proving the benefits of correct medical treatment and self-education by participating in Osteoporosis Awareness Month program, for example (Florida Charts, 2010).
Prevention
There are different programs for education purposes emerging. One of such programs is designed for the entire family ‘Families Building Strong Bones’. Largely, there should be adults participating in order to learn what exactly the risks are. The program unveils the risk factors adult may face and the prevention methods. Also, the adults find out more about diagnosis and its treatment. However, the primary goal is still left prevention through healthy living and eating.
There is a high school program called ‘Food for Thought’. This is a marvelous educative program for teenagers. They learn about osteoporosis on life-size skeletons. They see the outcomes of bad nutrition on the bones and muscles. The students also learn about bulimia, anorexia, different diets, and their outcomes.
References
Florida Charts. (2010). Florida Department of Health. Web.
Gaby, A. (1995). Preventing and Reversing Osteoporosis : What You Can Do About Bone Loss–A Leading Expert’s Natural Approach to Increasing Bone Mass. New York: Three Rivers Press.