Osteoporosis and the Associated Bone Fragility

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Table of Contents

Introduction
Symptoms
Causes
Current Treatments
Future Therapy
Comparison of Treatments
Conclusion
References

Introduction

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.

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